Cardiogenic Shock Nursing Care Plans

Quick Overview and Assessment Checklist

Cardiogenic shock is a critical, life-threatening condition where the heart fails to pump enough blood to meet the body’s needs—most often following a massive myocardial infarction (MI). The result is dangerously low blood pressure and poor organ perfusion.

Use the following rapid assessment checklist to identify key signs and symptoms:

  • Blood pressure: Systolic ≤90 mmHg or a sudden drop; narrow pulse pressure.

  • Heart rate: Tachycardia (initial compensatory) or new arrhythmias.

  • Skin and extremities: Cool, clammy, pale skin; weak or thready pulses. Cyanosis or mottling may develop.

  • Neurologic: Confusion, anxiety, or restlessness—indicating poor cerebral perfusion.

  • Lungs: Crackles or wheezes from pulmonary edema; breathlessness at rest or with minimal exertion.

  • Jugular venous distension (JVD): Often present due to right-sided backup.

  • Urine output: Less than 30 mL/hr signals renal hypoperfusion.

  • Hemodynamic criteria: Cardiac index <2.2 L/min/m² and pulmonary capillary wedge pressure (PCWP) >15 mmHg.

  • Diagnostics: ECG may show acute MI; echocardiogram reveals poor LV function; labs often show elevated troponin and lactic acidosis.

Nursing Care Plan #1: Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased cardiac output related to impaired ventricular function, as evidenced by hypotension and weak peripheral pulses.

Related Factors/Causes:

  • Extensive myocardial infarction causing pump failure

  • Severe ventricular arrhythmias

  • Cardiomyopathy or myocardial inflammation

Nursing Interventions and Rationales:

  • Monitor vital signs and ECG continuously: Hypotension and narrowing pulse pressure signal worsening shock.

  • Administer oxygen and support airway: Maximizing oxygen delivery reduces myocardial workload.

  • Give prescribed inotropes or vasopressors: Medications such as dobutamine or norepinephrine enhance cardiac contractility and maintain blood pressure.

  • Manage IV fluids judiciously: Administer fluids if preload is low; restrict if pulmonary edema develops.

  • Prepare for emergency measures: Keep a defibrillator available and anticipate arrhythmia management.

Desired Outcomes:

  • Systolic BP ≥90 mmHg

  • Heart rate 60–100 bpm with strong, regular pulses

  • Urine output ≥30 mL/hr indicating improved perfusion

Nursing Care Plan #2: Ineffective Tissue Perfusion

Nursing Diagnosis Statement:
Ineffective tissue perfusion (cardiopulmonary) related to decreased cardiac output, as evidenced by chest pain and low oxygen saturation.

Related Factors/Causes:

  • Severe reduction in cardiac output

  • Systemic vasoconstriction (increased afterload)

  • Coronary artery obstruction (ischemia)

Nursing Interventions and Rationales:

  • Monitor oxygen saturation and ABGs: Maintain SpO₂ ≥90% to prevent worsening ischemia.

  • Elevate head of bed (semi-Fowler’s): Improves lung expansion and reduces cardiac workload.

  • Administer prescribed vasodilators (e.g., nitroglycerin): Enhances coronary and systemic perfusion.

  • Reassure patient and minimize activity: Anxiety and exertion increase oxygen demand and stress the heart.

Desired Outcomes:

  • Oxygen saturation ≥90% on supplemental oxygen

  • Chest pain relieved or significantly reduced

  • No new ECG changes, indicating stabilized perfusion

Nursing Care Plan #3: Acute Pain (Chest Pain)

Nursing Diagnosis Statement:
Acute pain (chest) related to myocardial ischemia, as evidenced by the patient’s report of severe chest pressure.

Related Factors/Causes:

  • Acute myocardial infarction

  • Reduced coronary blood flow

Nursing Interventions and Rationales:

  • Administer sublingual nitroglycerin: Up to three doses every 5 minutes as ordered to relieve ischemic pain.

  • Give IV morphine if ordered: Reduces pain, anxiety, and myocardial oxygen demand.

  • Provide oxygen therapy: Maximizes oxygen delivery to the myocardium.

  • Keep patient calm and rested: Avoid unnecessary movement or exertion.

Desired Outcomes:

  • Pain reduced to ≤3/10

  • Stable vital signs without further elevation from baseline

Nursing Care Plan #4: Anxiety

Nursing Diagnosis Statement:
Anxiety related to a life-threatening condition, as evidenced by fear and restlessness.

Related Factors/Causes:

  • Critical diagnosis of cardiogenic shock

  • Respiratory distress or chest discomfort

Nursing Interventions and Rationales:

  • Explain all procedures and care: Understanding the situation reduces fear and uncertainty.

  • Encourage family presence: Familiar voices provide reassurance and comfort.

  • Maintain a calm, quiet environment: Reduces sensory overload and sympathetic response.

  • Administer anxiolytics if prescribed: Helps lower anxiety and prevent further cardiac strain.

Desired Outcomes:

  • Patient appears calm and reports reduced anxiety

  • Respiratory rate and heart rate decrease toward baseline

Study Tip and Printable Resource

Use this study guide to focus on key clinical indicators—such as hypotension, weak pulses, and cool skin—and the nursing priorities of supporting circulation and oxygenation.

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FAQ

Q: What is cardiogenic shock?
A: Cardiogenic shock is a medical emergency where the heart suddenly fails to pump enough blood, leading to a dangerous drop in blood pressure and organ perfusion. It most often follows a large myocardial infarction that impairs left ventricular function.

Q: What are the priority nursing assessments?
A: Monitor vital signs (especially BP ≤90 mmHg and narrowing pulse pressure), assess perfusion (skin color, pulses, mental status, urine output), and listen for lung crackles. Central monitoring lines provide additional data on fluid status and cardiac pressures.

Q: What is the primary nursing diagnosis?
A: Decreased Cardiac Output is the top priority diagnosis, as poor ventricular contractility directly impairs perfusion and oxygenation.

Q: What nursing interventions are essential?
A: Maintain airway and oxygenation, administer inotropes/vasopressors, manage fluids carefully, and prepare for emergency interventions like defibrillation or intra-aortic balloon pump. Pain and anxiety management are also critical.

Peer-Reviewed References

  • Carpenito, L. J. (2022). Handbook of Nursing Diagnosis (16th ed.). Wolters Kluwer.

  • Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M. M. (2021). Medical-Surgical Nursing (11th ed.). Elsevier.

  • Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (15th ed.). Lippincott Williams & Wilkins.

  • Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of Nursing (10th ed.). Elsevier.

  • O’Gara, P. T., et al. (2013). 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation.

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