Help with patient review

Esme12, ASN, BSN, RN · Oct 2, 2012

Welcome to AN! I have to get my kids from school but I'll be back.

Shock.....Welcome to Critical Care Medicine Tutorials

mandilynn13 · Oct 3, 2012

Did you check her medications? Is she on any prednisone or any other medications that can cause hyperglycemia?

Devochka · Oct 3, 2012

Cardiogenic shock is shock that is caused by the heart ceasing to beat. The MI caused the cardiogenic shock. The heart goes into a rhythm such as v-fib or non-pulsed/pulsed v-tach b/c of irritation from lack of oxygen from the coronary arteries and then ultimately goes into asystole. Depending on the time down, the lack of oxygen can cause damage to the other organs, which could cause the pancreas to function less efficiently. Trauma can also cause increased blood glucose, but it can also be that this person is an undiagnosed T2 diabetic. Infection and illness can also cause high blood sugars, as can steroids and some other antipsych meds. And, what do you mean by 'high' blood sugar? The standards today are ridiculous-saying that anything over 99 is high is unrealistic, as well as the new 'low standard' of 65. Sorry, but 65 is too low and requires treatment for most non-diabetics and some diabetics. Also, is the person on an IV meds, such as D5W? That will cause it as well. If they are a drinker, they can get pancreatitis (look for increased lipase levels) which can cause high levels.

brinks · Oct 3, 2012

I will throw my thoughts in there regarding the high glucose as it is something I have been doing some research on for an essay myself - you may want to look in to it further - or someone may want to correct me if I wrong!! Your patient is in a stressful situation - cortisol secretion can increase during stress - which in turn can increase the blood glucose levels through the stimulation of gluconeogenesis in the liver. This may be having an impact on her blood glucose. Hope that helps a little...but as I said someone correct me if I am wrong as I am not a nurse - just studying to be one!

Good luck

Devochka · Oct 3, 2012

@Brinks, you are correct in that the liver will start kicking out sugar to get the body ready for stress, but generally, this is compensated for by the pancreas kicking out more insulin, assuming they have a normally functioning endocrine system, in order to level out the blood glucose levels. Normally, unless there is damage to the pancreas a non-diabetic should not have high blood glucose. People who end up getting high glucose that did not previously have an issue are usually undiagnosed T2 diabetics. There are meds that can cause high blood glucose, but again, a lot of times, this only shows up in somebody that is T2 (or T1) and will go away once they are off the meds that caused it. Perfect example-my father had open heart surgery. He never had problems with his blood glucose before, but while he was in the hospital and for a while after, he had high blood sugars. They actually were injecting him with Novolog. This was due to the trauma of the surgery. He was a budding T2 diabetic, even though he was thin and a runner. I've only been a nurse for 3 years, but have been a medic for 12. I'm also a T1 diabetic. :)

brinks · Oct 3, 2012

Thanks for the clarification Devochka - I am researching an essay that does involve a patient with Type 1 Diabetic - so I was obviously thinking in a narrow context.... Thanks for pointing that out to me:up:

Esme12, ASN, BSN, RN · Oct 3, 2012

Ok so I'm trying to figure out whats going on with my patient. Her diagnosis is MI, but she has a history of cardiogenic shock and stroke, she also has a history of drug and alcohol abuse. her labs, most of them were abnormal (low rbc, hct, hgb, CA, glucose, BUN).
I'm trying to connect everything, so can u guys correct me if something is wrong with my analysis?
Ok so the cardiogenic shock caused the patient to have a stroke, which ultimately led to MI? right? And because of cardiogenic shock her kidney, liver, pancreas, and other organs are not functioning well, thus the imbalance of electrolytes. Am I correct?
I'm trying to figure out why her glucose is high. Is it because her pancreas is not working or is it because of an infection? What could cause her to have a cardiogenic shock? Is it because of her alcohol and drug abuse? Any nurses out there that could help me???? Thanks

Welcome to AN! The largest online nursing community!

What semester are you? What is your assessment of this patient. What other information do you have?

NO...the stroke can be independent of the Cardiogenic shock. Her abnormal labs are from her life style/age. Google Cardiogenic Shock. How remote is the episode of cardiogenic shock?

Cardiogenic shock occurs when there is such extensive damage done to the myocardium from an MI which leads to multi-system failure that can return to baseline when they recover from the cardiogenic shock.

Cardiogenic shock is an acute process not chronic. Does this patient have pancreatitis? Liver failure? Diabetes? What is "stroke? What causes a "stroke"? (CVA....cerebral vascular accident)

nurseprnRN, BSN, RN · Oct 3, 2012

Cardiac shock doesn't require a cardiac arrest-- just such lousy cardiac output that shock results (and the definition of shock is....?). Stroke doesn't cause MI. And...it's always possible to have more than one thing wrong with you.

Here's my repeated plug for students to have a good grasp of physiology, particularly cardiac and pulmonary...because this is totally a physiology disaster. This is why you take physiology. I used to tell my students that everyone we take care of has some failure of physiology and it's pretty important to understand why it's causing what you're looking at. If you have no heart function and no pulmonary function, you're a dead person and we don't need to take care of you anymore. Otherwise... we have to tune those as much as possible. Without them, kidneys, pancreas, gut, skin, even brain....not an issue anymore.

The Physiology Coloring Book. No joke. This will help you get the big picture you must master to be a nurse. Get it at your favorite online bookseller, and you can thank me later.