Cardiogenic Shock Nursing Care Plans Diagnosis and Interventions
Cardiogenic Shock NCLEX Review and Nursing Care Plans
Cardiogenic shock is a serious condition that occurs when the heart is unable to supply the body with enough oxygen-rich blood to meet its demands.
When the organs fail due to a lack of oxygen, it might be fatal. This is a life-threatening situation that demands quick medical attention.
A heart attack or heart failure are the most common causes of cardiogenic shock.
A systolic blood pressure that is less than or equal to 90 mm Hg for more than or equal to 30 minutes, or support to maintain a systolic blood pressure less than or equal to 90 mm Hg and urine output less than or equal to 30 mL/hr, or chilly extremities are among the clinical requirements.
The two hemodynamic criteria include a low cardiac index (less than or equal to 2.2 liters per minute per square meter of body surface area) and a high pulmonary-capillary wedge pressure (higher than 15 mm Hg).
Cardiogenic shock is a condition that results in end-organ hypoperfusion and tissue hypoxia due to a low cardiac output state of circulatory failure.
Acute myocardial infarction is the most prevalent cause of cardiogenic shock, however, various illnesses affecting the myocardium, valves, conduction system, or pericardium can also induce cardiogenic shock.
Despite breakthroughs in reperfusion therapy and mechanical circulatory support, morbidity and mortality among cardiogenic shock patients remain high.
Signs and Symptoms of Cardiogenic Shock
- Chest pain that lasts longer than a few minutes or that disappears and reappears. It could feel heavy, tight, full, or numb in the chest. Pressure, hurting, burning, or squeezing are all possible sensations. It’s possible that the discomfort is similar to heartburn. Chest discomfort isn’t often the major symptom for some patients, especially women.
- Upper body and/or left arm pain
- Upper abdominal, throat, or jaw pain
- Breathing problems
- Sweating, sometimes known as “cold sweats”
- Fast or erratic heartbeat
- Feeling extremely tired, dizzy, and/or worried
Cardiogenic shock might also cause the following symptoms:
- Confusion or a lack of awareness
- Weak peripheral pulses
- Breathing difficulties
- Urinating less frequently than usual
- Cool and clammy hands and feet
- Pale complexion
- Feeling very exhausted
- Swelling in the abdomen and legs
- Appetite problems
Causes of Cardiogenic Shock
Heart attack is the leading cause of cardiogenic shock. The main pumping chamber of the heart can be damaged by a major heart attack (left ventricle). the body can’t get enough oxygen-rich blood when this happens.
The bottom right chamber of the heart (right ventricle) is injured in rare cases of cardiogenic shock. The right ventricle is responsible for pumping blood to the lungs, where it receives oxygen before continuing on to the rest of the body.
Cardiogenic shock can also be caused by other disorders that weaken the heart such as:
- Damaged myocardium secondary to heart attack
- Inflammation of cardiac muscle (myocarditis)
- Infection of the inner lining and valves of the heart (endocarditis)
- An irregular heartbeat (arrhythmia)
- Excessive fluid or blood around the heart (cardiac tamponade)
- A blood clot in the lung that unexpectedly stops a blood vessel (pulmonary embolism)
- A problem with the heart valve, such as damaged muscles supporting the valve or a malfunctioning artificial valve
- Damage to the septum, which separates the heart’s left and right ventricles
- Heart failure
- Trauma to the chest
Cardiogenic shock’s mechanism is complex and poorly understood. Ischemia to the myocardium causes both systolic and diastolic left ventricular function to be disrupted, resulting in a significant reduction in myocardial contractility. This, in turn, sets off a potentially fatal and vicious cycle of decreased cardiac output and low blood pressure, sustaining coronary ischemia and contractility degradation. Several compensatory physiologic processes emerge. Among them are:
- The sympathetic nervous system’s activation, which causes peripheral vasoconstriction, may improve coronary perfusion at the expense of increased afterload, and
- Tachycardia raises myocardial oxygen demand, which exacerbates myocardial ischemia.
Risk Factors to Cardiogenic Shock
Cardiogenic shock can occur in around 5% to 8% of ST-elevation myocardial infarction (STEMI) cases and 2% to 3% of NON-STEMI cases. In the United States, this can amount to 40,000 to 50,000 cases per year.
