what is the most important goal of nursing care for a client who is in shock? This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you What is Cardiogenic Shock and how to care for it (Nursing Care Plan). Following along are instructions in the video below:
Guys in this lesson. Were going to take a look at the care plan plan for cardiogenic shock. So well briefly take a look at the pathophysiology and of this issue.
Were also going to take a look at additional things like subjective and objective data that your patient may present with as well as nursing interventions and rationales for this issue. All right lets jump in so the medical diagnosis is cardiogenic shock. Which is an acute and extreme version of heart failure.
Where the organs are not receiving adequate oxygenated blood. So guys cardiogenic shock. Is most definitely a medical emergency.
It can be caused by a few things like myocardial infarction or mi. Because of the hearts inability to pump effectively also issues that obstruct blood flow like cardiac tamponade. Which is a buildup of fluid around the heart.
Which compresses and prevents functional pumping also pulmonary embolism or pe. A blood clot in the pulmonary arteries can prevent forward blood flow and also cause cardiogenic shock. So the desired outcome for a patient with this issue is to reverse what is causing the problem and restore sufficient cardiac output.
So lets take a look at some of the subjective and objective data that your patient with this issue may present with now. Remember subjective data. These are going to be things that are based on your patients opinions or feelings so they may include feeling of crushing chest pain also they might express anxiousness or restlessness sudden and severe shortness of breath weakness maybe nausea objective data or a number of things including the evidence of an mi increased heart rate increased respiratory rate decrease blood pressure decrease oxygen saturation decreased temperature increase central venous pressure and decrease cardiac output your heart sounds they may sound muffled.
They may have decreased urine output crackles in the lungs. They may have a rapid thready pulse. And they may be diaphoretic with cold pale possibly mottled skin.
Okay. Nursing interventions are a super. Important part of a care plan.
So lets take a look at a few of those for cardiogenic shock. First off assess your patients risk for development developing. This issue.
Things like a history of an mi means your patient is more susceptible because of previous damage to the heart. So coronary artery disease. Obesity and hyperlipidemia all contribute to the risk of having an mi so assess your patients risk.
Also for a pulmonary embolism. Those on prolonged bed. Rest.
Postpartum. Mothers. Patients with dvts are all at a higher risk.
Finally. Blunt chest trauma puts the patient at risk of developing pericardial tamponade. Being aware of these risk factors in your patient.
Means cardiogenic. Shock. Can be prevented or caught early okay so for cardiogenic shock you will monitor vital signs to prevent decompensation or cardiac arrest.
Applying oxygen as needed as necessary monitor level of consciousness. Because decreased loc is a sign of advancing shock also assess lung sounds edema and your patients urine output a few more nursing interventions for this issue are assessed in your patients pain and managing that pain so your patient may have severe chest pain. Because of myocardial ischemia.
So pain should be assessed every four hours or even more often and of course. Reassess 30 minutes after you give any pain meds. So for monitoring hemodynamics.
It is critical. It will tell us as providers how severe the shock. Is and if the patient is responding to treatment mean arterial.
Pressure or map is the average pressure in the arteries decompensating shock. Will show a decreasing map. Below.
60 millimeters of mercury central. Venous. Pressure means preload in a patient with cardiogenic shock.
This pressure will be greater than 12 millimeters of mercury cardiac output is super important because in cardiogenic shock. Cardiac output takes the biggest hit so the goal is to increase cardiac output.
And this can be measured by the use of a flow tract or pulmonary artery catheter also systemic vascular resistance or svr. We can expect this to be high because the body will try to compensate with vasoconstriction so we watch this value because it will return to normal. If treatment is effective guys.
Dobutamine can also help to decrease this number finally vo to oxygen compensation. Which is the rate which oxygen is taken up into the tissues is decreased in shock so this is a classic sign of cardiogenic shock versus heart failure where vo2 is normal okay hemodynamic monitors. They must be calibrated for accurate readings.
They must be levelled and zeroed at the phlegm ostatic axis. Which is located at the fourth intercostal space mid axillary line. This is the most accurate reference point for the right atrium.
And where the cvp is measured using a central line guys. This is also the most accurate reference point of the aorta for map being measured with an arterial line be sure to prepare your patient for any possible procedures. Like an art line or central line placement for intubation or a surgical intervention to prepare for the arterial line.
Placement. Gather supplies and sure consent is obtained by the provider. Explain the procedure to the patient and family and prep.
Any fluids or tubing and ensure monitoring equipment is available all guys if the patient has decreased level of consciousness or comprise compromised ventilation intubation may be necessary make sure supplies. Including an ambu bag are available and notify respiratory therapy or the charge nurse for support. So for surgical interventions possibly to repair an injury or internal bleeding follow your facilitys protocol remove all jewelry from your patient clothing.
Obtain informed consent also this is by the provider and possibly facilitate transport so it may sound super simple. But its critical that in a patient with cardiogenic shock. The head of the bed must be greater than 30 degrees.
The reason for this is a patient with this issue that lays flat or lowering the head of the bed can be detrimental to the patients laying flat brings blood to the heart and baroreceptors. Which will make the body think that the problem has been fixed and compensation will then be stopped so it is important to say that in some cases lowering the head and raising the legs can help if there is an absence of other interventions. But not when we have more advanced therapies.
Available also guys patients with acute cardiogenic shock. Commonly have pulmonary edema. So laying them flat compromises their oxygenation elevate the patients legs and applying sdds helps to decrease.
Peripheral edema. And also facilitates venous return to prevent dvt s. Dv t.
s are the number one cause of pe s. Remember. Though.
Stds are contraindicated in a patient with a current dvt. A final intervention is to repair and manage the intra aortic balloon pump or iab p. Which is an advanced technique that is typically seen in the cardiovascular icu.
The iab p. Is used to decrease workload and afterload on the heart and assist with forward circulation. The iab p is inserted through the femoral artery and the descending aorta this i it inflates during diastole to help with filling pressures and deflate deflates with cicely for forward pressure so to repair for this prep like any other procedure.
But after the leg should be kept straight at all times. The patient should be on bed rest and repositioned every two hours and finally follow facility policy for documentation of their pressures. One final thing guys some patients may even require an lvad or even a heart transplant.
Okay here is a look at the final care plan for cardiogenic shock. All right lets do a quick review cardiogenic. Shock occurs due to organs not receiving adequate oxygenated blood due to heart failure.
Which is sudden acute in a medical emergency causes include an mi cardiac tamponade pulmonary embolism subjective data is crushing chest pain anxiety restlessness shortness of breath weakness and nausea objective data can include decreased bp sats temperature cardiac output level of consciousness increased heart rate respiratory rate cvp assess your patients risk monitor vital signs level consciousness lung sounds edema there hemodynamics as well as their pain. Calibrate. Hemodynamic.
Monitors. Prepare for any procedures. Elevate the head.
Greater than 30 degrees. The legs. Apply se ds.
Prepare and manage the intra aortic balloon pump thanks for watching another nursing comm. Lesson click the link below in the description to watch thousands more lessons over on nursing comm. Also be sure to hit the subscribe and the little bell to make sure youre reminded.
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