Cardiogenic Shock - 6 Nursing Diagnosis

Nursing Care Plan for Cardiogenic Shock

Definition

Cardiogenic shock is a clinical syndrome in which the heart is unable to pump blood adequately to meet the metabolic needs of the body due to dysfunction of the heart muscle.

Cardiogenic shock is a syndrome of severe pathophysiological disorders related to abnormal cellular metabolism, which is generally caused by poor tissue perfusion. Also known as peripheral circulatory failure thorough with inadequate tissue perfusion (Tjokronegoro, A., et al, 2003).


Etiology

Cardiogenic shock is usually caused by a sudden interruption in the function of the heart or as a result of a decrease in contractile function of chronic heart.
such as:

• Acute myocardial infarction with all its complications.
• Acute myocarditis.
• Acute cardiac tamponade.
• Infective endocarditis.
• Trauma heart.
• Spontaneous rupture of chordae tendineae.
• Cardiomyopathy in the final level.
• Severe valvular stenosis.
• Acute valvular regurgitation.
• Left atrial myxoma.
• Complications of cardiac surgery.

Predisposing factors

From several studies reported any factors predisposing the onset of cardiogenic shock, such as:

• Relatively older age (over 60 years).
• A history of heart trouble.
• Infarction old and new.
• AMI progressively widespread.
• Mechanical complications of AMI (septum torn, mitral insufficiency, ventricular dyssynergy).
• Myocardial extra factor: drugs penyabab hypotension or hypovolemia.

Clinical manifestations

Main complaints of Cardiogenic Shock:

• Oliguria (urine less than 20 ml / h).
• There may be a relationship with AMI (acute myocardial infarction).
• Substernal pain such as AMI.

Important sign of Cardiogenic Shock:

• Blood pressure: down less than 80-90 mmHg.
• Tachypnea and inside.
• Tachycardia.
• Rapid pulse, unless there is a block of A-V.
• Signs of lung dam: wet crackles in both lung bases.
• Very weak heart sounds, heart sounds often heard III.
• Cyanosis.
• Diaphoresis (sweating).
• Cold extremities.
• Mental changes.

Complication

• Cardiopulmonary arrest.
• Dysrhythmias.
• Multisystem organ fails.
• Stroke.
• Thromboembolism.

Nursing Diagnosis for Cardiogenic Shock

1. Decreased cardiac output related to changes in myocardial contractility / inotropic changes.
2. Impaired gas exchange related to changes in alveolar-capillary membrane.
3. Excess fluid volume related to a decrease in renal organ perfusion, increased sodium / water, hydrostatic pressure increase or decrease plasma proteins (absorbs water in the interstitial area / tissue).
4. Ineffective tissue perfusion related to reduction / cessation of blood flow.
5. Acute pain is related to ischemic tissues secondary to blockage or narrowing of coronary arteries.
6. Activity intolerance related to imbalance between the oxygen supply and needs, the ischemic / necrotic myocardial tissue.

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