Which assessment indicates the nurse about development of cardiogenic shock in M.I. patient in I.C.U.?

Chitranjjan National Cancer Institute Kolkata - 2021

Medical & Surgical Nursing

Medium

Appeared in: Chitranjjan National Cancer Institute Kolkata - 2021

Explanation

Oliguria (urine output less than 30 mL/hr or less than 0.5 mL/kg/hr) is a cardinal sign of cardiogenic shock.
It directly reflects decreased cardiac output and subsequent hypoperfusion of the kidneys, which is a primary consequence of pump failure.
Monitoring urine output is a critical, non-invasive way to assess the adequacy of organ perfusion in critically ill patients.
The development of oliguria in an MI patient is an ominous sign that requires immediate intervention to prevent irreversible organ damage.

Option A: Bradycardia (a slow heart rate) is not a typical sign of cardiogenic shock. The body's compensatory mechanism for low cardiac output is tachycardia (a fast heart rate).
Option B: Cardiogenic shock is defined by severe hypotension (low blood pressure), not increased blood pressure. The heart's failure as a pump leads to a drop in arterial pressure.
Option D: Warm and flushed skin is a classic sign of distributive shock (e.g., septic or anaphylactic shock), where massive vasodilation occurs.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Assessment of Cardiogenic Shock in acute care settings.
In the ICU, hourly urine output measurement is a vital nursing assessment. A consistent output below 30 mL/hr for two or more hours is a critical finding that must be reported to the provider immediately.
Early recognition of oliguria allows for timely interventions like administering inotropes (to improve contractility) and vasopressors (to increase blood pressure), which can improve patient outcomes.
What if? If the same hypotensive MI patient suddenly developed a fever and had warm, flushed skin, the diagnosis would shift towards septic shock complicating the MI. The priority would then include obtaining blood cultures and administering broad-spectrum antibiotics alongside hemodynamic support.

How to Approach the Question

First, identify the core clinical condition in the question: a patient with an MI is at risk for cardiogenic shock.
Recall the key pathophysiology of cardiogenic shock: it is a 'pump failure' problem, leading to low cardiac output and poor organ perfusion.
Think about the signs of poor organ perfusion. How does it affect the brain (confusion), skin (cool, clammy), and kidneys (low urine output)?
Evaluate each option against this understanding. Does it fit the picture of pump failure?
Eliminate options that are opposite to the expected findings (e.g., increased BP instead of low BP) or characteristic of other conditions (e.g., warm skin in septic shock).

Concept Tested & Keywords

Concept Tested: Assessment of Cardiogenic Shock
Stem keywords: cardiogenic shock, M.I. patient, I.C.U., assessment
Lead-in keywords: indicates
Clinical cues: Patient with Myocardial Infarction (MI) in ICU is at high risk for cardiogenic shock.
Negative lead-in flag: false

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