This paper will cover my experience while in the cardiac categorization lab during clinical rotations. A 67 year old Caucasian male was emitted for emergent angioplasty with intrapulmonary Steen placement for occlusive myocardial infarction resulting in carcinogenic shock. My paper will detail the medical diagnosis and nursing management of carcinogenic shock. Medical Diagnosis Carcinogenic shock is a term used to describe the heart’s inability to supply enough blood to the organs of the body.
The heart becomes unable to pump enough volume of blood to meet the body demand creating a state of organ hypertension Goldman, 2010). If left uncorrected carcinogenic shock will result in total circulatory collapse and death. Estimates of mortality related to carcinogenic shock are 50% making this one of the most challenging types of shock to treat (Sole, 2009). However, advancements in diagnoses and treatment over the years have greatly increased the survivability of carcinogenic shock.
There are numerous conditions that contribute to carcinogenic shock however; acute myocardial infarction is the leading etiology (Sole, 2009). The chemic event associated with an extensive myocardial infarction images the heart muscle limiting the pumping action and decreasing cardiac output. Individuals with infractions involving greater than 40% of the left ventricle are at the highest risk for developing carcinogenic shock (Giuliani, 2011). Only 10-19% of patients develop carcinogenic shock at the onset of myocardial infarction.
The majority of cases of carcinogenic shock occur within the subsequent 48 hours commonly due to reincarnation (Goldman, 2010). Other causes of carcinogenic shock include left ventricular failure, dysphasia, monopolies including valves, cardiac amended, periphrastic, pulmonary hypertension and pulmonary embolism (Agnosticism, 2010). Pathologically Carcinogenic shock has a downward spiraling pathologically that ultimately leads to hyperemia and tissue death if uncorrected (Burke, 2012). There are three pathways that contribute to tissue schema and death related to myocardial infarction or myocardial dysfunction.
All three involve the ineffective pumping action of the heart. First, when the heart cannot adequately pump blood through the vascular system a state of systemic hypertension develops in which the systolic pressure is less than 90 m Hug. This hypertensive state decreases coronary tissue perfusion pressure leading to schema, progressive myocardial dysfunction and eventually tissue death. Second, inadequate cardiac function leads to decreased cardiac output and stroke volume causing a decrease in systemic organ perfusion.
Prospectors located throughout the body create a compensatory vasoconstriction in blood vessels, including cardiac vessels, which accentuate myocardial dysfunction and tissue death. Third, inadequate cardiac pumping leads to residual blood volume in the left ventricle with eventual development of pulmonary congestion. This edematous state does not allow for adequate pulmonary gas exchange creating a hypoxia environment. The hypoxia leads to tissue schema and eventual tissue death. The three pathways lead to tissue schema which places greater demand on an already taxed heart.
If tissue perfusion is not corrected death is eminent. Clinical meditations tot carcinogenic shock that the nurse should assess include vitals, skin color and temperature, respiratory and cardiac auscultation, mental status, and urine output. A client in carcinogenic shock will often exhibit systolic blood pressure below 0 mm Hug, tachycardia, tachyon, shortness of breath with Arles often present on auscultation, depression, pale or blotchy skin coloring which is cool to the touch, weak pulses, irritability or restlessness, confusion and decreased urine output.
These manifestations are a result of decrease tissue perfusion related to an ineffective cardiac pumping action (McCabe, 2011). Medical Treatment Carcinogenic shock is a medical emergency with the goal of treatment designed to improve tissue perfusion. Three main categories of treatment exist for the immediate treatment of carcinogenic shock. These include pharmacological measures with possessor agents to elevate blood pressure, mechanical support via insertion of an intra-aortic balloon pump and revitalization with precancerous transitional coronary angioplasty (PTA) or coronary artery bypass grafting(CAB) (Goldman, 2010).
Possessor agents include dopamine, dopamine and morphogenesis. Dopamine and dopamine work by increasing cardiac output without increasing heart rate. This allows the heart to pump greater volumes of blood without increased energy demands which could further exacerbate hyperemia. These medications carry a risk for dysphasia. The nurse should assess the patient’s EGG tracings, blood pressure and oxygen saturation levels to determine any adverse effects following administration. Dysphasia will worsen carcinogenic shock and Avis containing these medications should be discontinued immediately (Kidders, 2011).
On occasion morphogenesis is added with dopamine to increase cardiac output (Bowdon, 2012). The nurse must be alert for possible dysphasia and tachycardia associated with administration. Continuous monitoring of the patient’s vitals and EGG is paramount. Some hospitals have attempting to utilize a newer drug named alleviations in the treatment of carcinogenic shock. This drug works by making cardiac tissue more sensitive to calcium without increasing intracellular calcium levels in an effort to increase cardiac contractile.