Cardiogenic shock occurs more frequently in the following patient groups:
- Patients with diabetes and hypertension
- Patients with a history of heart failure or heart attack
- Patients with coronary artery disease
- Left ventricular injury in the past
- Elderly population
Diagnosis of Cardiogenic Shock
In patients with cardiogenic shock, timely diagnosis, supportive care, and coronary artery revascularization are critical for optimal results. Thorough history taking by eliciting any current or recent symptoms experienced by the patient and physical examination are helpful in the diagnosis of cardiogenic shock. Healthcare providers may discover the following indicators of cardiogenic shock during a physical examination:
- A sluggish pulse
- Cold, clammy skin
- Low blood pressure
- Irregular heart rhythm or cardiac murmur upon auscultation
Several tests can be used to determine whether or not the patient has cardiogenic shock. Among these tests are:
- Blood pressure measurement – to check for low blood pressure, use a blood pressure cuff.
- Cardiac catheterization – this is a treatment that allows the doctor to locate blockages in the arteries that deliver blood to the heart (coronary arteries). A catheterization can also be used to check the amount of blood the heart pumps with each beat (cardiac output). A catheter is a long, thin tube that is placed into an artery through a small hole in the wrist or groin.
- Electrocardiogram (ECG/EKG) – a recording of the electrical activity of the heart (heart rhythm).
- Echocardiogram -an echocardiogram is an ultrasound of the heart that allows the healthcare professional to assess its strength and look for structural abnormalities such as valve problems.
- Chest X-ray -this is used to check for fluid in the lungs and take photos of the heart and blood vessels.
- Blood tests – to evaluate the blood oxygen levels and for damage to main organs such the kidneys, heart, and liver. the electrolyte level will also be checked.
Treatment for Cardiogenic Shock
Cardiogenic shock is a life-threatening disorder that requires immediate medical attention. To avoid injury, the most important component of treatment is to improve the flow of blood and oxygen to the main organs. The most critical intervention and standard therapy for patients with cardiogenic shock due to myocardial infarction is the early restoration of coronary blood flow. This can sometimes be accomplished by medicine. Support devices may be required in more severe cases to assist the heart.
In a hospital emergency room or intensive care unit, treatment may include:
- Medications administered intravenously to assist eliminate excess fluid, increase blood flow, and promote heart function.
- Use supplemental oxygen to maintain breathing.
- A Swan-Ganz catheter, a unique catheter that measures the pressures inside the heart, is implanted as a temporary monitoring line. This can assist the healthcare team in precisely monitoring the therapy response.
Prevention of Cardiogenic Shock
Making lifestyle modifications to keep the heart healthy and the blood pressure in check is the greatest strategy to avoid cardiogenic shock.
- Avoid smoking and secondhand smoke. Quitting smoking is the most effective strategy to lower the risk of a heart attack.
- Keep the weight in check. Other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease, and diabetes, are exacerbated by being overweight. Blood pressure and cholesterol levels can be improved by losing merely 10 pounds (4.5 kg).
- Reduce cholesterol and saturated fat intake. Limiting certain fats, particularly saturated fat, can help the patient avoid heart disease. Trans fats should be avoided.
- Reduce the salt intake. Excess salt (sodium) causes fluid retention in the body, which puts a strain on the heart. Sodium intake must be at most 2,300 milligrams per day. Many canned and processed foods include salt, so reading food labels is a smart idea.
- Reduce the sugar intake. This will help the patient avoid nutrient-deficient calories and maintain a healthy weight.
- Drink in moderation. Drink alcohol in moderation if the patient wish to do so. For healthy persons, this equates to one drink per day for women and two drinks per day for males.
- Exercise every day. Exercise can help decrease blood pressure and improve the health of the blood vessels and heart in general. Get in at least 150 minutes of moderate aerobic activity or 75 minutes of strenuous aerobic activity every week, or a combination of both. It is suggested that the patient do this workout over the course of a week. Increased physical exercise will provide even more health benefits.
