The document provides information on cardiogenic shock, including its causes and nursing care plans. Cardiogenic shock is caused by the heart's inability to pump sufficiently due to impaired contractility. It is usually associated with conditions like myocardial infarction. The nursing care plans for cardiogenic shock involve careful assessment, monitoring of vital signs and fluid status, and adjusting medications based on assessments. Five specific nursing care plans are outlined covering impaired gas exchange, decreased cardiac output, ineffective tissue perfusion, excess fluid volume, and anxiety. The plans describe potential signs and symptoms, desired outcomes, and nursing interventions with rationales.

1. Prepared by
Demonstrator at faculty of nursing MTI university
02 01064423095
02 01144127776
Mustafaabdalla31@gmail.com

2. Cardiogenic shock
 is a condition caused by the inability of the heart to pump blood sufficiently to
meet the metabolic needs of the body due to the impaired contractility of the
heart. Clients usually manifest signs of low cardiac output, with adequate
intravascular volume.
 It is usually associated with myocardial infarction (MI), cardiomyopathies,
dysrhythmias, valvular stenosis, massive pulmonary embolism, cardiac
surgery, or cardiac tamponade. It is a self-perpetuating condition because
coronary blood flow to the myocardium is compromised, causing further
ischemia and ventricular dysfunction
Nursing Care Plans
The nursing care plan in clients with cardiogenic shockinvolves
 careful assess the client
 observe cardiac rhythm
 monitor hemodynamic parameters
 monitor fluid status
 adjust medications and therapies based on the assessment data
.Here are five (5) nursing care plans (NCP) for cardiogenic shock:
1) Impaired Gas Exchange
2) Decreased Cardiac Output
3) Ineffective Tissue Perfusion
4) Excess Fluid Volume
5) Anxiety

3. 1) Impaired Gas Exchange
Impaired Gas Exchange:Excess or deficit in oxygenation and/or carbon dioxide
elimination at the alveolar-capillary membrane.
May be related to
 Changes in the alveolar-capillary membrane.
 Impaired ventilation-perfusion.
Possiblyevidenced by
 Abnormal arterial blood gasses (ABGs).
 Abnormal respiratory rate, depth, and rhythm.
 Changes in the level of consciousness.
 Crackles.
 Cyanosis.
 Headache.
 Hypercapnia.
 Hypoxia.
 Tachycardia.
Desired Outcomes
 Client will maintain optimal gas exchange, as evidenced by ABGs within
the normal range, oxygen saturation of 90% or greater, alert responsive
mentation or no further reduction in the level of consciousness, relaxed
breathing, and baseline HR for the client.
Nursing interventions
Nursing Interventions Rationale
Assess the client’s respiratory
rate, rhythm, and depth.
During the early stages of shock, the client’s
respiratory rate will be increased due to hypercapnia
and hypoxia. Once the shockprogresses, the
respirations become shallow, and the client will
begin to hypoventilate. Respiratory failure develops
as the client experiences
respiratory muscle fatigue and decreased lung
compliance.

4. Assess client’s heart rate
and blood pressure.
As shock progresses, the client’s blood pressure and
heart rate will decrease and dysrhythmias may occur.
Assess for any signs of
changes in the level of
consciousness.
Headache, restlessness are early signs of hypoxia.
Auscultate the lung for areas
of decreased ventilation and
the presence of adventitious
sounds.
Moist crackles are caused by increased pulmonary
capillary permeability and increased intra-alveolar
edema.
Assess for cyanosis or pallor
by examining the
skin, nail beds, and mucous
membranes.
Cool, pale skin may be secondary to a compensatory
vasoconstrictive responseto hypoxemia. Peripheral
tissues become cyanotic due to impaired oxygenation
and perfusion.
Monitor oxygen saturation
using pulse oximetry.
Pulse oximetry is used in measuring oxygenation
concentration. The normal oxygen saturation should
be maintained at 90% or higher.
Monitor arterial blood gasses.
Increasing Pac02 and decreasing Pa02 are signs of
hypoxemia and respiratory acidosis. As the client’s
condition begins to fail, the respiratory rate will
decrease and Pac02 will continue to increase.
Assist the client when
coughing, and suction the
client when needed.
Suction removes secretions if the client is unable to
effectively clear the airway.
Place the client’s head of bed
elevated.
This position facilitates optimal ventilation.
Administer oxygen as ordered.
Supplemental oxygen may be required to maintain
Pa02 at an acceptable level.
Prepare the client
for mechanical ventilation if
oxygen therapy is ineffective.
Early intubation and mechanical ventilation are
recommended to prevent full decompensation of the
client. Mechanical ventilation provides supportive
care to maintain adequate oxygenation and

