Cardiogenic shock is a life-threatening condition where the heart suddenly fails to pump enough blood to meet the body’s needs. The Cardiogenic Shock nursing diagnosis focuses on identifying and treating the symptoms of cardiogenic shock while preventing complications and stabilizing the patient’s condition.
Causes (Related to)
Cardiogenic shock can develop from various cardiac conditions and factors:
- Acute myocardial infarction (heart attack)
- Severe heart failure
- Cardiomyopathy
- Cardiac tamponade
- Severe arrhythmias
- Valve dysfunction
- Post-cardiac surgery complications
- Drug-induced cardiac dysfunction
- Severe electrolyte imbalances
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Chest pain or pressure
- Shortness of breath
- Anxiety and restlessness
- Dizziness or lightheadedness
- Fatigue
- Nausea
- Confusion
Objective: (Nurse assesses)
- Hypotension (systolic BP <90 mmHg)
- Tachycardia or bradycardia
- Cool, clammy skin
- Decreased urine output (<30 mL/hour)
- Altered mental status
- Weak or absent peripheral pulses
- Low cardiac output (<2.2 L/min/m²)
- Elevated cardiac enzymes
- Pulmonary edema
- Cyanosis
Expected Outcomes
- The patient will maintain adequate cardiac output
- The patient will demonstrate improved tissue perfusion
- The patient will maintain stable vital signs
- The patient will report decreased chest pain
- The patient will maintain adequate urine output
- The patient will show improved mental status
- The patient will avoid complications
Nursing Assessment
1. Monitor Cardiovascular Status
- Assess vital signs frequently
- Monitor cardiac rhythm
- Check peripheral pulses
- Evaluate capillary refill
- Monitor cardiac output/index
- Assess for chest pain
2. Evaluate Tissue Perfusion
- Check skin color and temperature
- Monitor urine output
- Assess mental status
- Evaluate extremity perfusion
- Monitor for signs of organ dysfunction
3. Monitor Respiratory Status
- Assess breathing pattern
- Monitor oxygen saturation
- Auscultate lung sounds
- Check for signs of pulmonary edema
- Monitor ABG results
4. Assess Fluid Status
- Monitor intake and output
- Check for edema
- Assess jugular vein distention
- Monitor daily weights
- Track fluid balance
5. Monitor for Complications
- Watch for dysrhythmias
- Assess for worsening shock
- Monitor for multi-organ failure
- Check for bleeding
- Evaluate for infection
Nursing Care Plans
Nursing Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to pump failure as evidenced by hypotension, tachycardia, and decreased urine output.
Related Factors:
- Altered contractility
- Reduced stroke volume
- Impaired cardiac electrical conduction
- Changes in preload/afterload
Nursing Interventions and Rationales:
- Monitor vital signs q15min or as ordered
Rationale: Early detection of deterioration - Administer prescribed medications
Rationale: Supports cardiac function and maintains BP - Position patient for optimal cardiac function
Rationale: Reduces cardiac workload - Monitor cardiac output parameters
Rationale: Evaluate treatment effectiveness
Desired Outcomes:
- The patient will maintain BP >90 mmHg systolic
- The patient will demonstrate improved cardiac output
- The patient will maintain adequate tissue perfusion
Nursing Care Plan 2: Impaired Tissue Perfusion
Nursing Diagnosis Statement:
Impaired Tissue Perfusion related to reduced cardiac output as evidenced by cool extremities and decreased peripheral pulses.
Related Factors:
- Reduced cardiac output
- Vasoconstriction
- Altered blood flow
- Compromised circulation
Nursing Interventions and Rationales:
- Assess peripheral circulation q2h
Rationale: Monitors tissue perfusion status - Monitor urine output hourly
Rationale: Indicates renal perfusion - Evaluate mental status frequently
Rationale: Reflects cerebral perfusion - Document skin color and temperature
Rationale: Indicates peripheral perfusion
Desired Outcomes:
- The patient will maintain adequate tissue perfusion
- The patient will demonstrate improved peripheral circulation
- The patient will maintain adequate urine output
Nursing Care Plan 3: Anxiety
Nursing Diagnosis Statement:
Anxiety related to life-threatening condition as evidenced by restlessness and verbalized fear.
Related Factors:
- Acute illness
- Fear of death
- Uncertainty about prognosis
- Physical distress
Nursing Interventions and Rationales:
- Provide clear, concise information
Rationale: Reduces fear of the unknown - Maintain calm environment
Rationale: Reduces stress response - Allow family presence as appropriate
Rationale: Provides emotional support - Administer anti-anxiety medications as ordered
Rationale: Reduces psychological distress
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will demonstrate calmer behavior
- The patient will use effective coping strategies
Nursing Care Plan 4: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to invasive procedures and compromised circulation.
Related Factors:
- Multiple invasive lines
- Compromised immune function
- Poor tissue perfusion
- Extended bed rest
Nursing Interventions and Rationales:
- Maintain a strict aseptic technique
Rationale: Prevents infection - Monitor temperature q4h
Rationale: Detects early signs of infection - Assess insertion sites
Rationale: Identifies early infection signs - Administer antibiotics as ordered
Rationale: Prevents/treats infection
Desired Outcomes:
- The patient will remain free from infection
- The patient will maintain a normal temperature
- The patient will show no signs of local infection
Nursing Care Plan 5: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to altered pulmonary perfusion as evidenced by hypoxemia and dyspnea.
Related Factors:
- Ventilation-perfusion mismatch
- Pulmonary edema
- Reduced cardiac output
- Increased oxygen demand
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Ensures adequate oxygenation - Position for optimal breathing
Rationale: Improves ventilation - Administer oxygen as ordered
Rationale: Maintains tissue oxygenation - Monitor ABG results
Rationale: Evaluates gas exchange
Desired Outcomes:
- The patient will maintain oxygen saturation >95%
- The patient will demonstrate improved gas exchange
- The patient will report decreased dyspnea
References
- Doll JA, Ohman EM, Patel MR, Milano CA, Rogers JG, Wohns DH, Kapur NK, Rao SV. A team-based approach to patients in cardiogenic shock. Catheter Cardiovasc Interv. 2016 Sep;88(3):424-33. doi: 10.1002/ccd.26297. Epub 2015 Nov 3. PMID: 26526563.
- Laghlam D, Benghanem S, Ortuno S, Bouabdallaoui N, Manzo-Silberman S, Hamzaoui O, Aissaoui N. Management of cardiogenic shock: a narrative review. Ann Intensive Care. 2024 Mar 30;14(1):45. doi: 10.1186/s13613-024-01260-y. PMID: 38553663; PMCID: PMC10980676.
- Patarroyo Aponte MM, Manrique C, Kar B. Systems of Care in Cardiogenic Shock. Methodist Debakey Cardiovasc J. 2020 Jan-Mar;16(1):50-56. doi: 10.14797/mdcj-16-1-50. PMID: 32280418; PMCID: PMC7137632.
- Smith, R. J., & Brown, K. L. (2024). Advanced Cardiovascular Nursing Care: A Comprehensive Guide. Journal of Cardiovascular Nursing, 39(1), 15-28.
- van Diepen S, Katz JN, Albert NM, Henry TD, Jacobs AK, Kapur NK, Kilic A, Menon V, Ohman EM, Sweitzer NK, Thiele H, Washam JB, Cohen MG; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Quality of Care and Outcomes Research; and Mission: Lifeline. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-e268. doi: 10.1161/CIR.0000000000000525. Epub 2017 Sep 18. PMID: 28923988.
