Question

Mr. T. was admitted to the critical care unit after being diagnosed with an MI, which severely injured the left anterior ventricle.  Mr. T. is 80 yrs. old, has a history of diabetes type 2, and hypertension.  He states he was “active” prior to his recent MI and liked to walk at the mall for exercise.  He is alert and oriented, has never smoked, and lives with wife and son.  

Mr. T. was placed on hemodynamic monitoring due to his low blood pressure and urine output.  Mr. T’s pulmonary artery wedge pressure (or pulmonary artery occlusion pressure, PAOP) is 22. Mr. T. has distended neck veins, dyspnea and audible crackles bilaterally.  

Questions:

1. Discuss the risk factors for the development of cardiogenic shock in Mr. T.

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2. Describe how the afterload affects the cardiac output in Mr. T.

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3. Discuss the goals of management in cases of cardiogenic shock.

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4. What is the nurse’s role in the goals of management? Describe specific nursing actions necessary to care for Mr. T.

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5. Review Sodium Nitroprusside (Nipride) in the Abrams Clinical Pharmacology book (p. 519). Describe the pharmacological action of Nitroprusside and why it is ordered for Mr. T. at this time. What should the nurse do to safely administer this drug?  

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6. What is the mortality rate for patients in cardiogenic shock following an MI?

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Answer 1

1.THE RISK FACTORS FOR THE DEVELOPMENT OF CARDIOGENIC SHOCK IN MR.T

First we can discuss the common risk factors for the development of cardiogenic shock ,tha includes ,

a) Older age

b) Heart failure

c) A prior to heart attack ( higher among women )

d) Coronary heart failure

e) High blood pressure

f) Diabetes .

Here we can see the patient Mr. T has history of diabetes type 2,hypertension ,and he has  also 80 years of old (older age ) .so the risk of cardiogenic shock is increased this pateint .

And about 80 percentage of cardiogenic shock after MI are due to left ventricular pumb failure .that means here the patient Mr.T severly injured left anterior ventricle .so this also helps to increase the risk for the development of cardiogenic shock in Mr.T .

2.CARDIAC OUTPUT OF MR.T CAUSED BY MI

Myocardial infraction (MI) is also called heart attack . The pathophysiology of MI is complex .Loss of viable myocardium imparis globl cardiac function ,whic can lead to reduced cardiac output .And if the damage is severe to cause cardiogenic shock .

So the pateint( Mr.T ) has low cardiac output because of myocardial infraction ,and he need hemodynamic monitoring also.

3.GOALS OF MANAGEMENT OF CARDIOGENIC SHOCK

Myocardial infraction leads to low cardiac output and if the damage is severe can cause cardiogenic shock and the cardiogenic shock remains the most common cause of death in patient with myocardial infraction .so the goals of management is very important to avoid the chance of death .

Goals of management are ,

Our goal of managment is to enhance cardiovascular status by,

a) Oxygen -to provide adequate amount of oxygen to the patient.

b) Angioplasty and stenting -a catheter is inserted into the blocked artery to open it .

c) Ballon pumb -a baloon pumb is inserted into the aorta to help blood flow and reduce workload of the heart .

d) Pain control - in a patient that exoerience chest pain iv morphine can administered for pain relief .

e) Fluid therapy - administration of fluids must be after close monitoring of fluid overload .

4.MAJOR GOLAS OF MANAGEMENT OF MR.T

a) Prevent recurrence of cardiogenic shock .

b) Monitor hemodynamic status .

c) Administer medications and intravenous fluids.

d) Maintain intra-aortic ballon counterpulsation .

e) Enhance safety and comfort for the pateint .

f) Educate the pateint relatives to the care of pateint after discharge .

5.IV NITROPRUSSIDE

Nitroprusside is a vasodialator thamay be used with a vasopressor to further improve cardiac output by decreasing peripheral vascular resistance and reducing preload .

Here the pateint Mr.T has low blood pressure and low urine output and low cardiac output and patient is in hemodynamic monitoring ,so that by the administration of nitroprusside ,the effect of nitroprusside on hemodynamic and regional myocardial specific blood flow to the heart .

here by the administration of nitroprusside help to increase the blood pressure of the pateint and urine output and cardiac output .

6.MORTALITY RATE FOR THE PATEINT IN CARDIOGENIC SHOCK FOLLOWIN MYOCARDIAL INFRACTION

Cardiogenic shock is the leading cause of death after acute myocardial infraction. the mortality rate among pateint with cardiogenic shock are high and that is 70 -90%.its depending upon the age and other severity .