5. ventilation to the client.
2) Decreased Cardiac Output
Decreased CardiacOutput: Inadequate blood pumped by the heart to meet
metabolic demands of the body.
May be related to
 Cardiac muscle disease.
 Dysrhythmias.
 Increased or decreased preload or afterload.
 Impaired left ventricular (LV) contractility.
 Septal defects.
 Valve dysfunction.
Possiblyevidenced by
 Changes in the level of consciousness.
 Crackles, dyspnea, and pulmonary congestion.
 Cyanosis and mottling of the extremities.
 Metabolic acidosis.
 Oliguria and/or anuria.
 Pale, cool, clammy skin.
 Respiratory alkalosis.
 Sustained hypotension with narrowing of pulse pressure.
 Tachycardia.
Desired Outcomes
 Client will maintain adequate cardiac output as evidenced by strong peripheral pulses, HR 60
to 100 beats per minute with regular rhythm, systolic BP within 20 mm Hg of baseline,
urinary output 30 ml hr or greater, warm and dry skin, and normal level of consciousness.
Nursing interventions
Nursing Interventions Rationale
Assess for any changes in
Restlessness and anxiety are early signs of cerebral
hypoxia while confusion and loss of consciousness

6. the level of consciousness. occurin the later stages. Older clients are especially
susceptible to reduced perfusion to vital organs.
Assess the client’s HR, BP,
and pulse pressure. Use
direct intra-arterial
monitoring as ordered.
Sinus tachycardia and increased arterial BP are seen
in the early stages to maintain an adequate cardiac
output. BP drops as condition deteriorates.
Auscultatory BP may be unreliable secondaryto
vasoconstriction. Pulse pressure (systolic minus
diastolic) decreases in shock. Older client have
reduced responseto catecholamines; thus their
responseto decreased cardiac output may be blunted,
with less increase in HR.
Assess the cardiac rate,
rhythm, and
electrocardiogram (ECG).
Cardiac dysrhythmias may occurfrom low perfusion,
acidosis, or hypoxia, as well as from side effects of
cardiac medications used to treat this condition. The
12-lead ECG may provide evidence of myocardial
ischemia (ST-segment and T-wave changes) or
pericardial tamponade (decreased voltage of QRS
complex).
Assess the heart sounds for
gallops ( S3, S4).
S3 is a classic sign of left ventricular failure and is
produced during passive left ventricular filling when
blood strikes a compliant left ventricle. and
S4is associated with reduced ventricular compliance,
which impairs diastolic filling.
Assess the central and
peripheral pulses.
Pulses are weak, with diminished strokevolume and
cardiac output.
Assess capillary refill. Capillary refill is slow and sometimes absent.
Assess respiratory rate,
rhythm, and auscultate
breath sounds.
Characteristics of a shockinclude rapid, shallow
respirations and adventitious breath sounds suchas
crackles and wheezes.
Monitor oxygen saturation
and arterial blood gasses.
Pulse oximetry is used in measuring oxygen
saturation. The normal oxygen saturation should be
maintained at 90% or higher. As shock progresses,
aerobic metabolism stops and lactic acidosis occurs,
resulting in the increased level of carbon dioxide and

7. decreasing pH.
Monitor the client’s central
venous pressure(CVP),
pulmonary artery diastolic
pressure (PADP),
pulmonary capillary wedge
pressure, and cardiac
output/cardiac index.
CVP provides information on filling pressures of the
right side of the heart; pulmonary artery diastolic
pressure and pulmonary capillary wedge pressure
reflect left-sided fluid volumes. Cardiac output
provides an objective number to guide therapy.
Assess fluid balance and
weight gain.
Fluid and sodium retention occurs due to the
compromised regulatory mechanisms. Body weight
is a good indicator of fluid and sodium retention.
Assess urine output.
The renal system compensates for low BP by
retaining water. Oliguria is a classic sign of
inadequate renal perfusion from reduced cardiac
output.
Monitor the following
laboratory:
 Potassium.
 Magnesium.
Hypomagnesemnia and Hypokalemia can lead to the
development of dysrhythmias which can further
reduce cardiac output.
Provide electrolyte
replacement as prescribed.
Electrolyte imbalance may cause dysrhythmias or
other pathological states.
Restrict fluids
and sodium as ordered if
increased preload becomes
a problem.
Fluid resuscitation reduces extracellular fluid volume
and decreases cardiac workload.
Administer IV fluids for
clients with a decreased
preload.
Optimal fluid status ensures effective ventricular
filling pressure. Too little fluid reduces circulating
blood volume and ventricular filling pressures; too
much fluid can cause pulmonary edema in a failing
heart. Pulmonary capillary wedge pressure guides
therapy.
Administer oxygen as
prescribed.
Oxygen may be required to maintain oxygen
saturation above 90% or as indicated by order or
protocol.
Administer medications as Medication therapy is more effective when initiated

