This document discusses cardiogenic shock, which occurs when the heart fails to pump effectively, reducing cardiac output and blood flow. It defines cardiogenic shock and lists its causes such as heart attacks. The document covers epidemiology, clinical manifestations, diagnostic assessments including echocardiograms and biomarkers, medical management using drugs, surgery, and nursing care including monitoring fluids, hemodynamics, and preventing recurrence. The goals are to treat the underlying heart issue, support organ function, and stabilize the patient's condition through a multi-disciplinary approach.

1. Cardiogenic Shock
Med-Surg - I
Professor:
Dr. Hector Barroso. RN, BSN, MS-FNP

2. Team
1. Luis Alvarez
2. Lilian Santana
3. Diana Soler
4. Favier Pastrana
5. Ian Guevara

3. Objectives
1. Concept of Cardiogenic Shock (CS).
2. Understand your Pathophysiology.
3. Know the statistics, incidence and its causes.
4. Recognize its clinical manifestations, the assessment and.
diagnostic finding.
5. Medical and surgical management.
6. Learn to elaborate an adequate nursing management.

4. Definition of CS
● Inadequate circulation due to primary failure of the heart to
function effectively (↓ ventricular contraction).
● Diminished cardiac output (CO).
● Systemic hypoperfusion and maladaptive cycles of ischemia,
inflammation, vasoconstriction, and volume overload.
Signs of tissue hypoperfusion:
● low urine production, cool extremities and altered mental of
consciousness.
Multi-organ failure and death.

5. Pathophysiology

6. Epidemiology (Incidence)
1. CS complicate 5 to 12 % of AMIs, > 40% loss of LV.
2. Most frequently:
a. > 75 year, Man (+ freq CAD), Woman (> 55 year).
b. Mechanical complications post AMI (free wall,
papillary muscle and IV septal rupture).
c. Patients with more associated comorbidities.

7. Epidemiology (Mortality)
3. CS: 80 to 90 % - historically
4. Post to the advent: ↓ 55 - 60 %
a. Thrombolytic, Graft coronary, PCI
b. Early diagnostic, medical treatment
and haemodynamic support (IABP)
a. MCS (mechanical circulatory support) = IMPELLA
(~50%)

10. Clinical manifestations
● Pale, cool and clammy skin.
● Systolic blood pressure (< 90 mmHg).
● Tachycardia (> 100 bpm).
● Dyspnea or shortness of breath.
● Oliguria (< 20 - 30 ml/h).
● Mental confusion.
● Cyanosis.

11. Assessment and Diagnostic Findings
Myocardial Damage:
● Laboratory Biomarkers for Ventricular Dysfunction
● Cardiac Enzyme levels and Biomarkers
● Serum Lactate
At BedSide
● Transthoracic Echocardiography
● Serial 12-lead Electrocardiograms

12. Assessment and Diagnostic Findings
● Auscultation
● Arterial Pressure Monitoring
● ABG Analysis
● Enzyme Levels

13. Surgical Management
Last option when drug therapy and medical
procedures do not work.
● Intra-Aortic Balloon Pump (IABP).

14. Medical Management
● Oxygen.
● Fluid therapy.
● Pain control.
● Balloon pump.
● Hemodynamic monitoring.
● Angioplasty and stenting.

15. Pharmacology Therapy
● Norepinephrine.
● IV dobutamine.
● IV dopamine.
● IV nitroprusside.

16. Nursing Management
Nursing Assessment
● Fluid overload
● Vital signs

17. Nursing Diagnosis
● Acute Pain
● Activity intolerance
● Excess fluid volume
● Decreased cardiac output
● impaired gas exchange
● ineffective tissue perfusion

18. Nursing Care Planning & Goals
● Maintain intra-aortic balloon counterpulsation.
● Monitor hemodynamic status.
● Administer intravenous fluids.
● Prevent recurrence of cardiogenic shock.

19. Nursing Interventions
● Fluids.
● Arterial blood gas.
● Prevent recurrence.
● Positioning.
● Enhance safety and comfort.
● Intra-aortic balloon counterpulsation.
● Hemodynamic status.

20. Evaluation
Expected outcomes include:
● Prevented recurrence of cardiogenic shock.
● Monitored hemodynamic status.
● Administered medications and intravenous fluids.
● Maintained intra-aortic balloon counterpulsation.

21. Discharge and Home Care
Lifestyle changes must be made to avoid the recurrence of
cardiogenic shock:
1. Control hypertension.
2. Avoid smoking.
3. Maintain a healthy weight.
4. Diet.
5. Exercise.

22. Documentation Guidelines
1. Baseline and subsequent findings and individual hemodynamic
parameters.
2. Prior medication use.
3. Plan of care.
4. Teaching plan.
5. Client’s responses to interventions, teaching, and actions
performed.
6. Attainment or progress toward desired outcomes.
7. Modifications to plan of care.

23. Discharge home
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