Because cardiogenic shock is usually caused by a heart attack, seeking quick treatment for a heart attack is the best method to avoid it. Consult the doctor to determine the risk of heart disease and take steps to enhance the cardiovascular health. If the patient have coronary artery disease, consult the doctor as soon as possible and follow the treatment plan to the letter (medications, lifestyle changes, etc.).
Cardiogenic Shock Nursing Diagnosis
Nursing Care Plan for Cardiogenic Shock 1
Nursing Diagnosis: Excess Fluid Volume related to decreased renal perfusion, increased water retention and sodium retention, and plasma proteins increases or decreases hydrostatic pressure secondary to cardiogenic shock as evidenced by alteration of mental status, cough, crackles, dyspnea, edema, distended jugular vein, orthopnea, respiratory congestion, difficulty of breathing, and weight gain.
Desired Outcome: The patient will demonstrate a stable fluid volume, as manifested by balanced intake and output, stable weight, normal vital signs, and the absence of edema.
|Cardiogenic Shock Nursing Interventions||Rationale|
|Monitor the amount and color of urine produced.||Due to reduced renal perfusion, urine production may be concentrated and sparse.|
|Auscultate the lungs for any unusual breath sounds, such as crackles or wheezing. Keep an eye out for cough, dyspnea, or orthopnea.||These symptoms could indicate pulmonary edema as a result of worsening lung congestion, and rapid treatment is required.|
|Monitor for the client’s intake and output.||Reduced cardiac output can lead to reduced renal perfusion and impairment, which can induce water and sodium retention, as well as oliguria.|
|Examine for edema.||Edema may begin in the feet and ankles and is a symptom of cardiogenic shock.|
|Examine the patient’s fluid balance and weight increase.||Because the regulating mechanisms are weakened, fluid and salt retention develops. The response to diuretic medication is measured by body weight.|
|Check for distended jugular veins.||Fluid overload can cause jugular vein distention.|
|Keep a record of the client’s electrolyte levels, especially potassium.||Because diuretics increase renal potassium output, hypokalemia might occur.|
|Monitor the patient’s chest x-ray.||Examine chest radiographs to determine whether the client’s condition is improving or deteriorating.|
|Position the client in semi fowler’s.||The semi-fowler’s position promotes diuresis by increasing renal filtration and decreasing ADH generation.|
|At least every two hours, rotate the client’s position.||Repositioning helps to improve breathing, reduce pressure ulcers, and mobilize secretions.|
|Insist on a low-sodium diet for the client.||Fluid and electrolyte retention can be reduced by following a low salt diet.|
Nursing Care Plan for Cardiogenic Shock 2
Nursing Diagnosis: Hyperthermia related to cardiac muscle dysfunction, dysrhythmias, preload or afterload has been increased or lowered, contractility of the left ventricle (LV) is impaired, septal abnormalities, and dysfunction of the valves secondary to cardiogenic shock as evidenced by altered level of consciousness, dyspnea, crackles, and pulmonary congestion, the extremities have mottling and cyanosis, metabolic acidosis, anuria and/or oliguria, skin that’s pale, cold, and clammy, respiratory alkalosis, hypotension that persists with a narrowing of the pulse pressure, and tachycardia.
Desired Outcome: The patient will exhibit strong peripheral pulses, HR of 60 to 100 beats per minute with a regular rhythm, systolic BP within 20 mm Hg of baseline, urine output 30 ml/hr or greater, warm and dry skin, and normal state of consciousness that is congruent to a person with adequate cardiac output.
