Cardiogenic shock is a condition caused by the inability of the heart to pump blood sufficiently to meet the metabolic needs of the body due to the impaired contractility of the heart. Clients usually manifest signs of low cardiac output, with adequate intravascular volume. It is usually associated with myocardial infarction (MI), cardiomyopathies, dysrhythmias, valvular stenosis, massive pulmonary embolism, cardiac surgery, or cardiac tamponade. It is a self-perpetuating condition because coronary blood flow to the myocardium is compromised, causing further ischemia and ventricular dysfunction.
Nursing Care Plans
The nursing care plan in clients with cardiogenic shock involves careful assess the client, observe cardiac rhythm, monitor hemodynamic parameters, monitor fluid status, and adjust medications and therapies based on the assessment data.
- Impaired Gas Exchange
- Decreased Cardiac Output
- Ineffective Tissue Perfusion
- Excess Fluid Volume
- See Also and Further Reading
Impaired Gas Exchange: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
May be related to
- Changes in the alveolar-capillary membrane.
- Impaired ventilation-perfusion.
Possibly evidenced by
- Abnormal arterial blood gasses (ABGs).
- Abnormal respiratory rate, depth, and rhythm.
- Changes in the level of consciousness.
- Client will maintain optimal gas exchange, as evidenced by ABGs within the normal range, oxygen saturation of 90% or greater, alert responsive mentation or no further reduction in the level of consciousness, relaxed breathing, and baseline HR for the client.
|Assess the client’s respiratory rate, rhythm, and depth.||During the early stages of shock, the client’s respiratory rate will be increased due to hypercapnia and hypoxia. Once the shock progresses, the respirations become shallow, and the client will begin to hypoventilate. Respiratory failure develops as the client experiences respiratory muscle fatigue and decreased lung compliance.|
|Assess client’s heart rate and blood pressure.||As shock progresses, the client’s blood pressure and heart rate will decrease and dysrhythmias may occur.|
|Assess for any signs of changes in the level of consciousness.||Headache, restlessness are early signs of hypoxia.|
|Auscultate the lung for areas of decreased ventilation and the presence of adventitious sounds.||Moist crackles are caused by increased pulmonary capillary permeability and increased intra-alveolar edema.|
|Assess for cyanosis or pallor by examining the skin, nail beds, and mucous membranes.||Cool, pale skin may be secondary to a compensatory vasoconstrictive response to hypoxemia. Peripheral tissues become cyanotic due to impaired oxygenation and perfusion.|
|Monitor oxygen saturation using pulse oximetry.||Pulse oximetry is used in measuring oxygenation concentration. The normal oxygen saturation should be maintained at 90% or higher.|
|Monitor arterial blood gasses.||Increasing Pac02 and decreasing Pa02 are signs of hypoxemia and respiratory acidosis. As the client’s condition begins to fail, the respiratory rate will decrease and Pac02 will continue to increase.|
|Assist the client when coughing, and suction the client when needed.||Suction removes secretions if the client is unable to effectively clear the airway.|
|Place the client’s head of bed elevated.||This position facilitates optimal ventilation.|
|Administer oxygen as ordered.||Supplemental oxygen may be required to maintain Pa02 at an acceptable level.|
|Prepare the client for mechanical ventilation if oxygen therapy is ineffective.||Early intubation and mechanical ventilation are recommended to prevent full decompensation of the client. Mechanical ventilation provides supportive care to maintain adequate oxygenation and ventilation to the client.|