Case Study Analysis: Deteriorating Patient with Cardiogenic Shock

This case study focuses on a 72-year-old patient, Mr. James, admitted with chronic heart failure who develops cardiogenic shock. The assignment meticulously details the patient's presentation, including shortness of breath, chest pain, and the subsequent diagnosis of pulmonary oedema. The report employs the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) to assess the patient's condition, addressing airway obstruction, breathing difficulties, circulatory issues, neurological status, and overall exposure. The analysis highlights the importance of immediate interventions, such as oxygen administration and monitoring. The case study also includes a structured ISBAR (Identify, Situation, Background, Assessment, Recommendation) handover to the doctor, providing a clear and concise summary of the patient's condition, history, and the nurse's assessment, culminating in recommendations for further treatment. The report emphasizes the critical nature of cardiogenic shock and the need for prompt and effective healthcare interventions.

The Deteriorating
Patient: Case
Studies

Contents
INTRODUCTION...........................................................................................................................1
PART 1............................................................................................................................................1
PART 2............................................................................................................................................3
Handover to the doctor using ISBAR..........................................................................................3
CONCLUSION................................................................................................................................4
REFERENCES................................................................................................................................5

INTRODUCTION
There are different type of health related issues that are faced by people and in order to
overcome them, it is important that healthcare providers are able to understand them and take
appropriate steps so that health can be improved (Fahmi and Hayes, 2016). Present report is
based on a case that includes Cardiogenic which is a type of shock. This report covers
consideration made on symptoms and signs in accordance with case. Lastly, it also includes
structured written handover to the doctor using ISBAR.
PART 1
As per the case, Frank James who is 72 years old who was admitted chronic heart failure.
Next morning he complained of shortness of breath chest pain. Then immediate chest x-ray was
taken in which it showed that his heart failure is worsening and this has developed pulmonary
oedema. In order to review the case in effective manner, ABCDE approach is used (Flynn,
Prescott and Jinks, 2016). When heart suddenly stops pumping enough oxygen, then it causes
cardiogenic shock. This type of shock causes damage to heart muscles. In order to follow them,
there are certain set of principles that has to be followed like complete assessment and
reassessment is important to be done, effects of treatment should be identified, life threatening
problems should be determined before going on to next part, etc. Further, before getting into the
steps involved, it is important that proper safety of the patient need to be ensured (Pozzilli, David
Leslie and Del Prato, 2010). Proper monitoring should be done so that changes in health
condition can be listed.
Airway obstruction (A): This is a type of condition in which patient face immense pain in
breathing. In such situation, it is important that proper care need to be provided. As per the case,
the patient was facing issues in taking up oxygen the next day when he was admitted (Hsu, Ton
and Blaha, 2013). In this context, it is essential that oxygen to be given at high concentration by
making use of oxygen reservoir and mask. In addition to this, it should be treated as a medical
emergency. Proper help from experts should be taken immediately. When condition of airway
obstruction is not treated, then it can cause hypoxaemia (Logarajah and Alinier, 2014). Lastly,
signs of airway obstruction should be identified as it causes abdominal movement and
paradoxical chest. In addition to this, central cyanosis is considered to be the last stage of airway
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obstruction. In cardiogenic shock the main pumping chamber gets damaged and due to this issue
the heart fails to pump enough oxygen.
Breathing (B): In this stage, it is essential that proper treatment to be given for life
threatening situations (Sciarretta, Palano and Volpe, 2011). In order to overcome them, care
providers should listen and feel general signs of respiratory distress. Further, there should be
count made of respiration rate. This will enable to identify the deviation. Further depth of breath
and its pattern should be observed. In addition to this, expansion of chest should equally be
determined (Mobeen, Hayes and Fulton, 2016). Further, position of trachea should be checked in
suprasternal notch. From the case, patient was suffering from serious pain in chest. Cardiogenic
shock is caused permanent or temporary derangements in entire circulatory system. Failure of
pumping blood can be determined to the primary insult. Most of the inadequate defects are
completely reversible. Further, from the test conducted, it was identified that the situation of the
patient was getting serious. In addition to this, bag-mask should be used in case the rate of
breathing rate is inadequate. Further, cardiogenic shock is considered to be the leading cause of
death in acute myocardial infarction (Nuño, Coleman and Sauto, 2012). As per the given case,
there are condition in which patient can be get affected with cardiovascular disease as his family
has a history in which older brother died from myocardial infarction and a sister who had 3 MI’s.
In addition to this, Mr. James has a history of 30 year cigarette smoking and this has continues
1/day.
Circulation (C): Hypovolaemia is considered to be the primary cause of shock. However,
in the case, there is situation in which cardiac has caused to the patient. Circulatory state of a
patient may get affected due to breathing problems like tension pneumothorax (Olgers, Dijkstra
and Ter Maaten, 2017). In order to treat this type of condition, care provides need to check
patient’s hands and digits. In case they are oink, pale, blue or mottled, then these are conditions
