Cardiogenic shock care intervention

Introduction

Cardiogenic shock is potentially complex and is hemodynamically diverse state inpatient. The condition may result in an organ hypoperfusion state and can lead to multisystem organ failure (Diapen, 2017). The essay depicts the nursing care requirements and management requirements after postoperative surgery. The essay addresses the sigh, symptoms, and other medical conditions of the patient and provides deep knowledge of the intervention adopted for patient care. The essay describes the possible outcome addressed for maintaining the health of John Clements. Johnny Clements is a 71-year-old man who has been admitted to hospital for the triple vessel coronary artery bypass surgery. Post-surgery, he has developed some symptoms associated with myocardial infection. The essay addresses the management skills that need to be adopted by the registered nurse to maintain the health of the patient.

Cardiogenic shock is a life-threatening condition that results in the low-cardiac output state, hypoxia, and hypoperfusion (Diapen, 2017). The onset of the disease is due to the dysfunction of the myocardium, pericardium, and improper conduction system; impair the function of the myocardium, and valves. These conditions result in clinical and biochemical effects of tissue hypoperfusion. The clinical criteria of the disease include lesser systolic blood pressure of 90 mm Hg. According to Kosaraju (2020), cardiac dysfunction is primarily responsible for a carcinogenic shock. The dysfunction for the shock includes myocardial ischemia, acute mitral regurgitation, wall rupture of ventricular, obstruction of left ventricular outflow, aortic stenosis, pulmonary embolus, aortic dissection, and many others (Kosaraju, 2020).

The pathophysiology of cardiogenic shock is complex, multi-potent, and complicated. The ischemia to cells of the myocardium causes the derangement of left ventricular function that further causes the hypertension characteristics. These conditions further lead to the catastrophic and vicious spiral, that further cause the reduced cardiac output and low blood pressure. Lower blood pressure causes the development of coronary ischemia, which causes a reduction in contractility (Diapen, 2017). Additionally, it was found that the shock could occur through acute and sub-acute derangements of the circulatory system. In this derangement, circulatory compensation and peripheral vasculature are the dominant activities that are witnessed as cardiac symptoms.

The mechanism responsible for the occurrence of the above-mentioned heart state is the pathological vasodilatation. These vasodilatations occur from the potent inflammatory markers such as various classes of interleukins (interleukin-1 and interleukin-6), tumor necrosis factor, nitric oxide, and high levels of peroxynitrite. The increased level of these inflammatory substances creates pathological vasodilatation and responsible for the radiotoxic effect. Moreover, the pathophysiology of the cardiac shock deepens on the self-perpetuating cycle, that further causes global hypoperfusion, multi-organ failure, and sudden death (Diapen, 2017).

The disease can be identified and prevented by early reperfusion in myocardial infarction patients. The higher age, hypertension, high sugar level, multi-vessel coronary artery, subsequent heart attack, and regular surgery are some of the risk factors associated with the disease development (Turker, 2019). The symptoms associated with the disease include rapid breathing, pale skin, unconsciousness, weak or degraded pulse rate, continuous sweating, inferior or lesser urination, hypertension, rapid and sudden heartbeat, and shortness of breath (Semhar et al., 2017). Similarly, Jonty Clements has developed myocardial infarction post-surgery. After a few hours is not responding properly and showing symptoms such as drowsiness, tiredness, unconscious with equal and reactive pupils. The patient shows the acute left and right ventricular problem with suspected ischemic etiology shows the immediate cardiac characteristics for the anatomy of the cardiac shock (Vahdatpour, 2019).The anatomy associated with the carcinogenic shock. Monitor the patient’s central venous pressure, pulmonary artery diastolic pressure, pulmonary capillary wedge pressure, and cardiac output. These characteristics provide insight knowledge on guide therapy and cardiac status.

The severity of myocardial infarction depends on the amount of occlusion development, duration of compromised blood flow in the heart, collateral circulation in an occluded vessel. The myocardial infarction can damage the heart in two ways: transmutable myocardial infarction and non-transmural myocardial infarction. The transmural myocardial infarction characterizes by the thickness of the cardiac wall from the endocardium towards the epicardium. However, the non-transmural myocardial infarction comprises partial thickness, tissue damage, degraded tissue in the endocardium, or extending toward the myocardium.

