Case Study Cardiogenic Shock
Frank James is a 72 year old male who was admitted in the ward due to the exacerbation of his heart failure. His condition dramatically worsened, having developed pulmonary oedema as depicted by bat wings on his chest x-ray as well as signs and symptoms of cardiogenic shock. Vital assessment tools in identifying and prioritising the nursing care for Frank consist of the ABCDE of primary survey in conjunction with physical examination such as inspection, palpation, percussion, and auscultation. This case study will explore relevant nursing assessments such as primary survey and physical examination; and the pathophysiology of cardiogenic shock and how it relates to Frank’s presenting signs and symptoms.
Primary survey is an imperative assessment …show more content…
In this case, central cyanosis and pallor were apparent through inspection. According to Warise et. al.,(2015, p.76), central cyanosis in the integument, tongue and mucous membrane imply severe hypoxia This manifestation is also thought to be a late indicator of airway blockage (Jevon, 2010 p.405). Similarly, as he progresses to shock, there is a reduction of circulating volume reaching his superficial blood vessels, thereby resulting to his pale appearance (Estes, 2010, p.303). It is equally imperative to inspect for his chest symmetry, use of accessory muscle, and the depth and rhythm of his breathing to detect abnormal findings (Thim et. al., 2012 p.119-20). Inspection of his jugular vein distention should also be done as this is considered a basis of his cardiac output status (Klein & Ramani, 2017, p.653). Following inspection is palpation. A light palpation on his radial pulse would help assess the quality, rate, and rhythm of his pulse. Findings of weak or faint pulses are a consequence of a decline in his cardiac output secondary to cardiogenic shock (Cooper & Panza, 2017, p.570; Estes 2010, p.270). His capillary refill should also be palpated on his nail beds. This is because a return of more than 3 seconds would likely indicate diminished oxygenation in his peripheries (Estes, 2010, …show more content…
• I am calling for your patient Frank James, a 72 year old male who was admitted at the ward due to acute exacerbation of his chronic heart failure.
Situation:
• Frank is complaining of severe chest pain with a pain score of 8/10 which radiates to his left arm.
• He also complains of shortness of breath and feeling restless.
• In addition, he appears confused.
Background:
• Frank has a history of stable angina for uncertain period.
• He also has a family history of cardiovascular disease.
• He smokes 1 pack of cigarette a day in the past 30 years.
• His medications include: Aspirin 7 mgs PO mane, Atenolol 50 mgs PO mane, Isosorbide mononitrate 30 mgs PO nocte, and Lisinopril 10 mgs PO mane.
• In the past 3 weeks, he experiences chest pain radiating to his back which occur every hour. His chest pain is relieved by sublingual nitroglycerin.
• This morning, the MO ordered an urgent chest x-ray which denotes an exacerbation of his heart failure and the development of pulmonary oedema.
Assessment:
• His current vital signs are as follows: BP of 96/50 mmHg from 140/100mmHg in the morning, HR of 128 bpm, RR of 36 bpm from 28 bpm this morning, SaO2 of 92 per cent despite administration of 10 litres FiO2, and U/O of 20 ml/hr in the past 2
Primary survey is an imperative assessment …show more content…
In this case, central cyanosis and pallor were apparent through inspection. According to Warise et. al.,(2015, p.76), central cyanosis in the integument, tongue and mucous membrane imply severe hypoxia This manifestation is also thought to be a late indicator of airway blockage (Jevon, 2010 p.405). Similarly, as he progresses to shock, there is a reduction of circulating volume reaching his superficial blood vessels, thereby resulting to his pale appearance (Estes, 2010, p.303). It is equally imperative to inspect for his chest symmetry, use of accessory muscle, and the depth and rhythm of his breathing to detect abnormal findings (Thim et. al., 2012 p.119-20). Inspection of his jugular vein distention should also be done as this is considered a basis of his cardiac output status (Klein & Ramani, 2017, p.653). Following inspection is palpation. A light palpation on his radial pulse would help assess the quality, rate, and rhythm of his pulse. Findings of weak or faint pulses are a consequence of a decline in his cardiac output secondary to cardiogenic shock (Cooper & Panza, 2017, p.570; Estes 2010, p.270). His capillary refill should also be palpated on his nail beds. This is because a return of more than 3 seconds would likely indicate diminished oxygenation in his peripheries (Estes, 2010, …show more content…
• I am calling for your patient Frank James, a 72 year old male who was admitted at the ward due to acute exacerbation of his chronic heart failure.
Situation:
• Frank is complaining of severe chest pain with a pain score of 8/10 which radiates to his left arm.
• He also complains of shortness of breath and feeling restless.
• In addition, he appears confused.
Background:
• Frank has a history of stable angina for uncertain period.
• He also has a family history of cardiovascular disease.
• He smokes 1 pack of cigarette a day in the past 30 years.
• His medications include: Aspirin 7 mgs PO mane, Atenolol 50 mgs PO mane, Isosorbide mononitrate 30 mgs PO nocte, and Lisinopril 10 mgs PO mane.
• In the past 3 weeks, he experiences chest pain radiating to his back which occur every hour. His chest pain is relieved by sublingual nitroglycerin.
• This morning, the MO ordered an urgent chest x-ray which denotes an exacerbation of his heart failure and the development of pulmonary oedema.
Assessment:
• His current vital signs are as follows: BP of 96/50 mmHg from 140/100mmHg in the morning, HR of 128 bpm, RR of 36 bpm from 28 bpm this morning, SaO2 of 92 per cent despite administration of 10 litres FiO2, and U/O of 20 ml/hr in the past 2