Decreased Cardiac Output
Inadequate blood pumped by the heart to meet metabolic demands of the body
• Altered heart rate and rhythm
• Abnormal heart rate response to activity
• Arrhythmias, palpitations, electrocardiographic changes
• Abnormal chest x-rays and cardiac enzymes
• Electrocardiographic changes reﬂecting ischemia
• Exertional discomfort
• Exertional dyspnea
• Verbal report of fatigue
• Verbal report of weakness
• Altered afterload
• Altered heart rhythm
• Altered contractility
• Altered preload
• Altered heart rate
• Altered stroke volume
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Cardiac function
• Respiratory function
• Fluid and electrolytes
The patient will
• Maintain pulse within predetermined limits.
• Maintain blood pressure within predetermined limits.
• Exhibit no arrhythmias.
• Maintain warm and dry skin.
• Exhibit no pedal edema.
• Maintain acceptable cardiac output.
• Verbalize understanding of reportable signs and symptoms.
• Understand diet, medication regimen, and prescribed activity level.
SUGGESTED NOC OUTCOMES
Cardiac Pump Effectiveness; Circulation Status; Tissue Perfusion:
Peripheral; Vital Signs
INTERVENTIONS AND RATIONALES
Determine: Monitor patient at least every 4 hr for irregularities in
heart rate, rhythm, dyspnea, fatigue, crackles in lungs, jugular venous
distension, or chest pain. Any or all of these may indicate impending
cardiac failure or other complications. Report changes immediately.
Perform: Administer oxygen as ordered to increase supply to
Turn and reposition patient at least every 2 hr. Establish a turning
schedule for the dependent patient. Post schedule at bedside and
monitor frequency. Turning and repositioning prevent skin
breakdown and improve lung expansion and prevent atelectasis.
Administer antiarrhythmic drugs, as ordered, to reduce or elimi-
nate rhythm disturbances. Monitor for adverse effects.
Administer stool softeners, as prescribed, to reduce straining dur-
ing bowel movements.
Measure and record intake and output. Decreased urinary output
without decreased ﬂuid intake may indicate decreased renal
perfusion resulting from decreased cardiac output.
Weigh patient daily before breakfast to detect ﬂuid retention.
Perform active or passive ROM exercises to all extremities every
2–4 hr. ROM exercises foster muscle strength and tone, maintain
joint mobility, and prevent contractures.
Inspect legs and feet for pedal edema.
Maintain dietary restrictions, as ordered, to prevent ﬂuid
retention, dehydration, weight gain or loss.
Gradually increase levels of activity within prescribed limits of
cardiac rate to allow heart to adjust to increased cardiac demands.
Inform: Educate patient and his or her family about chest pain and
other reportable symptoms, prescribed diet, medications (name,
dosage, frequency, and therapeutic and adverse effects), prescribed
activity level, simple methods of lifting and bending, and stress-
reduction techniques. Education promotes remembering of and com-
pliance with techniques to reduce energy consumption.
Attend: Provide emotional support and encouragement to help
improve patient’s self-concept.
Involve patient in planning and decision making. Having the ability to
participate will encourage greater compliance with the plan of treatment.
Have patient perform self-care activities. Begin slowly and increase
daily, as tolerated. Performing self-care activities will assist patient
to regain independence and enhance self-esteem.
Manage: Refer to case manager/social worker to ensure that a home
assessment has been done and that whatever modiﬁcations are
needed to accommodate the patient’s ongoing care have been made.
Refer to cardiac program for exercise when the time is appropriate.
SUGGESTED NIC INTERVENTIONS
Cardiac Precautions; Circulatory Precautions; Fluid Management;
Homodynamic Regulation; Vital Signs Monitoring
Kodiath, K., et al. (2005). Improving quality of life in patients with heart failure:
An innovative behavioral intervention. Journal of Cardiovascular Nursing,