|Cardiogenic Shock Nursing Interventions||Rationale|
|Examine the level of consciousness for any changes.||Early indicators of cerebral hypoxia include restlessness and anxiety, whereas later stages include confusion and loss of consciousness. Decreased perfusion to vital organs is especially dangerous for the elderly.|
|Evaluate the client’s heart rate, blood pressure, and pulse pressure. As directed, use direct intra-arterial monitoring.||To maintain an appropriate cardiac output, sinus tachycardia and elevated arterial blood pressure are noted in the early phases. As the situation worsens, BP lowers. Due to vasoconstriction, auscultatory BP may be inaccurate. Shock lowers pulse pressure (systolic minus diastolic). Because older clients have a lower catecholamine response, their response to decreasing cardiac output may be muted, resulting in a lower increase in heart rate.|
|Examine the client’s heart rate, rhythm, and electrocardiogram (ECG).||Low perfusion, acidosis, or hypoxia, as well as the negative effects of cardiac drugs used to treat this disease, can cause cardiac dysrhythmias. Myocardial ischemia (ST-segment and T-wave alterations) or pericardial tamponade can be detected using the 12-lead ECG (decreased voltage of QRS complex).|
|Auscultate for cardiac gallops ( S3, S4).||S3 is a classic symptom of left ventricular failure that occurs when blood impacts a compliant left ventricle during passive left ventricular filling. S4 is linked to a reduction in ventricular compliance, which affects diastolic filling.|
|Assess the client’s central and peripheral pulses.||The pulses are weak, and the stroke volume and cardiac output are both low.|
|Examine the capillary refill.||Capillary refill is sluggish and infrequent.|
|Examine the client’s respiratory rate and rhythm, and listen for breath sounds.||Rapid, shallow breathing and unexpected breath sounds such as crackles and wheezes are all signs of cardiogenic shock.|
|Monitor the client’s oxygen saturation and arterial blood gas levels.||Pulse oximetry is used for determining the level of oxygen saturation. A normal oxygen saturation of 90% or above should be maintained. As shock continues, aerobic metabolism stops and lactic acidosis sets in, resulting in a rise in carbon dioxide levels and a drop in pH.|
|Monitor the client’s CVP (central venous pressure), PADP (pulmonary artery diastolic pressure), pulmonary capillary wedge pressure, and cardiac output and cardiac index.||The right-sided filling pressures are measured by CVP, whereas the left-sided fluid volumes are measured by pulmonary artery diastolic pressure and pulmonary capillary wedge pressure.|
|Examine the client’s fluid balance and weight gain.||The impaired regulating mechanisms cause fluid and salt retention. Fluid and salt retention can be inferred by body weight.|
Nursing Care Plan for Cardiogenic Shock 3
Nursing Diagnosis: Ineffective Tissue Perfusion related to abnormal ABG levels and altered mental status secondary to cardiogenic shock, as evidenced by a capillary refill time of more than 3 seconds, cyanosis, dysrhythmias, dyspnea, and oliguria clients’ expressions of great dread and anxiety, agitation, hyperventilation, crying, and irritability.
Desired Outcomes: The patient will exhibit strong peripheral pulses, HR of 60 to 100 beats per minute with regular rhythm, systolic BP within 20 mm Hg of baseline, balanced intake and output, warm and dry skin, and alert/oriented that is congruent to enhanced perfusion.
|Cardiogenic Shock Nursing Interventions||Rationale|
|Evaluate the client’s heart rate, blood pressure, and pulse pressure. As directed, use direct intra-arterial monitoring.||To maintain an appropriate cardiac output, sinus tachycardia and elevated arterial blood pressure are noted in the early phases. As the situation worsens, BP lowers. Due to vasoconstriction, auscultatory BP may be inaccurate. Shock lowers pulse pressure (systolic minus diastolic).|
|Examine the client’s level of consciousness for any changes.||Early indicators of cerebral hypoxia include restlessness and anxiety, whereas later stages include confusion and loss of consciousness.|
|Examine the client’s capillary refill.||Capillary refilling is sluggish and infrequent.|
|Monitor client’s oxygen saturation and arterial blood gas levels||Pulse oximetry is a technique for determining oxygen saturation levels. A normal oxygen saturation of 90% or above should be maintained. As shock continues, aerobic metabolism stops and lactic acidosis sets in, resulting in a rise in carbon dioxide levels and a drop in pH.|
|Restrict the client’s activities and maintain the client in bed rest.||Maintain bed rest and limit the client’s activity to reduce oxygen demand.|
Nursing Care Plan for Cardiogenic Shock 4
Nursing Diagnosis: Impaired Gas Exchange related to the alveolar-capillary membrane changes, and ventilation-perfusion dysfunction secondary to cardiogenic shock as evidenced by altered arterial blood gasses (ABGs), altered level of consciousness, abnormal breathing rate, depth, and rhythm, crackles, cyanosis, headache, hypercapnia, hypoxia, and tachycardia.