Firstly, the primary and secondary management care needs to be adopted to treat the patient and prevent him from developing shock characteristics. The primary care requires cardiac rehabilitation. Cardiac rehab is found to show reduced symptoms and prevent the health condition of the patient. According to Warriner and Matok (2019), 25% patient shows positive response and improves the health quality. Mr.Jonty Clements has developed myocardial infarction post-surgery. After a few hours of surgery, he is not responding properly and showing symptoms such as drowsiness, tiredness, unconscious with equal and reactive pupils. Thus, his condition shows the vital sign of temperature, respiratory rate, saturated oxygen level, reduced heartbeat per minute hypertension condition, and mild pain assessment. Thus, this critical condition has been arising therefore the critical care with proper health management tips needs to follow for bringing the patient out of danger and increasing his recovery rate.

The main objective of the registered nurse is to make sure to prevent the patient from organ damage and restore her blood flow. The medicine that can be used for treating the underlying cause of the cardiogenic shock includes anti-arrhythmia medicine, blood thinners, vasopressors, and inotropes. The anti-arrhythmia medicines could be used to restore the heartbeat. Blood thinners and antiplatelet medicines can be used to dissolve the blood clot and reduce the platelets counts. These blood thinners would help in blocking coronary arteries. Along with this, vasopressors and inotropes could be used to increase the blood pressure and blood flow of the heart. The medicine includes norepinephrine and dobutamine. An electrocardiogram should perform within fifteen minutes and checks for any ischemic changes. The registered nurse must provide intravenous IV fluids to maintain the blood volumes and blood flow in the patient body. With the consultation with the senior doctor, the registered nurse could use oxygen therapy so that oxygen can reach to the other body organs such as the lungs, heart, and rest body parts. Regular checking of responsiveness, breathing, airway, and proper circulation needs to be done. As the patient is irresponsive and is developing vital sigh, the registered nurse should look into the evidence of the patient’s response in different parameters such as the development of hypoperfusion, hypertension, pale skin, impaired cognition, tachycardia, and other vital symptoms. Check for symptoms associated with left heart failure with hypoxia, aggressive oxygenation, stabilization of airway, diuretic therapy, and afterload (Abadeeret al., 2017). Auscultate the patient’s lung for decreased ventilation and check for the presence of any adventurous sounds. The checking ensures the presence of pulmonary capillary permeability and increases the level of intra-alveolar edema. Primarily asses for the respiratory rate, rhythm, and depth with the regular monitoring of oxygen saturation with the help of a pulse dosimeter must be done. Along with this, the arterial blood gas level should also be checked because the gaseous levels are responsible for acidosis and hypoxemia (Donovan, 2019). As the patient is in a diseased condition, his gaseous rate may vary. Monitor the patient’s central venous pressure, pulmonary artery diastolic pressure, pulmonary capillary wedge pressure, and cardiac output. These characteristics provide insight knowledge on guide therapy and cardiac status. Along with this, the registered nurses must maintain the hemodynamic status of the patient. Arterial lines¸ electrocardiogram status, cardiac, pulmonary status must be evaluated on a regular basis and should be reported to the supervisor (Donovan, 2019).

The patient can be treated with prophylactic IV beta-blocker, which can prevent arterial fibrillation and flutters (Patarroyo, 2020). The registered nurse must follow a shared decision-making approach while dealing with the patient. The patient has shown various degrading vital sigh, thus the patient medication should be properly administered and maintain. Thus, fluids and plasma must be properly given to the patient to maintain his health. As per the doctor’s prescription, the inotropic agents could be used that will help the patient in improving his heart function. Inotropic medicines include levophed & dopamine. These medicines belong to the norepinephrine class (Hussein, 2015). The patient has symptoms of blood clotting and clogging. Thus, aspirin could be used to reduce blood clotting and keeping blood flowing through a narrow artery. Along with this, the registered nurse can also give thrombolytics as the clot bluster or fibrinolytic. The antiplatelet medicines used includes oral clopidogrel, tirofiban, and eptifibatide (Behnam, 2019). These help in preventing the formation of new clots.