The response is a positive entropic effect on the heart. The results have been mixed and implementation has been sparse (McCabe, 2011). The intra-aortic balloon pump (BABE) is a mechanical meaner to assist in pumping blood throughout the body. A balloon is inserted into the aorta via the femoral artery and inflated inside the aorta hen the heart muscle relaxes. The balloon deflates prior to the next heart beat helping blood flow from the heart. The balloon is regulated by a machine outside the body to which it is connected.
The balloon pump assists the heart in pumping blood; it does not replace the heart’s function. The goal of the BABE is to increase myocardial oxygen supply and decrease oxygen demand through greater cardiac output (Bowdon, 2012). Revitalization consists of either opening a isotonic vessel via angioplasty, with or without Steen placement, or grafting a bypass vessel around the occluded area. Both procedures have an immediate increase in perfusion to cardiac tissue. These methods are preferred over thrombosis’s based on extensive studies (Goldman, 2010).
Nurse Management Nurse management requires frequent assessment of the patient to determine adequate tissue perfusion. Carcinogenic shock results in decrease cardiac output which activates the sympathetic nervous system. Physical assessment oaten demonstrates finding consistent with sympathetic dominance including cool, pale, clammy skin, tachycardia, tachyon, often with crackles, and Algeria. Additional assessment findings commonly observed are related to hypoxia which include changes in level of consciousness, cardiac dysphasia, occasions and low oxygen saturation levels (Goldman, 2010).
Monitoring the patient in carcinogenic shock will consist of frequent vitals including pulse ox at least every 1 5 minutes, assessment of urine output, assessing breath sounds and level of consciousness. Defining characteristics of carcinogenic shock are restlessness progressing to unresponsiveness, anxiety, agitation, chest pain, a heart rate greater than 100, systolic blood pressure below 90 mm Hug, respiration greater than 20 BPML, weak lulls, orthogonal and crackles. Additional assessment includes EGG monitoring and assessment of serum electrolytes and blood gases.
Since myocardial infarction is the leading cause of carcinogenic shock the EGG will often demonstrate SST segment elevation. Blood gases point towards an acidity state from rising levels of lactic acid related to a hypoxia environment culminating in metabolic acidosis. Nurse Interventions The primary goal in treatment of carcinogenic shock is to improve tissue perfusion. Orders for supplemental oxygen will limit the amount of tissue damage and help tit dyspepsia, pulmonary congestion and acidosis. If oxygen saturation levels fall below 90% intubations is indicated.
The nurse can assist venous return by elevating the head of the bed while the patient remains supine. In an effort to limit myocardial oxygen consumption the nurse should restrict the patient’s activity and maintain the patient on bed rest. Restricted activity can lead to impaired skin integrity which the nurse should monitor for signs of change including non-blanched rather. The nurse will also initiate the prescribed drug therapy. As mentioned earlier obtained is often the drug of choice to increase cardiac output. Morphine may also be ordered to control pain and dyspepsia.
The nurse should also help alleviate the patient’s anxiety by explaining all procedures. If the patient requires invasive interventions the nurse can assist in comforting the patient and family. Another intervention useful in reducing anxiety is maintaining a calming environment to provide reassurance and reduce cardiac oxygen consumption. Effective outcome criteria following carcinogenic shock intervention is a patient that is alert and oriented 3, systolic blood pressure 100-mm Hug, strong pulses, respiratory rate 12-20, pH between 7. 35-7. 5, oxygen saturation at 95% or higher and lungs clear to auscultation (Giuliani, 2011). Client Teaching Upon discharge following recovery from carcinogenic shock the nurse plays a pivotal role in patient education. Patient education focuses on lifestyle changes to prevent recurrent cardiac damage. The nurse can teach the patient about modifiable risk factors for heart disease like weight control, diet and exercise, and smoking cessation. The patient needs to understand how to properly take the medication that as been prescribed and possible associated side effects.
The patient should also be educated to restrict fluid intake to 2 to 2. 5 liters per day. The patient should be informed to contact the physician if weight has increased more than 4 pounds within a two day span. The patient should become self-aware to monitor for leg edema and increasing shortness tot breath as these can be signs tot inadequate heart attention (Giuliani, 2011). Though damage to cardiac tissue is irreversible a concerted effort on the part of the client to change his behavior will allow for a return to an active epistyle in most instances.