Desired Outcomes: The patient will have ABGs within the normal range, oxygen saturation of 90% or above, attentive responsive mental status or no further drop in the level of consciousness, relaxed breathing, and baseline HR for the client that is congruent with a person who has adequate gas exchange.
|Cardiogenic Shock Nursing Interventions||Rationale|
|Assess for the patient’s respiratory rate, rhythm, and depth.||Due to hypercapnia and hypoxia, the client’s respiratory rate will increase during the early stages of shock. As the shock worsens, the client’s breathing becomes shallow, and he or she begins to hypoventilate. As a result of respiratory muscle exhaustion and decreased lung compliance, the client may suffer respiratory failure.|
|Examine the client’s pulse and blood pressure.||The client’s blood pressure and heart rate will drop as the shock advances, and dysrhythmias may occur.|
|Examine the patient for any evidence of altered level of consciousness.||Hypoxia can cause headaches and restlessness.|
|Examine the client’s lungs for areas of poor ventilation and the presence of unusual breath sounds.||Increased pulmonary capillary permeability and increased intra-alveolar edema generate moist crackles.|
|Examine the skin, nail beds, and mucosal membranes for cyanosis or pallor.||A compensatory vasoconstrictive response to hypoxemia could explain the cool, pale skin. Because of poor oxygenation and perfusion, peripheral tissues become cyanotic.|
|Monitor the client’s oxygen saturation using pulse oximetry.||Pulse oximetry is a technique for determining oxygen saturation levels. A normal oxygen saturation of 90% or above should be maintained.|
|Assess the client’s arterial blood gas levels.||Hypoxemia and respiratory acidosis are indicated by an increase in PaC02 and a decrease in Pa02. The respiration rate will drop as the client’s condition deteriorates, whereas Pac02 will continue to rise.|
|Assist the client with coughing and perform suctioning if necessary.||If the client is unable to clear the airway efficiently, suction is used to eliminate secretions.|
|Elevate the head of the bed for the client. (Semi fowler’s position)||Semi Fowler’s position allows for maximum airflow.|
|If oxygen therapy fails, prepare the client for mechanical ventilation.||To avoid full decompensation, early intubation and mechanical ventilation are suggested. Mechanical ventilation is used to help the client maintain appropriate oxygenation and ventilation.|
Nursing Care Plan for Cardiogenic Shock 5
Nursing Diagnosis: Anxiety related to unfamiliar environment, change in health status, and fear of death as evidenced by increased questioning, increased alertness, sympathetic stimulation, verbalized anxiety, uncooperative behavior, and agitation.
- The patient will utilize effective coping methods.
- The patient will verbalize a decrease in anxiety levels.
|Cardiogenic Shock Nursing Interventions||Rationale|
|Examine the client’s previous coping mechanisms.||Anxiety and methods for reducing perceived anxiety are largely personal. When interventions are compatible with the client’s established coping habit, they are most effective. However, these procedures may no longer be practicable in an acute care context.|
|Determine the client’s anxiety level.||Shock can result in a life-threatening condition, causing the client and people close to the client to experience extreme levels of anxiety.|
|Explain each technique to the client as needed, keeping explanations simple.||Information can help the client to reduce their anxiety. Anxious clients tend to understand simple, straightforward, and concise directions.|
|Encourage the client to express their emotions verbally.||Talking about anxiety-provoking situations and thoughts can help the client perceive the situation as less threatening.|
|Recognize that the nurse is aware of the client’s anxiety.||Acceptance of the client’s feelings is communicated by acknowledgment of the client’s feelings.|
|Maintain a quiet setting to reduce unwanted external stimuli.||Excessive discussion, noise, and equipment near the client may exacerbate anxiety.|
|Maintain a confident and assured demeanor when dealing with clients. Assure the client and anyone involved that they will be closely monitored and that prompt intervention will be made.||The client may be able to sense the staff’s anxiety. In a quiet and non-threatening environment, the client’s sense of security grows. The presence of a trusted individual may make the client feel safer.|
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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