Decreased Cardiac Output Nursing Diagnosis & Care Plan

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.

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
• Anaphylaxis
• Congenital heart defects
• Malnutrition
• Kidney diseases
• High cholesterol level
• Smoking
• Diabetes
• Electrolyte imbalances
• Drug use

Signs and Symptoms of Decreased Cardiac Output

The following are the common signs and symptoms of decreased cardiac output:

• Hypotension
• Fatigue
• Weakness
• Tachycardia
• Weak, irregular pulse
• Tachypnea
• Dizziness
• Confusion
• Fainting
• Chest pain
• Oliguria
• Edema
• Weight gain

Expected Outcomes

• The patient will maintain or demonstrate improvement in cardiac output while waiting for treatment as evidenced by improved feeding ability.

• The patient will demonstrate understanding of interventions to reduce cardiac workload.

• The patient will maintain adequate cardiac output as evidenced by stable vital signs and normal level of consciousness.

• The patient will be able to regain adequate cardiac output.

Nursing Assessment for Decreased Cardiac Output Nursing

Vital Signs: Assess for changes in blood pressure, heart rate, and respiratory rate. Rationale: Decreased cardiac output can lead to hypotension, tachycardia, and increased respiratory rate as compensatory mechanisms.

Heart Sounds: Listen for abnormal heart sounds, such as murmurs or gallops, which may indicate underlying cardiac dysfunction.

Peripheral Pulses: Check peripheral pulses for quality and strength. Weak or diminished pulses may suggest reduced blood flow due to decreased cardiac output.

Capillary Refill Time: Evaluate the capillary refill time by pressing on a nail bed or skin and observing the time it takes for color to return. Prolonged refill time may indicate poor perfusion and decreased cardiac output.

Skin Color and Temperature: Assess the skin color for pallor or cyanosis and check for cool or clammy skin, which can occur when cardiac output is reduced.

Urine Output: Monitor urine output as decreased cardiac output can affect renal perfusion, leading to decreased urine output.

Nursing Interventions for Decreased Cardiac Output

• Monitor and record vital signs. Rationale: 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. Rationale: 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.

• Monitor fluid balance closely and administer intravenous fluids as prescribed. Rationale: To optimize intravascular volume and maintain adequate cardiac preload.

• Administer medications as ordered, such as vasodilators, inotropes, diuretics, or beta-blockers. Rationale: To improve cardiac contractility, reduce afterload, or manage fluid volume.

• Encourage a relaxed and restful environment. Rationale: A relaxed and restful environment can help reduce the body’s metabolic requirement.

• Provide supplemental oxygen as ordered. Rationale: A reduced cardiac output can cause a reduced delivery of oxygen in the systemic circulation. Oxygen supplementation may be required in some cases.

• Discuss the signs and symptoms of decreased cardiac output with the patient using easy-to-understand words. Rationale: The patient will need to understand his/her condition fully to promote compliance to the prescribed treatments.

Decreased Cardiac Output Nursing Care Plan

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.

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.

Aortic Aneurysm

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.

Acute Coronary Syndrome

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.

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.

Sample Nursing Test Questions for Decreased Cardiac Output

Which assessment finding is consistent with decreased cardiac output?

a. Hypertension

b. Bradycardia

c. Increased urine output

d. Diminished peripheral pulses

Answer: d. Diminished peripheral pulses

Rationale: Decreased cardiac output can result in inadequate blood flow to the extremities, leading to diminished peripheral pulses.

2. A client with decreased cardiac output is at risk for impaired tissue perfusion. Which intervention should the nurse prioritize?

a. Administering prescribed medications

b. Encouraging physical activity

c. Monitoring vital signs

d. Providing emotional support

Answer: a. Administering prescribed medications

Rationale: Administering prescribed medications, such as inotropes or vasodilators, can help improve cardiac contractility and reduce afterload, ultimately improving tissue perfusion in clients with decreased cardiac output.

3. Which intervention is appropriate for a client with decreased cardiac output and signs of fluid overload?

a. Restricting fluid intake

b. Administering diuretics as prescribed

c. Elevating the legs

d. Encouraging high-sodium diet

Answer: b. Administering diuretics as prescribed

Rationale: Diuretics help reduce fluid volume overload by promoting diuresis and decreasing overall fluid retention, thereby improving cardiac function in clients with decreased cardiac output.

4. Which nursing action is essential in the immediate postoperative period for a client at risk for decreased cardiac output?

a. Administering pain medication as prescribed

b. Encouraging deep breathing and coughing exercises

c. Promoting a low-sodium diet

d. Monitoring peripheral edema

Answer: b. Encouraging deep breathing and coughing exercises

Rationale: Deep breathing and coughing exercises help prevent complications such as atelectasis and pneumonia, which can further compromise cardiac function and lead to decreased cardiac output.

5. A client with decreased cardiac output is experiencing anxiety. What nursing intervention is most appropriate?

a. Providing a quiet and calm environment

b. Encouraging increased fluid intake

c. Administering a beta-blocker as prescribed

d. Facilitating active range-of-motion exercises

Answer: a. Providing a quiet and calm environment

Rationale: Anxiety can increase sympathetic stimulation and heart rate, exacerbating decreased cardiac output. Providing a quiet and calm environment can help alleviate anxiety and promote relaxation.

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. 

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. 

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

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