Decreased Cardiac Output Nursing Diagnosis & Care Plan

Understanding and managing decreased cardiac output is crucial for nursing care. This comprehensive guide covers everything nurses need to know about this critical nursing diagnosis, from assessment to interventions and care planning.

What is Decreased Cardiac Output?

Decreased cardiac output occurs when the heart fails to pump sufficient blood to meet the body’s metabolic needs. Normal cardiac output ranges from 4-8 liters per minute, varying based on factors like physical activity, body size, and metabolic demands. Understanding this condition is essential for effective nursing care and patient outcomes.

Key Factors Affecting Cardiac Output

  • Preload: The volume of blood in the ventricles before contraction
  • Afterload: The resistance against which the heart must pump
  • Contractility: The heart muscle’s strength of contraction
  • Heart Rate: Number of contractions per minute

Common Causes

Clinical Manifestations

Cardiovascular Signs

  • Hypotension or hypertension
  • Tachycardia or bradycardia
  • Dysrhythmias
  • Weak or absent peripheral pulses
  • Decreased central venous pressure
  • Extended capillary refill time

Respiratory Signs

  • Dyspnea
  • Tachypnea
  • Orthopnea
  • Crackles in lung fields
  • Decreased oxygen saturation

Neurological Signs

  • Altered mental status
  • Confusion
  • Restlessness
  • Dizziness
  • Syncope

Other Signs

  • Oliguria
  • Cool, clammy skin
  • Fatigue
  • Weakness
  • Decreased exercise tolerance
  • Peripheral edema

Nursing Assessment

Primary Assessment

Vital Signs Monitoring

  • Blood pressure trends
  • Heart rate and rhythm
  • Respiratory rate and pattern
  • Temperature
  • Oxygen saturation

Cardiovascular Assessment

  • Heart sounds
  • Peripheral pulses
  • Capillary refill
  • Presence of edema
  • Jugular vein distention

Respiratory Assessment

  • Breath sounds
  • Work of breathing
  • Use of accessory muscles
  • Presence of cough

Secondary Assessment

Laboratory Values

  • Complete blood count
  • Basic metabolic panel
  • Cardiac enzymes
  • Brain natriuretic peptide (BNP)
  • Arterial blood gases

Diagnostic Tests

  • 12-lead ECG
  • Chest X-ray
  • Echocardiogram results
  • Cardiac catheterization findings

General Nursing Interventions

Hemodynamic Monitoring

  • Continuous cardiac monitoring
  • Regular vital signs assessment
  • Central venous pressure monitoring when indicated
  • Pulmonary artery pressure monitoring if ordered

Oxygenation Support

  • Oxygen administration as prescribed
  • Position optimization
  • Regular pulse oximetry monitoring

Activity Management

  • Activity restriction during the acute phase
  • Graduated activity progression
  • Energy conservation techniques
  • Physical therapy collaboration

Medication Administration

  • Cardiac medications
  • Anticoagulants
  • Diuretics
  • Pain management

Patient Education

  • Disease process
  • Medication compliance
  • Lifestyle modifications
  • Warning signs and symptoms
  • Follow-up care

Nursing Care Plans

Care Plan 1: Acute Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased cardiac output related to reduced contractility secondary to acute myocardial infarction as evidenced by hypotension, tachycardia, and decreased peripheral perfusion.

Related Factors/Causes:

  • Myocardial damage
  • Reduced ejection fraction
  • Altered preload/afterload
  • Pain and anxiety

Nursing Interventions and Rationales:

Monitor vital signs every 15 minutes until stable

  • Rationale: Early detection of deterioration

Maintain continuous cardiac monitoring

  • Rationale: Identify life-threatening arrhythmias

Administer prescribed medications

  • Rationale: Improve cardiac function and reduce workload

Position patient in semi-Fowler’s position

  • Rationale: Optimize respiratory function and reduce cardiac work

Desired Outcomes:

  • Stable vital signs within the target range
  • Improved peripheral perfusion
  • Reduced work of breathing
  • Absence of chest pain

Care Plan 2: Chronic Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased cardiac output related to altered contractility secondary to chronic heart failure as evidenced by fatigue, exercise intolerance, and peripheral edema.

Related Factors/Causes:

  • Ventricular remodeling
  • Chronic volume overload
  • Medication non-compliance
  • Poor dietary choices

Nursing Interventions and Rationales:

Implement fluid restriction

  • Rationale: Prevent volume overload

Monitor daily weights

  • Rationale: Track fluid status

Provide progressive activity planning

  • Rationale: Build exercise tolerance safely

Teach medication management

  • Rationale: Improve compliance and outcomes

Desired Outcomes:

  • Maintained optimal fluid balance
  • Improved activity tolerance
  • Enhanced medication compliance
  • Reduced symptoms

Care Plan 3: Decreased Cardiac Output with Arrhythmia

Nursing Diagnosis Statement:
Decreased cardiac output related to irregular heart rhythm secondary to atrial fibrillation as evidenced by palpitations, dizziness, and fatigue.

Related Factors/Causes:

  • Electrical conduction abnormalities
  • Structural heart changes
  • Electrolyte imbalances
  • Medication effects

Nursing Interventions and Rationales:

Maintain continuous rhythm monitoring

  • Rationale: Track rhythm changes and response to treatment

Administer anticoagulation as ordered

  • Rationale: Prevent thromboembolism

Monitor electrolyte levels

  • Rationale: Prevent worsening arrhythmias

Provide fall prevention measures

  • Rationale: Protect against injury due to dizziness

Desired Outcomes:

  • Rate control achieved
  • No thromboembolic complications
  • Improved symptom management
  • Safe mobility maintained

Care Plan 4: Post-operative Decreased Cardiac Output

Nursing Diagnosis Statement:
Decreased cardiac output related to altered preload secondary to post-operative bleeding as evidenced by tachycardia, decreased blood pressure, and reduced urine output.

Related Factors/Causes:

  • Surgical blood loss
  • Fluid shifts
  • Pain
  • Mechanical ventilation

Nursing Interventions and Rationales:

Monitor surgical site drainage

  • Rationale: Early detection of excessive bleeding

Maintain strict I&O records

  • Rationale: Track fluid balance

Administer blood products as ordered

  • Rationale: Replace volume losses

Monitor hemodynamic parameters

  • Rationale: Guide fluid replacement

Desired Outcomes:

  • Stabilized hemodynamics
  • Adequate urine output
  • Normalized hemoglobin/hematocrit
  • Pain control achieved

Care Plan 5: Decreased Cardiac Output with Cardiogenic Shock

Nursing Diagnosis Statement:
Decreased cardiac output related to pump failure secondary to cardiogenic shock as evidenced by hypotension, altered mental status, and poor tissue perfusion.

Related Factors/Causes:

  • Severe myocardial dysfunction
  • Mechanical complications
  • Medication-induced hypotension
  • Multiple organ dysfunction

Nursing Interventions and Rationales:

Implement emergency protocols

  • Rationale: Rapid response to critical situation

Assist with mechanical support devices

  • Rationale: Maintain tissue perfusion

Administer vasopressors as ordered

  • Rationale: Support blood pressure

Monitor end-organ function

  • Rationale: Assess treatment effectiveness

Desired Outcomes:

  • Stabilized blood pressure
  • Improved mental status
  • Enhanced tissue perfusion
  • Preserved organ function

References

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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.