5 Nursing Care Plans for Decreased Cardiac Output
Cardiac output is defined as the amount of blood pumped by the heart for systemic circulation in one minute. It is measured in liters per minute, and it is dependent upon the heart rate and stroke volume.
The normal range for cardiac output is between 4 to 8 liters per minute. Decreased Cardiac Output is a nursing diagnosis that refers to the cardiac output level below 4 liters per minute.
The heart pumps blood to supply nutrients including oxygen to meet the body’s metabolic demands. In the case of decreased cardiac output, these demands are not met. This condition can lead to severe complications, including cardiac problems.
Signs and Symptoms of Decreased Cardiac Output
The following are the common signs and symptoms of decreased cardiac output:
- Weak, irregular pulse
- Chest pain
- Weight gain
Causes of Decreased Cardiac Output
There is no single cause for decreased cardiac output. This condition can occur due to several reasons which may include:
- Valvular heart disease
- Hypertension or hypotension
- Congenital heart defects
- Kidney diseases
- High cholesterol level
- Electrolyte imbalances
- Drug use
Nursing Care Plans for Decreased Cardiac Output
Nursing Care Plan 1
Congenital Heart Disease
Nursing Diagnosis: Decreased cardiac output related to structural heart defect secondary to atrial septal defect as evidenced by feeding difficulties
Desired Outcome: The patient will maintain or demonstrate improvement in cardiac output while waiting for treatment as evidenced by improved feeding ability.
|Monitor and record vital signs.||Vital signs measure the status of circulation and perfusion. Constant or sudden changes in the patient’s vital signs can signify unresolved or worsening condition. After treatment, the patient’s vital signs will also be a non-invasive way to evaluate the success of the procedure.|
|Assess the patient’s skin color, texture, temperature, and moisture.||tissue perfusion can be assessed through the patient’s skin. Decreased cardiac output can be manifested by cold, clammy, and pale skin. Also, if the patient has difficulty feeding, assessment of the skin’s moisture can help signify dehydration and can direct treatment to provide supplemental nutrition.|
|Encourage a relaxed and restful environment.||A relaxed and restful environment can help reduce the body’s metabolic requirement.|
|Provide supplemental oxygen as necessary.||A reduced cardiac output can cause a reduced delivery of oxygen in the systemic circulation. Oxygen supplementation may be required in some cases.|
|Position the patient in semi-fowler’s position as tolerated.||An upright position aids maximum lung expansion.|
|Administer supplemental nutrition as ordered.||Due to the reduced oxygen delivery in the system, the patient may experience easy fatiguability which can affect his/her ability to feed. The patient’s nutrition may be compromised and supplementation may be required.|
Nursing Care Plan 2
Heart Valve Disease
Nursing Diagnosis: Decreased cardiac output related to altered heart rate secondary to valvular heart disease as evidenced by a persistent heart rate of >120 bpm
Desired Outcome: The patient will demonstrate understanding of interventions to reduce cardiac workload.
|Assess and record the patient’s vital signs and oxygen saturation.||The patient’s vital signs are important markers to monitor the status of tissue perfusion which is directly affected by the cardiac output. The oxygen saturation can measure peripheral perfusion.|
|Assess the characteristics and presence of the patient’s peripheral pulses.||A decreased cardiac output can be manifested by weak peripheral pulses.|
|Monitor the patient’s urine output and commence the patient on a fluid balance chart.||The body compensates from decreased cardiac output by reabsorbing fluid from the renal tubules back into systemic circulation to increase blood volume.|
|Discuss the signs and symptoms of decreased cardiac output with the patient using easy-to-understand words.||The patient will need to understand his/her condition fully to promote compliance to the prescribed treatments.|
|Discuss ways to reduce oxygen requirements with the patient:Bed restPromote normal, regular breathingReduce unnecessary activitiesRequest for assistance with intensive activitiesSemi to high-fowler’s positionUse of bedside commodeElevation of legs||There are ways to reduce the body’s metabolic requirements. These will help the body to meet oxygen demand and minimize the serious effects of decreased cardiac output.|
|Allow time for questions from the patient.||The patient may have questions regarding his/her condition. Being available to answer questions can relieve his/her anxieties which will help promote relaxation.|
Nursing Care Plan 3
Nursing Diagnosis: Decreased cardiac output related to progressive dissection of the aorta secondary to aortic aneurysm
Desired Outcome: The patient will maintain adequate cardiac output as evidenced by stable vital signs and normal level of consciousness.
