Decreased Cardiac Output related to Cardiogenic Shock

Nursing Care Plan for Cardiogenic Shock

Nuyrsing Diagnosis : Decreased cardiac output related to changes in myocardial contractility / inotropic changes.

Characterized by:
Systolic arterial pressure less than 90 mmHg (absolute hypotension) or at least 60 mm Hg under basal pressure (relative hypotension), postural changes were recorded from the bed to sitting up, rapid pulse is not strong or weak, irregular, extra heart sound S3 or S4 may indicate heart failure or lowering an ventricular contractility, symptoms of skin tissue hypoperfusion; diaphoresis (moist skin), pale, cold acral, cyanosis, veins on the backs of the hands and feet collapse, mental function disorders, anxiety, revolt, apathy, confusion, decreased consciousness and coma, urine output of less than 30 ml / h (oliguria).

Intervention:

1. Auscultation BP. Compare both hands and measure with sleeping, sitting, standing, if possible.
Rational: Hypotension may occur in connection with ventricular dysfunction, myocardial hypoperfusion and vagal stimulation. However, hypertension is also a common phenomenon, possibly related to pain, anxiety, catecholamine expenses, and or previous vascular problems. Orthostatic hypotension (postural) may be associated with complications of infarction.

2. Evaluation of the quality of the pulse as indicated.
Rational:
Decreased cardiac output causes decreased weakness / strength of the pulse. Suspected irregularity dysrhythmias, which require further evaluation.

3. Record the sound S3, S4
Rational:
S3 occurs in CHF but also looks at the failed mitral (regurgitation) and left ventricular work overload accompanied by severe infarction. S4 may be associated with myocardial ischemia, ventricular stiffness, and pulmonary or systemic hypertension.

4. Record the voice murmur / friction.
Rational:
Shows disruption of normal blood flow in the heart, is not a good example valves, damage to the septum, or papillary muscle vibration / chordae tendineae. Friction with infarction is also associated with inflammation, examples of pericardial effusion and pericarditis.

5. Monitor heart rate and rhythm. Record dysrhythmias via telemetry.
Rational:
Frequency and heart rhythm that responds to medication and activities in accordance with the occurrence of complications / dysrhythmias (premature ventricular contraction particular or heart block), which affects the function of the heart or increase ischemic damage. Beats / fibrillation acute or chronic coronary artery may look at or involvement valve and possibly a pathological condition.

6. Provide tools and emergency medicine.
Rational:
Coronary occlusions sudden, lethal dysrhythmias, infarct expansion and worsening conditions of shock is a condition that trigger cardiac arrest, which require immediate life-saving therapy.

7. Collaboration in the provision of supplemental oxygen, as indicated.
Rational:
Increase the amount of oxygen preparations for myocardial demand.

8. Collaboration to maintain the way in IV as indicated.
Rational:
Track patents essential to the delivery of emergency medicine at the dysrhythmias and chest pain.

9. Collaboration on re-examination of the ECG, chest x-ray, laboratory data examination (cardiac enzymes, GDA, electrolytes).
Rational:
ECG may provide information with respect to the progress / improvement of cardiogenic shock, ventricular function status, electrolyte balance and the effects of the drug.
Chest x-ray may show pulmonary edema in connection with ventricular dysfunction.
Cardiac enzymes Events can monitor the progress of the patient, presence of hypoxia showed the need for additional oxygen, electrolyte balance exemplarily hypo- / hyperkalemia very large effect on heart rhythms and contractions.

10. Collaboration in the provision of anti dysrhythmias as indicated, and when used in the installation of aids / maintain pacemaker.
rational:
Dysrhythmias, usually on the basis symptomatic except for PCV, which often threaten prophylactically.
Pacemaker is a temporary support measures during the acute phase / required permanently on condition that heavy damage conduction system (Such as: Cardiogenic Shock)

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