Cardiogenic shock is a life-threatening condition in which the heart cannot pump enough blood to meet the body’s needs. It typically follows extensive myocardial damage (most often from a large myocardial infarction) and results in low cardiac output and widespread tissue hypoperfusion.
Clinically, cardiogenic shock is defined by sustained hypotension (e.g., systolic ≤90 mmHg) with signs of organ hypoperfusion. Because cardiogenic shock leads to rapid decline and multi-organ failure if untreated, nurses must recognize it as a medical emergency and begin aggressive support immediately.
Assessment Cues and Diagnostics
Vital signs: Hypotension (SBP ≤90), tachycardia or bradycardia, and narrow pulse pressure. A cardiac index <2.2 L/min/m² and pulmonary capillary wedge pressure (PCWP) >15 mmHg confirm the shock state.
Heart and lung exam: Weak, rapid peripheral pulses; jugular venous distention (JVD); diminished heart sounds (possible S3 gallop). Auscultation often reveals crackles or rales from pulmonary edema.
Skin and neuro: Cool, pale, clammy skin with peripheral mottling. Altered mentation (confusion or restlessness) is common. Oliguria (<30 mL/hr) indicates poor renal perfusion.
Diagnostics: ECG may show acute MI changes or arrhythmias. Echocardiography typically demonstrates poor left ventricular function and low ejection fraction. Labs often reveal elevated cardiac enzymes, metabolic acidosis, and high BNP. Chest X-ray may show pulmonary congestion.
Pathophysiology
In cardiogenic shock, severe myocardial ischemia or infarction causes a sharp drop in left ventricular contractility. This leads to a vicious cycle: falling cardiac output and blood pressure trigger compensatory mechanisms (sympathetic activation, vasoconstriction, and RAAS), which initially maintain perfusion but ultimately worsen the condition.
As perfusion continues to decline, tissues shift to anaerobic metabolism, producing lactic acidosis. Inflammatory mediators cause capillary leak, worsening edema and microthrombosis. Without prompt intervention, global hypoperfusion and organ failure rapidly ensue.
Nursing Care Plan #1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased cardiac output related to impaired ventricular function as evidenced by hypotension, weak peripheral pulses, and oliguria.
Related Factors/Causes:
- Acute myocardial infarction (damaged myocardium)
- Dysrhythmias (ineffective cardiac contractions)
- Cardiomyopathy or myocarditis
- Mechanical issues (e.g., valve dysfunction, cardiac tamponade)
- Excessive preload or afterload (e.g., hypertension)
Nursing Interventions and Rationales:
- Monitor hemodynamics: Continuously monitor BP, HR, pulse pressure, and ECG to detect early signs of worsening shock.
- Provide oxygen and airway support: Administer high-flow oxygen to reduce myocardial workload. Consider mechanical ventilation if necessary.
- Administer vasoactive and inotropic medications: Give agents such as dobutamine or norepinephrine to improve contractility and maintain adequate BP.
- Manage fluid status: Administer IV fluids judiciously based on hemodynamic readings to balance preload without causing pulmonary edema.
- Prepare for emergency interventions: Have a defibrillator ready and coordinate for possible balloon pump or emergency revascularization.
- Evaluate response to treatment: Monitor urine output and mental status; improvement indicates better perfusion.
Desired Outcomes:
- Adequate cardiac output evidenced by warm skin, strong pulses, HR 60–100 bpm, and stable systolic BP.
- Urine output ≥30 mL/hr.
- Capillary refill <3 seconds.
Nursing Care Plan #2: Ineffective Tissue Perfusion (Cardiopulmonary)
Nursing Diagnosis Statement:
Ineffective tissue perfusion (cardiopulmonary) related to decreased cardiac output as evidenced by chest pain and cool extremities.
Related Factors/Causes:
- Severely reduced cardiac output
- Systemic vasoconstriction
- Microvascular dysfunction
- Coronary artery obstruction
Nursing Interventions and Rationales:
- Monitor oxygenation: Maintain SpO₂ ≥90% to improve perfusion.
- Assess neurologic status: Watch for confusion or agitation, signs of cerebral hypoperfusion.
- Position patient semi-Fowler’s: Promotes lung expansion and reduces preload.
- Administer prescribed medications: Use nitrates or diuretics as ordered to reduce afterload and fluid overload.
