Cardiogenic and Septic Shock

By Dominic Wilson-Ing
 Student Objectives
• Recapitulate on shock.
• Identify the causes of cardiogenic shock.
• Describe how a patient in cardiogenic shock
presents.
• Describe the basic pathophysiology of
cardiogenic shock.
 Objectives Continued
• Identify monitoring that is used for patients in
cardiogenic shock.
• List the medical treatments used for
cardiogenic shock.
• Using the Mead Model, draw up a nursing
care plan for a patient in cardiogenic shock.
 Objectives Continued
• Identify the causes of septic shock.
• Describe how a patient in septic shock
presents.
• Describe the basic pathophysiology of septic
shock.
• List the medical treatments of a patient in
septic shock.
• Using the mead model, draw up a care plan
for a patient in septic shock.
 Objectives Continued
• Describe the differences between cardiogenic
and septic shock.
Recapitulation of Shock
 Shock – What Is It?
• Shock is when the blood pressure is too low
to sustain a supply of oxygen and nutrients;
and to remove waste products from body
cells, tissues and organs. It may be
hypovolaemic, cardiogenic, distributive or
obstructive.
 The Key Symptoms in Shock
• Hypotension.
• Oliguria / Anuria.
• Decreased levels of consciousness.
• Altered heart rate.
• Diaphoresis.
Cardiogenic Shock
 What Is Cardiogenic Shock?
• Cardiogenic shock is failure of the heart to
pump blood around the body to a degree
where life is incompatible.
 Causes of Cardiogenic Shock
• Anterior myocardial infarction – most common
cause.
• Other myocardial infarctions.
• Congenital heart defects such as sever
ventricular septal defects.
• Myocardial rupture.
• Postoperative cardiac surgery.
 Patient Presentation of
Cardiogenic Shock
• Severely hypotensive.
• Cyanosis.
• Cold and clammy.
• Dyspnoea.
• Elevated central venous pressure.
• Tachycardia.
• Oliguria.
 Basic Pathophysiology of
Cardiogenic Shock
• The pump fails e.g. myocardial infarction.
• Cardiac output decreases.
• Hypotension ensues.
• Heart rate increases to compensate for
hypotension.
• Oxygen demand exceeds supply.
• Peripheral vasoconstriction occurs.
• Blood is redirected away from the gut.
Pathophysiology of Cardiogenic
Shock Continued
• Chemicals released by dying cells cause further
suppression of myocardial function and increase
vasoconstriction centrally.
• The work the heart must do is increased thus so is
the oxygen demand.
• Vital organs such as the kidneys, brain and liver and
lungs are hypoperfused and tissue damage occurs.
• A vicious cycle is then in place and without
treatment the patient will die.
 The Cycle of Cardiogenic Shock
Decreased Cardiac
↓Stroke ↓BP
Output
Volume

↑ HR
↓ Contractility

↑SVR
↑Myocardial ↓DO2 ↑MVO2
Ischaemia
Key
DO2 – Oxygen Supply MVO2 – Myocardial Oxygen Demand
SVR – Systemic Vascular Resistance
Monitoring a Patient in
Cardiogenic Shock
• Continuous cardiac monitoring – rhythm.
• Continuous arterial blood pressure
monitoring.
• Hourly urine output.
• Hourly nasogastric output.
• Strict fluid balance monitoring.
• Hourly temperature monitoring.
• Continuous central venous pressure
monitoring.
 Monitoring Continued
• Respirations.
• Arterial blood gas.
• Blood sugar.
 Medical Management of
Cardiogenic Shock
• Initiate monitoring as described above.
• Administration of inotropes.
• Administration of oxygen.
• Initiation of intra-aortic balloon pump
counterpulsation (if not contraindicated).
• Administration of diuretics.
• May administer GTN.
• Active warming.
 A Nursing Careplan For
Cardiogenic Shock - Respiratory
• Dyspnoea.
• Hypoxia.
• Oxygen administration –
– Facemask.
– CPAP.
– Ventilator.
• Blood gas analysis.
 Cardiovascular
• Rhythm – tachycardia.
• Blood pressure.
• Fluid management.
• Temperature.
• Clotting studies.
• Electrolytes.
 Neurological
• Altered level of consciousness.
• Uraemic seizures.
• Confusion / disorientation.
 Pain and Sedation
• Pain from ischaemic myocardium.
• Pain from ischaemic tissues.
• Pain from insertion of monitoring lines.
• Level of consciousness.
• Administration of sedation if ventilated.
 Nutrition and Hydration
• Strict fluid balance monitoring.
• Variable blood sugar.
• Paralytic ileus.
• Increased nutritional requirements.
 Elimination
• Oliguria / anuria.
• Bowels.
• Inability of cells to rid themselves of toxins –
acidic blood.
 Mobility, Hygiene and Wounds
• Reduced mobility – reduced skin integrity.
• Assistance with maintaining hygiene needs.
• Surgical wounds / line sites.
 Psychological
• Fear of dying.
• Explanations of treatments to patient.
• Support of patient.
• Support of family / significant others.