NCLEX RN Practice Question # 425

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CARDIOGENIC SHOCK

Description

  • Cardiogenic shock is failure of the heart to pump adequately, thereby reducing cardiac output and compromising tissue perfusion.
  • Necrosis of more than 40% of the left ventricle occurs, usually as a result of occlusion of major coronary vessels.
  • The goal of treatment is to maintain tissue oxygenation and perfusion and improve the pumping ability of the heart.

Assessment

  • Hypotension: BP lower than 90 mm Hg systolic or 30mmHg lower than the client’s baseline
  • Urine output lower than 30 mL/hr
  • Cold, clammy skin
  • Poor peripheral pulses
  • Tachycardia
  • Pulmonary congestion
  • Tachypnea
  • Disorientation, restlessness, and confusion
  • Continuing chest discomfort

Interventions

  • Administer morphine sulfate intravenously as prescribed to decrease pulmonary congestion and relieve pain.
  • Administer oxygen as prescribed.
  • Prepare for intubation andmechanical ventilation.
  • Administer diuretics and nitrates as prescribed while monitoring the BP constantly.
  • Administer vasopressors and positive inotropics as prescribed to maintain organ perfusion.
  • Prepare the client for insertion of an intraaortic balloon pump, if prescribed, to improve coronary
  • artery perfusion and improve cardiac output.
  • Prepare the client for immediate reperfusion procedures such as PTCA or coronary artery bypass graft.
  • Monitor arterial blood gas levels and prepare to treat imbalances.
  • Monitor urinary output.
  • Assist with the insertion of a pulmonary artery (Swan-Ganz) catheter to assess degree of heart failure; readings obtained from the catheter correlating to cardiogenic shock include an increased pulmonary capillary wedge pressure (PCWP) and a decreased cardiac output
  • Monitor distal pulses and maintain the transducer at the level of the right atrium if the client has a Swan-Ganz catheter.

Hemodynamic monitoring

Central venous pressure (CVP)

  • The CVP is the pressure within the superior vena cava; it reflects the pressure under which blood is returned to the superior vena cava and right atrium.
  • The CVP is measured with a central venous line in the superior vena cava.
  • Normal CVP pressure is about 3 to 8mmHg.
  • An elevated CVP indicates an increase in blood volume as a result of sodium and water retention, excessive IV fluids, alterations in fluid balance, or renal failure.
  • A decreased CVP indicates a decrease in circulating blood volume and may be a result of fluid imbalances, hemorrhage, or severe vasodilation, with pooling of blood in the extremities that limits venous return.

Measuring CVP

  • The right atrium is located at the midaxillary line at the fourth intercostal space; the zero point on the transducer needs to be at the level of the right atrium.
  • The client needs to be supine, with the head of the bed at 45 degrees.
  • The client needs to be relaxed; note that activity that increases intrathoracic pressure,

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