of shock. Further, temperature of limb should be determined by feeling patient’s hands.
Moreover, capillary refill time (CRT) need to be measured. The condition of the patient is
critical as the type of records show that the chest pain score is 8/10 (Strauer and Steinhoff, 2011).
In addition to this, the x-ray of chest resembles “bat wings”. This is caused due to leaking of
interstitial tissues in to small airways and alveoli. Further, in this stage, it is essential that
position of the trachea in the suprasternal notch should be checked (Boehm, Ely and Mion,
2014). Treatment related with respiratory disorder can be provided when causes are identified.
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As per the case, it can be stated that the main case for the patient to face chronic heart failure is
due to smoking and family history for having deaths due to myocardial infarction (Heunks and
van der Hoeven, 2010). In addition to this, when kidney does not work properly, then there are
changes found in the chemicals in the body. In this context, the muscles and heart becomes more
week.
Disability (D): This can be determined to be the common causes of unconsciousness
which includes cerebral hypoperfusion, hypercapnia, profound hypoxia, etc. In this situation,
review of ABCs should be done and this need to exclude hypotension and hypoxia. Further, drug
chart should be checked in order to identify causes of depression (Barker, Rushton and Smith,
2015). In this context, Mr. James was taking medication of Aspirin 7mgs PO mane, Atenolol
50mgs PO mane, Isosorbide mononitrate 30mgs PO nocte and Lisinopril 10mgs PO mane.
Further, pupils should be examined like its size, reaction to light and equality. Moreover,
patient’s conscious level should be assessed by making use of AVPU method. As an alternative
method Glasgow Coma Scale score should be used (McMurray, 2015). In order to exclude
hypoglycaemia, blood glucose needs to be measured with the help of rapid finger-prick bedside
testing method. For example, when there is any type of changes in blood sugar like its less than
4.0 mmol L-1 then he/she should be given initial dose of 50mL of 10% glucose solution. Further,
there are condition which are identified in which patient face issues with respect of heart attacks.
In addition to this, cardiogenic shock can cause life threatening situation and as per the case if
the patient is not immediately treated, then he can even die. Further, the age of the patient is 72
and so the heart condition is already week and the situation became more worse due to the
smoking habit that patient has.
Exposure (E): The patient may be come for showing any type of disease or issue that they
are facing. There are condition in which it becomes difficult for the professional to identify the
main cause of the problem (Logarajah and Alinier, 2014). In this condition, it is important that
full body check up should be made. This professionals get to identify the main problems and as
per the findings made medication should be provided to the patient.
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PART 2
Handover to the doctor using ISBAR
Clinical handover can be determined to be the professional responsibilities and
accountability. Proper information about the client is provided in the current condition and the
type of meditations that were taken, etc. (Steyerberg and Vergouwe, 2014). In this context,
ISBAR framework for handover is considered for the same and for the case given, it is as
follows:
 I (Identify): The name of the patient is Mr. James which is male and is 72 years old. My
role is of nurse in which it is my responsibility to make sure that the situation that is faced
by the patient is to be identified. Accordingly appropriate steps to be taken to over come
the problem (Hodgson, Berney and Bellomo, 2013). Further, it is also important for me to
have effective communication so that trust and confidence can be developed so that they
share their issues.
 S (Situation): This patient was admitted due to chronic heart failure. As per the history
that is identified is that, it is been 30 years since he has started smoking and consumed 1
cigarette/day. Further, his older brother died due to myocardial infarction (MI) and his
sister had 3 MI’s (Fraccarollo, Galuppo and Bauersachs, 2012). This show that the rate of
changes with respect of issues in relation with lungs is high. In addition to this, the
patient was complaining to have chest pain the next day when he was admitted. The rate
of blood pumped is very low due to which this has caused him get cardiogenic shock.
 B (Background): Due to complain that was done the next day for chest pain, chest x-ray
was taken. It was identified that he has developed pulmonary oedema. When further
examination was done, then he was confused, sweating, pale and centrally cyanosed
(Campbell and Suzuki, 2012). Further, there are certain meditation that were taken by the
patient due to which the rate of depression also raised. The meditation taken were Aspirin
7mgs PO mane, Atenolol 50mgs PO mane, Isosorbide mononitrate 30mgs PO nocte and
Lisinopril 10mgs PO mane.
 A (Assessment): As per the assessment made, by me, it can be stated that the patient is
going through serious condition of issues like chronic bronchitis. Further, the x-ray that
was taken of the patient it showed “bat wings”. It is important that proper care need to be
taken so that the rate of depression and shock can be reduced (Gardner, Bailie and
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Dowden, 2011). In addition to this, there is immediate steps to be taken for reducing the
pain in chest. It is important that proper steps need to be taken so that cardiogenic shock
as it can increase life threatening situation.
 R (Request): Patient should not be allowed to consume cigarettes. Further, meditation that
were previously given should also be stopped. Moreover, continuous oxygen supply need
to be given as patient complained for serious chest pain.
CONCLUSION
Nurses or any other care provides should understand the requirement of patients and
appropriate steps need to be taken for the issues that are faced by them. Patient need to be able to
able to develop trust and confidence among care providers and this enables to reduce the issues
at high extent.
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REFERENCES
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Intensive Care Unit. In Acute Care for Elders (pp. 233-244). Springer New York.
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