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Cardiogeneic shock

Introduction

Cardiogeneic shock is potentially complex and is hemodynamically diverse state in patient. The condition my result in organ hypoperfusion state and can led to multisystem organ failure (Diapen, 2017).  The essay depicts the nursing care require and management require after the postoperative surgery. The essay address the sigh, symptoms, and other medical condition of the patient and also provide the deep knowledge on the intervention adopted for the patient care. The essay describe the possible outcome addressed for maintaining the health of Jonty Clements. Johnty Clements is 71 year old man who has been admitted to hospital for the triple vessel coronary artery bypass surgery. Post surgery, he has developed some symptoms associated with myocardial infection

Sign, symptoms and pathophysiology

Cardiogenic shock is the life threatening condition which result in low-cardiac output state, hypoxia, and hypoperfusion (Diapen, 2017). The onset of disease is due the dysfunction od myocardium, pericardium, improper conduction system, impair function of mycocardium, and valves. These conditions result in clinical and biochemical effects of tissue hypoperfuion. The clinical criteria of the disease includes lesser systolic blood pressure of 90 mm Hg. According to Kosaraju (2020), cardiac dysfunction is primarily responsible for carcinogenic shock. The dysfunction for the shock includes mycocardial ischemia, acute mitral regurgitation, wall rupture of ventricular, obstruction of left ventricular outflow, aortic stenosis, pulmonary embous, aortic dissection, and many others (Kosaraju, 2020).

The pathophysiology of cardiognic shock is complex, multi-potent, and complicated. The ischemia to cells of mycocardium cause the derangement of left ventricular function, that further cause the hypertension characteristics. These condition further lead to the catastrophic and vicious spiral, that further cause the reduced cardiac output and low blood pressure. The lower blood ressure cause the development of coronary ischemia, that cause the reduction in contractility (Diapen, 2017). Additionaly, it was found that the shock can occur through acute and subacute derangements of the circulatory system. In this derangement, circulatory compensation and peripheral vasculature are the dominate activities that are witnessed.

The mechanism responsible for the occurrence of above mentioned  heart state are the pathologic vasodilatation. These vasodilations occurs from the potent inflammatory markers such as various class of  interlukins (interlukin-1 and interlukin-6), tumour necrosis factor, nitric oxide, and high levels of peroxynitrite. The increased level of these inflammatory substances create pathologic vasodilatation and responsible for radiotoxic effect. Moreover, the path physiology of the cardiac shock deepens on the self-perpetuating cycle, that further cause global hypoperfusion, multiorgan failure, and sudden  death (Diapen, 2017).

The disease can be identified and prevented by early reperfusion in myocardial infarction patients. The higher age, hypertension, high sugar level, multivessel coronary artery, subsequent heart attack, and regular surgery are some of the risk factors associated with the disease development (Turker, 2019). The symptoms associated with the disease includes rapid breathing, pale skin, unconsciousness, weak or degraded pulse rate, continuous sweating, inferior or lesser urination, hypertension, rapid and sudden heartbeat, and shortness of breath (Semhar et al., 2017). Similary, Jonty Clements has developed mycocardial infarction post surgery. After few hours is not responding properly and showing symptoms such as  drowsiness, tired, unconscious with equal and reactive pupils. The patient shows the acute left and right ventricular problem with suspected ischemic etiology shows the immediate cardiac characteristics for anatomy of the cardiac shock (Vahdatpour, 2019). The anatomy associated with the cardiogenic shock.

 

Nurse interventions

Firstly, the primary and secondary  care need to be adopted to treat the patient and prevent him from developing shock characteristics. The primary care require cardiac rehabilitation. The cardiac rehab is found to show the reduced symptoms and prevent the health condition of patient. According to Warriner and Matok (2019),  25% patient shows positive response and also improve the health quality.  

Primary care of interventions

The primary care includes physical, psychological and therapeutic care which help the patient to health properly and prevent complications. Electrocardiogram should be performed within fifteen minutes and check for any ischemic changes. Regular checking of responsiveness, breathing, airway, and proper circulation. The registered nurse should look into the evidence of the patient response in different parameters such as  development of hypoperfusion, hypertension, pale skin, impaired cognition, tachycardia, and other vital symptoms.  check for symptoms associated with left heart failure with hypoxia, aggressive oxygenation, stabilisation of airway, diuretic therapy, and afterload. Ausculate the patient lung for decreased ventilation and check for the presence of any adventurous sounds.  The checking ensure the preence of pulmonary capillary permeability and increase level of intra-alveolar edema. Primarily asses for the respiratory rate, rhythm, and depth. Regular monitoring of oxygen saturation with the help of pulse dosimeter must be done.along with this, the arterial blood gase level should also be checked because the gaseous level are responsible for acidosis and hypoxemia. As the patient is in diseased condition, his gaseous rate may vary. Monitor the patients central venous pressure, ulmonary artery diastolic pressure, pulmonary capillary wedge pressure and the cardiac output. These characteristics provide the insight knowledge on the   guide therapy and cardiac ssatus.

Secondary care of interventions

Treat the patient immediately with ventricular arrhymias because of the degraded cardiac output and exacerbation of myocardial ischemia. The registered nurse should continuously check for the cardiac health by monitoring with the proper devices. For the betterment of patent, should administer less than 90% of oxygen in respiratory distress and check for intravenous access. The patient can be treated with prophylactic IV beta blocker, that can prevent the rterial fibrillation and flutterness.  

The disease can be identified and prevented by early reperfusion in myocardial infarction patients. The higher age, hypertension, high sugar level, multivessel coronary artery, subsequent heart attack, and regular surgery are some of the risk factors associated with the disease development (Turker, 2019). The symptoms associated with the disease includes rapid breathing, pale skin, unconsciousness, weak or degraded pulse rate, continuous sweating, inferior or lesser urination, hypertension, rapid and sudden heartbeat, and shortness of breath (Semhar et al., 2017). Similary, Jonty Clements has developed mycocardial infarction post surgery. After few hours is not responding properly and showing symptoms such as  drowsiness, tired, unconscious with equal and reactive pupils. The patient shows the acute left and right ventricular problem with suspected ischemic etiology shows the immediate cardiac characteristics for anatomy of the cardiac shock (Vahdatpour, 2019). The anatomy associated with the cardiogenic shock.

The mechanism responsible for the occurrence of above mentioned  heart state are the pathologic vasodilatation. These vasodilations occurs from the potent inflammatory markers such as various class of  interlukins (interlukin-1 and interlukin-6), tumour necrosis factor, nitric oxide, and high levels of peroxynitrite. The increased level of these inflammatory substances create pathologic vasodilatation and responsible for radiotoxic effect. Moreover, the path physiology of the cardiac shock deepens on the self-perpetuating cycle, that further cause global hypoperfusion, multiorgan failure, and sudden  death (Diapen, 2017).

 

 

 

 

 

Conclusion

From the above discussion it can be concluded that the adoption of proper intervention procedure help Mr.Clements to recover early. The timely adoption of critical care practices and care priorities fulfil the needs of patient and help her to maintain health. Nurse with the effective clinical reasoning skills shows the positive impact on the patient health and outcomes. The diagnosis of the priority-listed disease must be done before medication.  The nursing care practise require for maintaining the health of Mr.Clements must be clearly defined and discussed with the supervisor before implementing. This is because, Mr. Clement  witness repeated injury and suffer a lot from disease. Thus, her care needs to be critically managed. Although with the adoption of health strategies and measure, Mr. clement’s  health shows positive response and now can be discharged from the hospital in next four to five days.

 

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