Question

A nurse is assisting with the care of a client who has developed cardiogenic shock. When evaluating circulation to the client’s brain, which of the following pulse sites should the nurse use?

a.	Femoral
b.	Carotid
c.	Popliteal
d.	Radial

Answer 1

Answer : Carotid.

Reason: Cardiogenic shock is a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion. It is characterized by a low cardiac output state of circulatory failure that results in end organ hypoperfusion and tissue hypoxia.

PATHOPHYSIOLOGY:-

Ischemia to the myocardium ===> Derangement to the ventricular function ===> reduced cardiac output and low blood pressure ===> coronary ischemia amd impairement of contractility.

all of this leads to:-

1. Peripheral vasoconstriction which may improve coronary perfusion at the cost of increased afterload.
2. Tachycardia which increases myocardial oxygen demand and subsequently worsens myocardial ischemia.

SYMPTOMS OBSERVED:-

1. Peripheral pulses are faint, rapid and sometimes irregular if there is an underlying arrhythemia.
2. Peripheral edema may be present in the setting of fluid overload.

hence, as Radial, Popliteal and Femoral pulse sites are peripheral and due to cardiogenic shock, pulses at these sites will be faint, irregular, so we can understand that due to hypoperfusion of the tissues evaluation of circulation to the client's brain wiil be best evaluated at the carotid pulse site.