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Flashcards in Week 4 - Cardiogenic Shock Deck (35)
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1

 

what is cardiogenic shock?

  • occurs when the hearts pumping ability is compromised to the point at which it cannot maintain cardiac output and adequate tissue perfusion
  • HEARTS ABILITY TO CONTRACT AND TO PUMP BLOOD IS IMPAIRED LEADING TO DECREASED CO 

2

 

COMMON CAUSES FOR

CARDIOGENIC SHOCK

 

  • Myocardial Infarction (most common)
  • Arrhythmias
  • Cardiomyopathies
  • Severe Hypoxemia
  • Acidosis
  • Cardiac Surgery
  • Valvular Issues

HINT:    'MACSAC V'

3

 

_____________ is the most common

cause of cardiogenic shock

Myocardial Infarction

4

 

OVERALL GOALS R/T MEDICAL

MANAGEMENT OF PT

W/CARDIOGENIC SHOCK

  • Limit further damage to the myocardium and preserve healthy tissue
  • Improve cardiac output
  • Identify underlying cause and correct it

5

Name three (3) types of Colloids

Albumin (Naturally Occurring) Dextran , Hetastarch (synthetics)

6

 

How does albumin help with shock? 

 

 

  • Albumin is a large molecule
  • Water is attracted to the large molecule

If we give a patient Albumin then we are able to HOLD  onto fluid in the vascular space.

7

Albumin is a naturally occurring colloid. 

What are the two SYNTHETIC colloids?

 

  • Dextran
  • Hetastarch

8

 

Do you need two nurses to administer Albumin?

No.  Even though ALBUMIN is a "blood product" it does not go through all the same checks as other blood products do. 

  • you do NOT need two nurses for administration, and
  • you do NOT need any special tubing or filter tubing for administration.

IMPORTANT TO NOTEPatients that often refuse "blood products" (ie, Jehovahs Witness) WILL refuse Albumin because the albumin is synthesized out from blood that is donated

 

9

Colloids can affect platelet adhesion causing//

causing our patients an increased risk of bleeding

10

(True / False)

 

Colloids (Albumin, dextran, Hetastarch) reduce platelet

adhesiveness and is associated with reductions is blood coagulation.

TRUE

 

  • We should be monitoring the clients:(values listed below are the normal lab values)
    • PT            10-15 seconds  
    • INR           1 - 1.2 seconds  
    • Platelets  150,000 - 400,000 /mm3
    • aPTT         < 35 sec

11

True / False Primary medications for cardiogenic shock consist mostly of DILATORS and INOTROPES?

TRUE

12

In cardiogenic shock--should we stimulate the BETA receptors?

NO--because this will end up making the heart work harder than it needs to

13

 

Why are DILATORS good for pts with Cardiogenic shock--

 

It dilates leaving less work load on the heart

14

if cardiogenic shock patient is BRADYCARDIC we might need _________ and/or a __________

ATROPINE PACEMAKER

15

>

Medical Management of 

Cardiogenic Shock

  • Supplement the hearts own functioning w/ meds/devices
  • Control Chest Pain
  • Fluid Management
    • Be conservative (dont want to overload their heart)
  • Diuretics
    • may be needed to get rid of excess volume so heart can function better
  • Colloids 
    • Albumin (naturally occurring colloid)
    • Dextran (synthetic)
    • Hetastarch (synthetic)
  • VASOACTIVE MEDS
    • Primarly given:
      • DILATORS
      • INOTROPES (Dobutamine---strictly there to strengthen the contraction but doesnt increase heart rate)
    • (in extreme cases vasoconstriction is necessary to maintain MAP)
  • CONTROLLING/SUPPORTING HEART RATE/RHYTHM
    • ​If Bardycardic- use ATROPINE and possibly a pacemaker
  • ASSISTIVE DEVICES
    • IABP
    • LVAD
    • ECMO
  • LABS
    • Brain Natriuretic Peptide (BNP)
      • >100 pg/mL  (can be indicative of heart failure)
    • Creatinine Kinase (CK)
      • > 200 U/L (indicative of muscle damage)
    • Troponin
      • > 0.4 ng/mL
  • EKG
  • ECHO (u/s of heart)