8. prescribed: early. The goal is to maintain systolic BP greater
than 90 or 100 mm Hg.
Antidysrrhythmics
Antidysrrhythmics are used when cardiac anti
dysrhythmias are further compromising a low output
state.
Diuretics
Diuretics are used when volume overload is
contributing to pump failure.
Inotropics
 Dobutamine Dobutamine is used in the treatment of cardiac
decompensation due to depressed contractility.
 Dopamine
Dopamine stimulates beta-1 adrenergic receptors,
resulting in increased cardiac output and
stimulates dopaminereceptors, resulting in
vasodilatation.
 Inamrinone Inamrinone is a phosphodiesteraseinhibitor with
positive inotropic and vasodilator activity.
 Norepinephrine (L
evophed)
Norepinephrine stimulates beta1- and alpha-
adrenergic receptors, resulting in increased
cardiac muscle contractility, heart rate, and
vasoconstriction.
Morphine
Morphine decreases pain, which reduces
sympathetic stress and provides some preload
reduction.
Vasodilators
 Nitroglycerin (NT
G)
NTG causes relaxation of vascular smooth muscle by
stimulating intracellular cyclic guanosine
monophosphateproduction resulting in a decrease in
preload and blood pressure
 Sodium Nitropruss
ide (Nipride)
Sodium Nitroprusside increase cardiac output by
decreasing afterload and produces peripheral and
systemic vasodilation by direct action to the smooth
muscles of the blood vessels.
Institute an intra-aortic
balloon pump (IABP) or
ventricular assist device
(VAD) if mechanical
assistance by
counterpulsation is
indicated.
Mechanical assist device such as VAD or IABP
temporarily helps the pumping action of the heart in
order to improve cardiac output. These devices are
used in client’s who do not respond to the medical
management. IABP increases myocardial oxygen
supply and decreases myocardial workload through
increased coronary artery perfusion. The
client’s stroke volume increases thereby improving

9. perfusion to the vital organs.
Prepare the client for
surgical intervention if
ordered.
Acute valvular problems or septal defects often
require surgical treatment.
3) Ineffective Tissue Perfusion
Ineffective TissuePerfusion: Decreased in the oxygen resulting in the failure to
nourish the tissues at the capillary level.
May be related to
 Reduction/cessation of blood flow.
Possiblyevidenced by
 Abnormal ABG’s.
 Altered mentation
 Capillary refill longer than 3 seconds.
 Cyanosis.
 Dysrhythmias.
 Dyspnea.
 Oliguria.
Desired Outcomes
 Client will demonstrate increased perfusion as individually appropriate as
evidenced by strong peripheral pulses, HR 60 to 100 beats per minute with
regular rhythm, systolic BP within 20 mm Hg of baseline, balanced intake and
output, warm and dry skin, and alert/oriented.
Nursing interventions
Nursing Interventions Rationale
Assess the client’s HR, BP,
and pulse pressure. Use direct
intra-arterial monitoring as
ordered.
Sinus tachycardia and increased arterial BP are
seen in the early stages to maintain an adequate
cardiac output. BP drops as condition deteriorates.
Auscultatory BP may be unreliable secondaryto
vasoconstriction. Pulse pressure (systolic minus

10. diastolic) decreases in shock.
Assess for any changes in the
level of consciousness.
Restlessness and anxiety are early signs of
cerebral hypoxia while confusion and loss of
consciousness occurin the later stages.
Assess capillary refill. Capillary refill is slow and sometimes absent.
Monitor oxygen saturation and
arterial blood gasses.
Pulse oximetry is used in measuring oxygenation
concentration. The normal oxygen saturation
should be maintained at 90% or higher. As shock
progresses, aerobic metabolism stops and lactic
acidosis occurs, resulting in the increased level of
carbondioxide and decreasing pH.
Restrict the patient’s activity,
and maintain the client on a bed
rest.
Minimize oxygen demand by maintaining bed rest
and limiting the client’s activity.
Provide oxygen therapy as
indicated.
Oxygen is administered to increase the amount of
oxygen carried by available hemoglobin in the
blood.
Administer IV fluids as
ordered.
Sufficient fluid intake maintains adequate filling
pressures and optimizes cardiac output needed
for tissue perfusion.
4) Excess Fluid Volume
Excess FluidVolume:Increased isotonic fluid retention
May be related to
 Decrease in renal organ perfusion.
 Increased sodium and water retention.
 Hydrostatic pressure increase or decrease plasma proteins.