- Prevent further ischemia: Keep patient calm; anxiety raises oxygen demand.
Desired Outcomes:
- Pulse oximetry ≥90%.
- Relief of chest discomfort.
- Mental alertness maintained.
- Stable vital signs without progression of shock.
Nursing Care Plan #3: Acute Pain (Chest Pain)
Nursing Diagnosis Statement:
Acute pain (chest) related to myocardial ischemia as evidenced by patient report of pain ≥7/10.
Related Factors/Causes:
- Acute myocardial infarction
- Decreased coronary perfusion
- Increased myocardial oxygen demand
Nursing Interventions and Rationales:
- Administer nitroglycerin: Up to 3 sublingual doses as ordered to relieve ischemic pain.
- Administer analgesics: IV morphine reduces pain and decreases sympathetic stimulation.
- Provide supplemental oxygen: Enhances oxygen delivery to ischemic tissue.
- Position for comfort: Keep patient at rest with HOB elevated.
- Assess pain characteristics: Monitor for associated signs such as sweating or nausea.
Desired Outcomes:
- Pain reduced to ≤3/10 within 30 minutes.
- Stable vital signs.
- No new ischemic ECG changes.
Nursing Care Plan #4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to life-threatening illness as evidenced by verbal expressions of fear and restlessness.
Related Factors/Causes:
- Sudden critical diagnosis
- Sensation of dyspnea or pain
- ICU environment
Nursing Interventions and Rationales:
- Provide reassurance and information: Clear explanations reduce fear and confusion.
- Maintain calm environment: Minimize noise and stimulation.
- Encourage family presence: Familiarity improves comfort.
- Teach relaxation techniques: Breathing exercises lower oxygen demand.
- Administer anxiolytics: Use as ordered to reduce severe anxiety.
Desired Outcomes:
- Patient verbalizes reduced fear and appears calmer.
- Diminished anxiety signs (restlessness, tachycardia).
Nursing Care Plan #5: Activity Intolerance
Nursing Diagnosis Statement:
Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue and dyspnea on minimal exertion.
Related Factors/Causes:
- Poor cardiac output
- Muscle weakness
- Deconditioning from bedrest
Nursing Interventions and Rationales:
- Plan frequent rest periods: Prevents oxygen demand from exceeding supply.
- Provide oxygen during activity: Supports increased metabolic needs.
- Monitor response to activity: Stop activity if fatigue or dyspnea worsens.
- Collaborate on rehabilitation: Involve PT/OT for gradual conditioning.
Desired Outcomes:
- Patient completes basic activities without distress.
- Reports tolerable fatigue.
- Gradual improvement in endurance.
Patient Education and Safety
Symptom education: Instruct patient to report chest pain, dyspnea, or palpitations immediately.
Medication teaching: Explain purpose and side effects of cardiac medications and emphasize adherence.
Lifestyle modifications: Encourage low-sodium diet, fluid restriction, smoking cessation, and gradual activity increase.
Safety precautions: Implement fall prevention measures and assist during ambulation.
Emotional support: Encourage family involvement and offer stress-management resources.
FAQ
Q: What is cardiogenic shock and what causes it?
A: Cardiogenic shock is a severe form of heart failure where the heart suddenly fails to pump enough blood. It most often follows a large myocardial infarction or other severe cardiac injury.
Q: What is the primary nursing diagnosis for cardiogenic shock?
A: The priority diagnosis is Decreased Cardiac Output due to impaired heart function.
Q: What assessments are critical for a patient in cardiogenic shock?
A: Monitor vital signs, skin temperature, mental status, urine output, and lung sounds. Continuous ECG and hemodynamic monitoring are essential for early intervention.
Q: What nursing interventions are essential in cardiogenic shock?
A: Support oxygenation, administer inotropes/vasopressors, manage fluids carefully, and prepare for emergency cardiac procedures. Pain and anxiety management are also key.
Peer-Reviewed References
- Carpenito, L. J. (2022). Handbook of Nursing Diagnosis (16th ed.). Wolters Kluwer.
- Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2021). Medical-Surgical Nursing (11th ed.). Elsevier.
- Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Lippincott Williams & Wilkins.
- Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of Nursing (10th ed.). Elsevier.
- O’Gara, P. T., et al. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation.
