Cor pulmonale

Cor pulmonale Nursing Care Plans Diagnosis and Interventions

Cor pulmonale NCLEX Review Care Plans

Nursing Study Guide on Cor Pulmonale

Cor pulmonale is a medical condition characterized by the enlargement of the right ventricle of the heart, leading to its failure.

It is typically caused by a lung disorder. Also, it is oftentimes referred to as right-sided heart failure due to its location.

Cor pulmonale results to less effective pumping of blood into the systems of the body, which then causes a cascade of symptoms.

Many cases of cor pulmonale are long-term; however, some cases are only acute and can be reversed.

It is usually diagnosed through echocardiography, and treatment is directed as to what caused the disease.

Early management is necessary to avoid structural changes in the heart to become irreversible.

Signs and Symptoms of Cor Pulmonale

Cor pulmonale may be asymptomatic at first due to it occurring as a secondary illness.

Most manifestations are similar or are the same as the main illness. Signs and symptoms may include the following:

  • Shortness of breath
  • Feeling of tiredness
  • High or increased heart rate
  • Feeling of light-headedness
  • Chest pain
  • Swelling of the legs or feet
  • Fainting
  • Excessive coughing
  • Wheezing noise when breathing
  • Exertion fatigue
  • Distended jugular veins
  • Hepatomegaly – the enlargement of the liver

Causes of Cor Pulmonale

Cor pulmonale can be caused by several conditions that are mostly related to the lungs.

Any disease that results to pulmonary hypertension or high blood pressure in the arteries of the lungs can cause strain on the right side of the heart, therefore leading to cor pulmonale.

The following are the common conditions that can result to cor pulmonale:

Acute Cor Pulmonale

Chronic Cor Pulmonale

  • Chronic Cor Pulmonale
  • Chronic obstructive pulmonary disease (COPD)
  • Extensive loss of lung tissue due to surgery or trauma
  • Unresolved pulmonary emboli
  • Systemic sclerosis
  • Pulmonary interstitial fibrosis
  • Kyphoscoliosis
  • Obesity
  • Neuromuscular disorder with respiratory muscles involvement
  • Idiopathic alveolar hypotension
  • Sleep apnea

Complications of Cor Pulmonale

Shock, severe fluid retention, and life-threatening dyspnea can occur due to progressive pulmonary hypertension related to cor pulmonale.

These are particularly dangerous if the disease is not addressed immediately.

Diagnosis of Cor Pulmonale

Diagnosing cor pulmonale can sometimes be tricky.

The signs and symptoms associated with the disease are oftentimes the same as the cause of the disease.

However, diagnosing cor pulmonale is not impossible. The following steps are included in the diagnosis of the disease:

  • Physical exam and medical history taking – both the medical history and physical exam will give important information regarding the presence of cor pulmonale and its possible cause.
  • Blood tests – a series of blood testing is required to check for antibody levels and presence of brain natriuretic peptide which is an amino acid secreted by the heart when it is under stress.
  • Echocardiogram – this diagnostic technique is important in the diagnosis of cor pulmonale. It will help in the evaluation of the right and left ventricular functions. It can also assess the right ventricular pressure however it is quite limited in assessing pulmonary function.
  • Chest X ray – this form of imaging can present right ventricular enlargement and proximal pulmonary artery enlargement which can help physicians suspect of the presence of cor pulmonale. 
  • Electrocardiography – ECG tracings can provide evidence of right ventricular hypertrophy.
  • CT scan of the chest – a scan of the chest can help detect lung problems including the presence of blood clots.
  • Lung function tests – this can help evaluate how well the lungs function.
  • Right heart catheterization – this procedure includes the insertion of a small catheter into an artery towards the coronary arteries. Images are then taken while a contrast dye is injected.
  • Biopsy – a small tissue sample of the lungs is rarely needed to assess an underlying lung problem.

Treatment of Cor Pulmonale

The treatment of cor pulmonale is directed towards the cause of the disease.

In cases of chronic cor pulmonale, a palliative approach is often done.

This involves interventions depending on the signs and symptoms. In general, interventions include the following:

1. Medication. The use of medications to treat and reduce pulmonary hypertension may be required.
  • Diuretics. The use of diuretics to avoid fluid retention and maintain a normal sodium level is also often done. This is particularly helpful in the presence of peripheral edema in the presence of left ventricular failure and pulmonary fluid overload. Diuretics should be prescribed with caution as a small decrease in the preload or the stretching of the cardiac muscles can worsen cor pulmonale.
  • Blood thinners. These drugs may also be used to avoid blood clots specially in patients with chronic cor pulmonale.
  • Vasodilators. These medications can help improve the blood flow by widening the blood vessels in the heart and lungs.
2. Oxygen therapy. Oxygen support can also be given if saturation levels fail to stay in normal levels.
3. Organ transplant. Severe cases of cor pulmonale may require heart or lung transplant.

Nursing Care Plans for Cor Pulmonale

Nursing Care Plan 1

Nursing Diagnosis: Decreased Cardiac Output related to increased pulmonary blood pressure and subsequent increase in pulmonary resistance resulting to cor pulmonale, as evidenced by irregular heartbeat, heart rate of 128, dyspnea upon exertion, leg edema, ECG showing right ventricular hypertrophy, and fatigue

Desired outcome: The patient will be able to maintain adequate cardiac output.

InterventionsRationales
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer the cardiac medications and diuretics as prescribed.  To alleviate the symptoms of cor pulmonale and heart failure and to treat the underlying condition.  
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels.

Nursing Care Plan 2

Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures as evidenced by shortness of breath, SpO2 level of 85%, and crackles upon auscultation.

Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Encourage small but frequent meals.To avoid abdominal distention and diaphragm elevation which lead to a decrease in lung capacity.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 3

Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand resulting to COPD-related chronic cor pulmonale, as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.To gradually increase the patient’s tolerance to physical activity. To prevent exacerbation of COPD by allowing the patient to pace activity versus rest.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.

Nursing Care Plan 4

Nursing Diagnosis: Risk for Shock (Cardiogenic)

Desired Outcome: The patient with establish normal vital signs, balanced input and output, and usual mentation.

InterventionsRationales
Place the patient on continuous vital signs monitor. Assess and monitor for any signs of impending cardiogenic shock or heart attack.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment or worsening of illness.
Start strict input and output monitoring. Measure the urine output hourly.Decreased urinary output is a sign of diminished renal perfusion, indicating damage to the kidneys.
Assess for changes of level of consciousness/ mentation.Decreasing level of consciousness indicate diminished cerebral perfusion and/or hypoxemia.
Administer intravenous fluid therapy.  To facilitate effective tissue perfusion and maintain circulatory blood volume.  
Administer the cardiac medications and diuretics as prescribed.  To alleviate the symptoms of cor pulmonale and heart failure and to treat the underlying condition.  
Place the patient on bed rest. Assist him/her with important activities of daily living or ADLs.To decrease myocardial workload and oxygen consumption.
Strongly encourage the patient to join a smoking cessation program.Smoking increases the risk for cardiogenic shock and myocardial infarction, especially in cases of cor pulmonale.

Other nursing diagnoses:

  • Fatigue
  • Ineffective Breathing Pattern
  • Risk for Shock
  • Powerlessness

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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