RN initial response to cardiogenic shock

  1. I'm a 4th semester nursing student working on a case study related to cardiogenic shock. Assessment has been done (bp 106/66- pts norm is 160/96, p 110 rapid and thready, resps 30 labored, crackles, wheezing, skin pale, cyanotic, cold, moist).
    The question is asking to apply the principles of collaborative care to determine what the nurses' initial response would be and why. I know that ABC's are the priority and he is dyspneic. I would think that putting on some o2 (according to protocol) would be the first action. Seeing that his breathing is already labored, pt may need to be bagged, but at this point putting him on some o2 would fit. Finding out his o2 sats would also be necessary. As far as o2, use a mask at 10-12L/min or higher in an attempt to get up o2 sats to around 97-98%? As cardiac nurses, would this be the first thing that you would do?
    It's difficult to think as a nurse already working on the floor when all I'm seeing are scenarios in the book. Thanks for any feedback.
    Last edit by chevyv on Sep 30, '08 : Reason: typo
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    About chevyv, BSN

    Joined: Apr '08; Posts: 1,692; Likes: 1,605
    Behavioral Health; from US
    Specialty: 20+ year(s) of experience in Gero Psych, Ortho Rebab, LTC, Psych


  3. by   ghillbert
    Always airway first. If he's in cardiogenic shock, he has cardiac pump failure and it likely in pulmonary edema - hence the dyspnea, crackles etc. Being cyanotic is a late, and VERY BAD SIGN of severe hypoxia/hypoxemia.

    I would definitely get an arterial blood gas and start O2 therapy initially (via mask, as long as patient has an adequate conscious level, depending on how bad the gases are).

    After that, they may need diuretics to relieve the pulmonary edema, but keep in mind that reducing the circulating volume will also reduce your heart's stroke volume, so may further reduce your cardiac output.

    You won't really be able to improve oxygenation without having adequate blood supply to get the O2 to the tissues. So the patient needs the cause of their cardiac failure fixed - may be inotropes/intra aortic balloon pump.

    Hope that's a start off the top of my head.