16

Important Labs / Diagnostics to check (Cardiogenic Shock)

NORMAL BNP <100 pg/mL **Labs will be ELEVATED NORMAL CK 22 - 198 U/L **Labs will be ELEVATED NORMAL TROPONIN 0 - 0.4 ng/mL **Labs will be ELEVATED **ECHOCARDIOGRAM **EKG

17

medications that act directly on the smooth muscle, relaxing arterioles and veins

vasodilators

18

 

How to Vasodilators affect the heart

 

  • acts directly on the smooth muscle, relaxing both arterioles and veins
    • RESULTS In.....decreased O2 demands of the heart
      • Decreased PRELOAD
      • Decreased AFTERLOAD

 

    • Examples:   Nitroglycerin, Nitroprusside

19

 

Nursing management of Cardiogenic Shock

  • Recognition of S/S
    • Poor perfusion?   Cyanosis?  Chest pains?  Arrhythmias?
  • Monitoring hemodynamic status
    • CVP- make sure pt isnt overloaded with fluid
    • Pulmonary Artery Catheter
    • Vasodilators can lead to rebound tachycardia and increases O2 demands of the heart
  • Administering fluids and medications
    • Closely watch for fluid overload
    • Complications of vasoactives
  • Management of Assistive Devices

20

(TRUE / FALSE) Pulmonary Artery Catheter sits in the PA and measures the pressures in the lungs and left side of the heart and measures cardiac output

TRUE

21

 

 

Reasons for a Pulmonary Artery Catheter

 

 

1) Early detection/treatment of life threatening conditions of the heart and lung

2) Evaluation of clients immediate response to treatment

3) Evaluation of the effectiveness of Central Venous function

22

 

Assistive devices (3) sometimes

used in the management of

Cardiogenic Shock

Intra-Aortic Balloon Pump (IABP)

Left Ventricular Assist Device

Extracorporeal membrane oxygenation

23

What does the IABP do?

 

Intra-Aortic Balloon Pump

  • Mechanical device used to:
    • Increase myocardial oxygen perfusion
    • Increase cardiac output

 

Placed through femoral artery via sheath

filled with helium

sits distal to left subclavian artery

INFLATES on diastole to IMPROVE LV Volume and perfuse coronary arteries

DEFLATES on systole to pull blood out of LV (via vacuum effect)--decreased afterload

24

Complications of IABP

 

  • Lower Extremity Compromise
    • Ischemia 
    • Compartment Syndrome ----Pain, Pallor, Pulse, Paresthesia, Paralysis
    • Infection
    • Aortic Dissection (tear in Aorta)
    • Device Malfunction

25

Indications for IABP

 

  • Cardiogenic Shock- b/c it supports functioning of the heart
  • Post-Op cardiac surgery- as temporary/supportive measure 
  • Cardiac (mechanical) defects
    • Mitral Valve Regurgitation
    • septal perforation

26

 

Circulatory DEVICE that is used

to partially (or completely) replace

the function of a failing heart

 

 

Left Ventricular Assist Device (LVAD)

27

 

What is a LVAD

Left Ventricular Assist Device (LVAD)

--it is used to partially or completely replace the function of a failing heart

28

 

How long can you use a LVAD?

 

  • SHORT TERM: 
    • following a MI or heart surgery to prevent / treat cardiogenic shock
  • LONG TERM:
    • used with severe Heart Failure (EF 5 - 10%)
    • often used as a bridge to transplant

29

 

What is ECMO

 

  • Extracorporeal Membrane Oxygenation --advanced life support technique --provides long term breathing / heart support *blood is taken outside the body-oxygenate, warmed, CO2 removed, then pumped back into the body

30

 

Types (2) of set-up for the ECMO

VENO-ARTERIAL (vein to artery) ---Primarily cardiac failure w/ respiratory support VENO-VENOUS (Vein to Vein) ---Primarily for Respiratory failure (ARDS)