- Is a shock state which results from profound left ventricular failure usually from massive MI.
- It results to low cardiac output, thereby systemic hypoperfusion.
- It has a high mortality rate.
NURSING INTERVENTIONS:
- Perform hemodynamic monitoring: PAP,PCWP measurements, intra-arterial BP.
- Administer oxygen therapy.
- Correct hypovolemia. Administer IV fluids as ordered.
- Pharmacotherapy:
- Vasodilators: Nitroprusside, Phentolamine, Nitroglycerine.
- Inotropic agents: Digitalis, Dopamine, Dobutamine.
- Diuretics: Furosemide.
- Na bicarbonate to relieve lactic acidosis.
- Monitor hourly urine output, LOC, arrhythmias.
- Provide pychosocial support.
- Decreases pulmonary edema.
- Auscultate lung fields for crackles and wheezes.
- Note for dyspnea, cough, hemoptysis, orthopnea.
- Monitor ABG for hypoxiaand metabolic acidosis.
- Place in high fowler's position to reduce venous return.
- Administer during therapy as ordered:
* Aminophylline to reduce bronchospasm caused by severe congestion.
* Vasodilators to reduce venous return (Nitroprusside, Nitroglycerine).
* Diuretics to decrease circulating volume.
- Utilize counterpulsation to decrease ventricular work of the client aith severe shock.
- Counterpulsation (mechanical cardiac assistance / diastolic augmentation) involves introduction of the intra-aortic balloon catheter via the femoral artery.
- The intra-aortic balloon pump (IABP) augments diastole, resulting in increased perfusion of the coronary arteries and the myocardium and a decrease in left ventricular workload.
- The balloon is inflated during diastole; it is deflated during systole.
- Indications:
* AMI (Acute myocardial Infarction)
* Unstable angina pectoris
* Open heart surgery
