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
- Heart Failure (both systolic and diastolic)
- Myocardial Infarction
- Valvular Heart Disease
- Dysrhythmias
- Hypovolemia
- Pulmonary Embolism
- Cardiac Tamponade
- Cardiomyopathy
- Septic Shock
- Severe Electrolyte Imbalances
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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