Cor pulmonale is characterized by right ventricular enlargement and failure secondary to pulmonary hypertension caused by diseases affecting lung structure or function. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and improving patient outcomes.
Causes (Related to)
Cor pulmonale can develop due to various underlying conditions:
- Primary Lung Diseases:
- Chronic Obstructive Pulmonary Disease (COPD)
- Pulmonary fibrosis
- Cystic fibrosis
- Bronchiectasis
- Vascular Disorders:
- Pulmonary embolism
- Pulmonary arterial hypertension
- Sleep apnea syndrome
- Other Contributing Factors:
- Obesity
- Chest wall deformities
- Chronic hypoxemia
- Smoking history
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Shortness of breath (dyspnea)
- Fatigue and weakness
- Chest pain or discomfort
- Dizziness
- Syncope
- Exercise intolerance
- Sleep disturbances
Objective: (Nurse assesses)
- Elevated jugular venous pressure
- Peripheral edema
- Hepatomegaly
- Ascites
- Cyanosis
- Right ventricular heave
- Decreased oxygen saturation
- Third heart sound (S3)
- Tachycardia
- Distended neck veins
Expected Outcomes
- The patient will maintain adequate oxygenation
- The patient will demonstrate reduced peripheral edema
- The patient will report improved exercise tolerance
- The patient will maintain stable vital signs
- The patient will demonstrate an understanding of the medication regimen
- The patient will verbalize understanding of the disease process
- The patient will maintain optimal weight
Nursing Assessment
Monitor Cardiopulmonary Status
- Assess vital signs
- Monitor oxygen saturation
- Evaluate breathing patterns
- Check for peripheral edema
- Assess activity tolerance
Evaluate Fluid Status
- Monitor daily weights
- Track intake and output
- Assess for edema
- Monitor electrolytes
- Check skin turgor
Assess Psychological Status
- Evaluate anxiety levels
- Check sleep patterns
- Assess coping mechanisms
- Monitor depression symptoms
- Evaluate support system
Nursing Care Plans
Nursing Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to right ventricular failure secondary to pulmonary hypertension as evidenced by dyspnea, fatigue, and decreased exercise tolerance.
Related Factors:
- Right ventricular dysfunction
- Increased pulmonary vascular resistance
- Chronic hypoxemia
- Fluid volume overload
Nursing Interventions and Rationales:
- Monitor vital signs and hemodynamics
Rationale: Identifies early signs of decompensation - Position patient to optimize cardiac function
Rationale: Reduces cardiac workload - Administer prescribed medications
Rationale: Improves cardiac function and reduces symptoms
Desired Outcomes
The patient will:
- Maintain stable vital signs
- Report decreased dyspnea
- Demonstrate improved exercise tolerance
Nursing Care Plan 2: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to ventilation-perfusion mismatch as evidenced by hypoxemia and dyspnea.
Related Factors:
- Altered blood flow
- Ventilation-perfusion imbalance
- Thickened alveolar membrane
- Right-to-left shunting
Nursing Interventions and Rationales:
- Monitor oxygen saturation continuously
Rationale: Ensures adequate oxygenation - Position for optimal breathing
Rationale: Improves ventilation - Administer oxygen therapy as prescribed
Rationale: Maintains adequate tissue oxygenation
Desired Outcomes
The patient will:
- Maintain oxygen saturation >92%
- Demonstrate improved breathing patterns
- Report decreased dyspnea
Nursing Care Plan 3: Excess Fluid Volume
Nursing Diagnosis Statement:
Excess Fluid Volume related to right-sided heart failure as evidenced by peripheral edema and increased jugular venous distention.
Related Factors:
- Decreased cardiac output
- Sodium retention
- Decreased plasma oncotic pressure
- Venous congestion
Nursing Interventions and Rationales:
- Monitor daily weights and intake/output
Rationale: Tracks fluid status - Administer diuretics as prescribed
Rationale: Promotes fluid elimination - Implement fluid restrictions as ordered
Rationale: Prevents fluid overload
Desired Outcomes
The patient will:
- Demonstrate decreased edema
- Maintain stable weight
- Show improved breathing patterns
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue and dyspnea on exertion.
Related Factors:
- Decreased cardiac output
- Impaired gas exchange
- Deconditioning
- Fatigue
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity level - Implement a graduated activity program
Rationale: Builds endurance safely - Teach energy conservation techniques
Rationale: Maximizes available energy
Desired Outcomes
The patient will:
- Demonstrate improved activity tolerance.
- Perform ADLs without excessive fatigue.
- Use energy conservation techniques
Nursing Care Plan 5: Knowledge Deficit
Nursing Diagnosis Statement:
Knowledge Deficit related to lack of information about cor pulmonale management as evidenced by verbalization of questions and misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Complexity of treatment regimen
- Language barriers
Nursing Interventions and Rationales:
- Provide disease process education
Rationale: Increases understanding and compliance - Teach medication management
Rationale: Ensures proper treatment adherence - Instruct on lifestyle modifications
Rationale: Promotes optimal health outcomes
Desired Outcomes
The patient will:
- Verbalize understanding of the disease process
- Demonstrate proper medication administration
- Implement recommended lifestyle changes
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.
- Aubry A, Paternot A, Vieillard-Baron A. Cœur pulmonaire [Cor pulmonale]. Rev Mal Respir. 2020 Mar;37(3):257-266. French. doi: 10.1016/j.rmr.2019.10.012. Epub 2020 Feb 19. PMID: 32088063.
- Leschke M, Wädlich A. Rechtsherzinsuffizienz und Cor pulmonale [Right heart failure and cor pulmonale]. Internist (Berl). 2007 Sep;48(9):948-60. German. doi: 10.1007/s00108-007-1902-1. PMID: 17628762.
- Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Weitzenblum E, Chaouat A. Cor pulmonale. Chron Respir Dis. 2009;6(3):177-85. doi: 10.1177/1479972309104664. PMID: 19643833.
