Nursing 211

N211: Health Differences Across the Lifespan I Include beta-adrenergic blockers, calcium channel blockers, diuretics, inotropic drugs (dopamine) and anticoagulants. Interventions include monitoring for arrhythmias and ischemia, monitor for hypokalemia (s/e of diuretics), monitor respiratory and cardiovascular status for signs of heart failure, and administer O2 and medications to improve oxygenation and cardiac output. 1.24 Cardiogenic Shock Cardiogenic Shock is related ischemia or impairment in tissue perfusion resulting from MI, serious arrhythmias or heart failure. All these causes decreased cardiac output. The heart fails to pump, reducing cardiac output and compromising tissue perfusion. The decreased stroke volume increases back volume in the left ventricle. Blood from the left ventricle backs up into the lungs creating pulmonary edema. Compensation for decreased carbon dioxide increases heart rate and contractility, increasing the need for oxygen. An imbalance between supply of oxygen and demand for oxygen increase myocardial ischemia further impairing the heart’s pumping action. Causes include MI, heart failure, myocarditis, cardiomyopathy and advanced heart block Signs and symptoms are cold, clammy skin, hypotension with a narrow pulse pressure, oliguria (less than 30 ml/hr), S3 and S4 heart sounds, tachycardia, tachypnea, and weak thready pulse. Diagnostics EKG shows enlarged Q wave, elevated ST segment (MI). Nursing Int rventions Include NPO status to reduce risk of aspiration, administer medications, fluids, oxygen to maximize cardiac, pulmonary and renal function. Use of IABP (intra-aortic balloon pump) an inflatable balloon is inserted through the femoral artery into the descending aorta. Coronary artery perfusion increases when the aortic valve closes and the balloon inflates during diastole (rest). It deflates during systole (squeeze) to reduce cardiac workload by reducing resistance to ejection. Restoration of cardiac function must take priority. Administration of cardio tonic drugs (Digitalis) may increase cardiac contractility. Other drugs that enhance contractility include dopamine (Inotropin). Vasoconstricting agents such as dopamine (Inotropin) and norepinephrine (Levophed) may be used for cardiogenic shock. If cardiogenic shock exists in the presence of pulmonary edema (from pump failure), position the client to reduce venous return (high Fowler position with legs down) to decrease further venous return to the left ventricle. 1.25 Hypovolemic Shock

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