Nursing diagnosis – decreased cardiac output

Decreased Cardiac Output

DEFINITION

Inadequate blood pumped by the heart to meet metabolic demands of the body

DEFINING CHARACTERISTICS

• 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

• Crackles

• Cough

• Anxiety/restlessness

RELATED FACTORS

• Altered afterload

• Altered heart rhythm

• Altered contractility

• Altered preload

• Altered heart rate

• Altered stroke volume

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Cardiac function

• Activity/exercise

• Respiratory function

• Fluid and electrolytes

EXPECTED OUTCOMES

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

myocardium.

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

Reference

Kodiath, K., et al. (2005). Improving quality of life in patients with heart failure:

An innovative behavioral intervention. Journal of Cardiovascular Nursing,
20(1), 43–48.

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