Decreased cardiac output is a serious clinical condition where the heart cannot pump enough blood to meet the body’s needs. This reduced output can lead to inadequate oxygen delivery to tissues, impaired organ function, and potentially life-threatening complications if untreated. For nurses, recognizing and managing decreased cardiac output is essential to prevent deterioration and improve patient outcomes.
Pathophysiology & Causes
Cardiac output (CO) is the amount of blood the heart pumps per minute. It is calculated as:
CO = Stroke Volume × Heart Rate
- Stroke Volume (SV): The amount of blood pumped with each heartbeat.
- Heart Rate (HR): The number of beats per minute.
When either SV or HR is significantly impaired, cardiac output drops.
Mechanisms leading to decreased CO include:
- Reduced preload – inadequate blood filling (e.g., hypovolemia, hemorrhage).
- Reduced contractility – weakened heart muscle (e.g., myocardial infarction, cardiomyopathy).
- Increased afterload – excessive resistance (e.g., hypertension, aortic stenosis).
- Heart rate abnormalities – too slow or too fast (e.g., bradycardia, tachyarrhythmias).
Common causes:
- Heart failure
- Myocardial infarction
- Cardiac arrhythmias (atrial fibrillation, ventricular tachycardia)
- Severe valvular disease
- Cardiomyopathy
- Cardiac tamponade
- Pulmonary embolism
- Shock states (septic, hypovolemic, cardiogenic)
Signs & Symptoms
Mild:
- Fatigue
- Dizziness on exertion
- Mild shortness of breath
- Palpitations
Moderate:
- Orthopnea (difficulty breathing when lying flat)
- Swelling in ankles and feet
- Cool, clammy skin
- Low urine output
Severe:
- Confusion or altered mental status
- Severe hypotension
- Cyanosis (bluish lips, nails)
- Pulmonary edema (pink frothy sputum)
- Weak or absent pulses
Nursing Assessment
Subjective Data:
- Patient reports fatigue, chest pain, or palpitations
- Shortness of breath on exertion or at rest
- Feeling faint or lightheaded
Objective Data:
- Low blood pressure
- Weak peripheral pulses
- Jugular venous distention
- Abnormal heart sounds (S3, S4, murmurs)
- Edema in extremities
- Decreased urine output
- ECG abnormalities
Nursing Diagnosis (NANDA-I 2024–2026)
Definition:
A state in which the heart is unable to pump sufficient blood to meet the metabolic needs of the body.
Related Factors:
- Altered heart rate or rhythm
- Altered contractility
- Increased afterload
- Decreased preload
Risk Factors:
- Cardiovascular disease history
- Electrolyte imbalance
- Myocardial damage
- Blood volume deficit
Defining Characteristics:
- Changes in blood pressure and heart rate
- Diminished peripheral pulses
- Dyspnea
- Fatigue
- Oliguria
Nursing Goals & Outcomes
Short-Term Goals:
- Maintain systolic BP within patient’s baseline range
- Reduce dyspnea within 24 hours
- Increase urine output to >30 mL/hour
Long-Term Goals:
- Maintain adequate cardiac output as evidenced by stable vital signs, warm extremities, and improved activity tolerance
- Prevent recurrence or worsening of decreased cardiac output
5 Nursing Care Plans with Rationales
Care Plan 1: Heart Failure
Assessment Data:
- Fatigue, dyspnea, peripheral edema, S3 heart sound
NANDA-I Diagnosis:
Decreased Cardiac Output related to impaired contractility secondary to heart failure
Related Factors:
- Myocardial weakness
Expected Outcomes:
- Patient maintains oxygen saturation >95%
- Patient reports reduced shortness of breath within 24 hours
Nursing Interventions & Rationales:
- Monitor vital signs and oxygen saturation – detects early signs of deterioration.
- Assess lung sounds for crackles – identifies pulmonary congestion.
- Administer prescribed diuretics – reduces fluid overload and preload.
- Position patient in semi-Fowler’s – facilitates lung expansion and reduces venous return.
- Encourage rest between activities – decreases myocardial oxygen demand.
Evaluation:
- Stable vital signs, improved breathing, reduced edema.
Care Plan 2: Myocardial Infarction
Assessment Data:
- Chest pain, hypotension, diaphoresis, ECG changes
NANDA-I Diagnosis:
Decreased Cardiac Output related to altered heart rhythm and contractility secondary to myocardial infarction
Related Factors:
- Myocardial tissue damage
Expected Outcomes:
- Maintain BP within target range
- Pain relief within 30 minutes after intervention
Interventions & Rationales:
- Continuous cardiac monitoring – detects dysrhythmias early.
- Administer oxygen – increases oxygen delivery to myocardium.
- Give prescribed beta-blockers – reduces heart workload.
- Monitor urine output – assesses renal perfusion.
- Prepare for possible advanced interventions – timely response to worsening status.
Evaluation:
- Pain resolved, stable rhythm, adequate BP.
Care Plan 3: Arrhythmia
Assessment Data:
- Irregular pulse, dizziness, palpitations
NANDA-I Diagnosis:
Decreased Cardiac Output related to altered heart rate secondary to arrhythmia
Related Factors:
- Abnormal electrical conduction
Expected Outcomes:
- Heart rate maintained within normal range
- No dizziness reported
Interventions & Rationales:
- Monitor ECG – identifies type and severity of arrhythmia.
- Administer antiarrhythmic medications as ordered – restores normal rhythm.
- Educate patient on avoiding stimulants – reduces arrhythmia risk.
- Assess for signs of decreased perfusion – early detection of complications.
Evaluation:
- Normal sinus rhythm maintained, improved symptoms.
Care Plan 4: Hypovolemia
Assessment Data:
- Hypotension, tachycardia, weak pulses
NANDA-I Diagnosis:
Decreased Cardiac Output related to decreased preload secondary to hypovolemia
Related Factors:
- Blood/fluid loss
Expected Outcomes:
- BP returns to baseline
- Adequate urine output restored
Interventions & Rationales:
- Monitor fluid balance – prevents further depletion.
- Administer IV fluids as ordered – restores preload and CO.
- Assess for bleeding – identifies source of loss.
- Monitor mental status – detects cerebral hypoperfusion.
Evaluation:
- Stable hemodynamics, improved perfusion.
Care Plan 5: Cardiomyopathy
Assessment Data:
- Fatigue, dyspnea, orthopnea
NANDA-I Diagnosis:
Decreased Cardiac Output related to impaired contractility secondary to cardiomyopathy
Related Factors:
- Myocardial structural abnormality
Expected Outcomes:
- Maintain oxygen saturation >94%
- Increase activity tolerance
Interventions & Rationales:
- Monitor daily weight – detects fluid retention early.
- Administer ACE inhibitors as ordered – reduces afterload.
- Encourage low-sodium diet – prevents fluid retention.
- Teach energy conservation techniques – preserves cardiac reserve.
Evaluation:
- Improved exercise tolerance, stable weight.
Patient Education
- Medication Adherence – Take medications exactly as prescribed.
- Diet – Limit salt and fluid intake as advised.
- Activity – Balance rest with light activity.
- Monitoring – Report sudden weight gain, swelling, or increased shortness of breath.
- Follow-Up – Attend all appointments for monitoring.
Image suggestion: Infographic showing “5 Key Self-Care Steps for Heart Health.”
References
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