|Monitor and record the patient’s vital signs, oxygen saturation, urine output, and neurologic status.||The vital signs, oxygen saturation, and neurologic status measure the patient’s hemodynamic status. Fluctuating and severely high or low readings are critical markers for the urgency for interventions to be carried out.|
|Prepare the patient for surgical interventions.||The dissection of the aorta is a serious medical emergency that needs prompt treatment.|
|Collect blood samples for routine blood tests and crossmatching.||The patient may need blood transfusion to maintain adequate blood volume.|
|Administer medications and intravenous fluids as prescribed.||Patients with aortic dissection may need medications and additional fluid to support adequate blood volume.|
|Provide supplemental oxygenation.||Oxygen supplementation may be required to help the body meet the metabolic demand.|
Nursing Care Plan 4
Nursing Diagnosis: Decreased cardiac output secondary to increased vascular resistance as evidenced by high blood pressure level of 170/89, fatigue and inability to do ADLs as normal
Desired outcome: The patient will be able to regain adequate cardiac output.
|Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess heart 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. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer prescribed medications for acute coronary syndrome.||Aspirin – to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates – to relax the blood vessels. Anti-cholesterol drugs (e.g. statins) – to reduce the deposits on the arterial walls Beta blockers – to decrease the cardiac demand for oxygen by means of lowering the heart rate and blood pressure levels Calcium channel blockers – used in combination with beta blockers Ranolazine – to treat angina|
|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. Reducing stress is also an important aspect of dealing with fatigue.|
Nursing Care Plan 5
Beta Blocker Toxicity / Overdose
Nursing Diagnosis: Decreased cardiac output secondary to beta blocker toxicity as evidenced by respiratory rate of 10 cycles per minute (bradypnea), blood pressure level of 80/50 (hypotension), difficulty of breathing or shortness of breath, arrhythmia, excessive sweating, light-headedness and dizziness
Desired outcome: The patient will be able to regain adequate cardiac output.
|Attach the patient to a cardiac monitor and check vital signs at least every 15 to 30 minutes until stable.||To monitor the patient’s respiratory rate, heart rate, and blood pressure levels which are deranged due to beta blocker toxicity.|
|Perform first aid for beta blocker toxicity or overdose, which includes:Gastric lavage Administration of activated charcoal Administration of adrenaline||To reverse the side effects of beta blocker toxicity or overdose, the following should be done: Gastric lavage to eliminate the drug from the stomachAdministration of activated charcoal to avoid absorptionAdministration of adrenaline, which is an antidote, to counter the effects of the drug|
|Ask the patient questions on self-administration of beta blockers.||To verify whether the symptoms are due to overdose of beta blockers and to determine when the symptoms have begun. Exploring the cause may also inform the nurse why the overdose happened, as some patients may have done this for self-harm and therefore requires psychological and social support.|
|Do not abruptly stop beta blockers. Administer them in tapered doses as prescribed by the physician.||Beta blockers should not be discontinued abruptly as doing so may increase the likelihood of a heart attack and other cardiac problems.|
|Administer beta blockers ideally with meals and/or at bedtime.||To ensure optimal absorption and therapeutic action by beta blockers, as well as reduce possible side effects.|
|Administer beta blockers about 1 hour before or 2 hours after administering other oral medications, as prescribed.||Ideal spacing of beta blockers and other oral medications will ensure adequate absorption of the drugs administered.|
|Discourage intake of fish oil, grape juice, and orange juice with beta blockers.||Fish oil can enhance hypotensive effect of beta blockers. Grape juice and orange juice can affect the potency of the drugs.|
|Encourage tobacco smoking sensation and reduction of alcohol consumption.||Tobacco smoking and alcohol can reduce the benefits of beta blockers. Alcohol consumption must be avoided during the course of treatment, because alcohol can lower the blood pressure, increase dizziness, and pose the risk for sudden hypotension.|
|Encourage the patient to change position slowly.||To prevent orthostatic hypotension.|
|Advise the patient not to break or crush the medications, unless it is safe to do so.||Sustained release beta blocker tablets should not be broken or crushed as doing so may affect the potency of the drugs.|
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
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
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