The registered nurse must investigate the decreased cardiac output as per the changes in myocardial contractility or inotropic activity. Regular monitoring of excess fluid volume must be assessed timely because of a decrease in renal organ perfusion, a higher level of sodium, hydrostatic pressure increase, and decrease plasma protein (Thompson, 2019). With respect to these observations, the registered nurse must observe IV infusion because the patient may witness tissue necrosis and sloughing if the vasopressin drug infiltrates in the tissue (Baran et al, 2019). The junior nurse must ensure the counterpulsation of the intra-aortic balloon to maximize the effectiveness by synchronization with the cardiac cycle (Kataja, 2017). During the treatment with intra-aortic balloon counterpulsation, the patient must perform passive motion exercise in the supervision of a registered nurse or the medical care provider. The exercise will prevent the breakdown of skin (Kristen &Bigham,2014). The registered nurse must review the chest radiograph to evaluate the progress of the worsening condition of the lung. Administer diuretics or other vasodilators as prescribed to reduce the circulating volume and decrease the preload effect. The registered nurse may adopt various pharmacological medicines for the treatment of the patient’s condition. The medications include dobutamine, nitroglycerine, dopamine, and some vasoactive medications such as epinephrine, norepinephrine, and vasopressin (Dittman, 2019).

Some of the key points that need to be kept in mind while dealing with the patient’s health care that the nurse has to manage the vitals before and after the administration of medicines and IV fluids. Properly administer fluids, medicine, and diet to patients and ensure no side effect must be accompanied (Jones et al, 2018). Regular assessment of IV infusion site for bleeding or any other allergic response is to be done. The registered nurse must also monitor for the urine output, urine volume, pus formation, serum release, and blood urea nitrogen. These parameters help the nurse to identify the chances of renal dysfunction. Renal dysfunction is one of the common sequels of carcinogenic shock and can lead to the development of acute kidney injury (Abadeeret al., 2017).

Conclusion

From the above discussion, it can be concluded that the adoption of proper intervention procedure help Mr. Clements to recover early. The timely adoption of critical care practices and care priorities fulfil the needs of the patient and help her to maintain health. Nurse with effective clinical reasoning skills shows a positive impact on patient health and outcomes. The diagnosis of the priority-listed disease must be done before medication. The nursing care practice requires for maintaining the health of Mr. Clements must be clearly defined and discussed with the supervisor before implementing it. Although with the adoption of health strategies and measures, Mr. Cement’s health shows positive response and the vital sign was under control. His pulse rate, respiratory rate, and heart rate are under the normal standard.

References

Abadeer, A., Kurlansky, P., Chiuzan, C., Truby, L., Radhakrishnan, J., Garan, R., Topkara, V., Yuzefpolskaya, M., Colombo, P., Takea, K., Naka, Y. &Takayama, H. (2017). Importance of stratifying acute kidney injury iin cardiogenic shock resuscitated with mechanical circulatory support therapy. The Journal of Thoracic and Cardiovascular Surgery, 154, 856-864. http://dx.doi.org/10.1016/j.jtcvs.2017.04.042

Baran, D., Grines, C., & Bailey, S. (2019). SCAI clinical expert consensus statement on the classification of cardiogenic shock.CatheterCardiovascInterv, 2, 1– 9.https://doi.org/10.1002/ccd.28329

Behnam, N. (2019). Standadised team-based care for cardinogenicshock.Journal of the American College of Cardiology, 73, 1-12.DOI: 10.1016/j.jacc.2018.12.084

Diapen, S., Katz, J., Albert, N., Henry, T., Jacobs, A., Kapur, N., Kilic, A., Menon, V., Ohman, E., weitzer, N., Thiele, H., Wshmanx, J., & Cohen, M. (2019).Contemporary management of cardiogenic shock.AHA Scientific Journal, 136, 232-268. DOI: 10.1161/CIR.0000000000000525

Donovan, K. (2019). Management of cardiogenic shock complicating T-segment elevation myocardial infarction:2. British Journal of Cardiac Nursing, 14, 80-85. DOI: 10.12968/bjca.2019.14.2.80

Dittman, B (2019). Percutaneous biventriculate mechanical heart support in cardiogenic shock: A nursing case report. Critical Care Nurse, 39, 15-28. DOI: 10.4037/ccn2019477

Hussain, A. (2015). Assessment of nurse’s knowledge concerning ardiogenic shock for patients in cardiac care unit at Baghdad hospital.IASJ, 2, 1-7

Jones, T., Nakamua, K., &McCabe, J. (2018).Cardiogenic shock: Evolving definitions and future directions in management. Heart Failure And Cardiomyopathies, 1, 1-5. http://dx.doi.org/10.1136/openhrt-2018-000960

Kosaraju, A., Pendela, V., &Hai, O (2020).Cardiogenic shock.StatPearls Publishing, Finland.