11. Possiblyevidenced by
 Changes in mental status.
 Cough.
 Crackles.
 Dyspnea.
 Edema.
 Jugular vein distention.
 Oliguria.
 Orthopnea.
 Pulmonary congestion.
 Shortness of breath.
 Weight gain.
Desired Outcomes
 Client will have stable fluid volume as evidenced by balanced intake and
output, stable weight, vital signs within normal limits, and absence of
edema.
Nursing interventions
Nursing Interventions Rationale
Monitor urine output, observe its
color and amount.
Urine output may be concentrated and scanty
due to decreased renal perfusion.
Auscultate the lung for the
presence of adventitious breath
sound such as crackles, wheezing.
Note for presence of cough,
dyspnea, or orthopnea.
These may indicate pulmonary edema from a
worsening pulmonary congestion and
intervention must be done immediately.
Monitor client’s intake and output.
Decreased cardiac output may lead to
decreased renal perfusion and impairment
with excess fluid volumewhich causes water
and sodium retention and oliguria.
Assess for edema. Edema (usually pitting edema) that starts in
the feet and ankles and gradually lead to

12. weight gain.
Assess fluid balance and weight
gain.
Fluid and sodium retention occurs due to the
compromised regulatory mechanisms. Body
weight is used to detect responseto diuretic
therapy.
Assess for distended neck veins.
Jugular vein distention may indicate fluid
excess.
Monitor client’s electrolyte levels
esp. potassium.
Hypokalemia can occursince diureticspromote
renal potassium secretion.
Monitor client’s Chest x-ray.
Review chest radiographs to evaluate the
client’s progress or a worsening lung
condition.
Place the client in a semi position.
Semi fowler’s position increases
renal filtration and decreases the production of
ADH thus promoting diuresis.
Frequently change the client’s
position at least every 2 hours.
Repositioning promotes enhanced breathing,
decreases pressure ulcer and mobilization of
secretions.
Instruct the client to have a low
sodium diet.
Low sodium diet can decrease fluid and
electrolyte retention.
Administer diuretics (e.g., furosem
ide) as indicated.
Diuretics decrease plasma volume and
peripheral edema.
5) Anxiety
Anxiety:Vague uneasy feeling of discomfortor dread accompanied by an autonomic
response.
May be related to
 Change in health status.

13.  Fear of death.
 Guarded prognosis;mortality rate 80%.
 Unfamiliar environment.
Possiblyevidenced by
 Agitation.
 Avoid looking at equipment or keeps vigilant watch over equipment.
 Increased questioning.
 Increased awareness.
 Sympathetic stimulation.
 Verbalized anxiety.
 Uncooperative behavior.
Desired Outcomes
 Client will use effective coping mechanisms.
 Client will describe reduction in level of anxiety experienced
Nursing interventions
Nursing Interventions Rationale
Assess previous coping
mechanism used.
Anxiety and ways of decreasing perceived anxiety are
highly individualized. Interventions are most effective
when they are consistent with the client’s established
coping pattern. However, in the acute care setting
these techniques may no longer be feasible.
Assess the client’s level of
anxiety.
Shockcan result in an acute life-threatening situation
that will producehigh levels of anxiety in the client as
well as in significant others.
Explain all procedures as
appropriate, keeping
explanations basic.
Information helps reduce anxiety. Anxious clients
unable to understand anything more than simple,
clear, brief instructions.
Encourage the client to
verbalized his or her
feelings.
Talking about anxiety-producing situations and
anxious feelings can help the client perceive the
situation in a less threatening manner.

14. Acknowledge an awareness
of the client’s anxiety.
Acknowledgement of the client’s feelings validates
the client’s feelings and communicates acceptance of
those feelings.
Reduce unnecessary
external stimuli by
maintaining a quite
environment. If medical
equipment is a sourceof
anxiety, consider providing
sedation to the client.
Anxiety may escalate with excessive conversation,
noise, and equipment around the client.
Maintain a confident,
assured manner while
interacting with the client.
Assure the client and
significant others of close,
continuous monitoring that
will ensure prompt
intervention.
The staff’s anxiety may be easily perceived by the
client. The client’s feeling of stability increases in a
calm and non-threatening atmosphere. The presence
of a trusted personmay help the client feel less
threatened.