Kataja, A. &Harjola, V. (2017). Cardiogenic shock: current epidemiology and management. Continuing Cardiology Education, 1, 121-124.https://doi.org/10.1002/cce2.62

Kristen, A. &Bigham, M. (2014).Cardiogenic shock.The Open Paediatrics Journal, 7, 19-27.

Semhar, Z., Liu, S. &Winters, M. (2017).Cardiogenic shock.Cardiology shock, 36, 53-61.DOI:https://doi.org/10.1016/j.ccl.2017.08.009

Patarroyo, M., Manrique, C., &Kar, B. (2020).Methodist DebkeyCardiovasc Journal, 18,50-56 articles/PMC7137632/

Turker, F. (2019).Cardiogenic shock.IntechOpen, 1, 1-15.DOI: 10.5772/intechopen.76688 ·

Thompson, D. (2019). Mangement of the patient with acute myocardial infarction.ClinicalMyocrdial Infarction, 9, 34-38.doi: 10.7748/ns.4.9.34.s35.

Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic shock. Journal of American Heart Association, 9, 1-10. https://doi.org/10.1161/JAHA.119.011991

Annotated reference:

Abadeer, A., Kurlansky, P., Chiuzan, C., Truby, L., Radhakrishnan, J., Garan, R., Topkara, V., Yuzefpolskaya, M., Colombo, P., Takea, K., Naka, Y. &Takayama, H. (2017). Importance of stratifying acute kidney injury iin cardiogenic shock resuscitated with mechanical circulatory support therapy. The Journal of Thoracic and Cardiovascular Surgery, 154, 856-864. http://dx.doi.org/10.1016/j.jtcvs.2017.04.042

“The author describe the various option that could be used for the treatment of the disease. He has also depicted various sign and symptoms associated with left heart failure with hypoxia, aggressive oxygenation, stabilisation of airway, diuretic therapy, and after load”

Diapen, S., Katz, J., Albert, N., Henry, T., Jacobs, A., Kapur, N., Kilic, A., Menon, V., Ohman, E., weitzer, N., Thiele, H., Wshmanx, J., & Cohen, M. (2019).Contemporary management of cardiogenic shock.AHA Scientific Journal, 136, 232-268. DOI: 10.1161/CIR.0000000000000525

“ The author describe the cardia state of the person sufferin with mycocardial infarction. According to author, Cardiogeneic shock is potentially complex and is hemodynamically diverse state in patient. The condition may result in organ hypoperfusion state and can led to multisystem organ failure.”

Hussain, A. (2015). Assessment of nurse’s knowledge concerning ardiogenic shock for patients in cardiac care unit at Baghdad hospital.IASJ, 2, 1-7

Jones, T., Nakamua, K., & McCabe, J. (2018). Cardiogenic shock: Evolving definitions and future directions in management. Heart Failure And Cardiomyopathies, 1, 1-5. http://dx.doi.org/10.1136/openhrt-2018-000960

“The author depicts the nursing interventions required for the patient care. He stat that vitals before and after the administration of medicines and IV fluids. Properly administer fluids, medicine, and diet to patient and ensure no side effect must be accompanied”

Kataja, A. &Harjola, V. (2017). Cardiogenic shock: current epidemiology and management. Continuing Cardiology Education, 1, 121-124.https://doi.org/10.1002/cce2.62

“ In the paper author describe the importance of counter pulsation. According to him, the counter pulsation of intra-aortic balloon help in maximising the effectiveness by synchronisation with the cardiac cycle”

Kristen, A. &Bigham, M. (2014).Cardiogenic shock.The Open Paediatrics Journal, 7, 19-27.

“The author and colleague provide the information on the importance of During the treatment with intra-aortic balloon counter pulsation, the patient must perform passive motion exercise in supervision of registered nurse or the medical care provider. The exercise will prevent the breakdown of skin”

Thompson, D. (2019). Mangement of the patient with acute myocardial infarction.ClinicalMyocrdial Infarction, 9, 34-38.doi: 10.7748/ns.4.9.34.s35.

“The author describe theimportance of regular monitoring of excess fluid volume must be assessed timely because of decrease in renal organ perfusion, higher level of sodium, hydrostatic pressure increase, and decrease plasma protein”

Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic shock. Journal of American Heart Association, 9, 1-10. https://doi.org/10.1161/JAHA.119.011991

“The author depicts the possible symptoms associated with the cardiac disease. According to the author, the acute left and right ventricular problem with suspected ischemic etiology shows the immediate cardiac characteristics for anatomy of the cardiac shock”

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