Impaired Cardiovascular Function Nursing Care Plans Diagnosis and Interventions
Impaired Cardiovascular Function NCLEX Review and Nursing Care Plans
An impaired cardiovascular function is usually associated with pre-existing diseases and cardiovascular disorders, most notably atherosclerosis, affecting both the heart and blood vessels.
It induces changes in cardiovascular function, affects hemodynamics, and may cause injury and damage to other body systems.
Anatomy and Physiology of the Cardiovascular System
Heart. Situated in the mediastinum (space between the lungs) that approximately weighs 7 to 15 ounces in adults. It circulates blood throughout the body and controls blood pressure, rate, and rhythm of heart rate. The heart contains the following structures:
- Four chambers. The right atrium receives deoxygenated blood and transports it to the right ventricle, which then carries the oxygen-poor blood to the lungs for oxygenation. The left atrium then pumps oxygen-rich blood to the left ventricle, which delivers the blood throughout the body.
- Four valves. The heart valves consist of the tricuspid, mitral, pulmonary, and aortic valves. The tricuspid valve is located between the right atrium and right ventricle. It regulates and separates the opening between the atrium and ventricle. Similarly, the mitral valve controls blood flow between the left atria and left ventricle. The semilunar valves (aortic valve and pulmonary valve) restrict the backflow of blood so oxygenated and deoxygenated blood don’t cross.
- Heart walls. Composed of three layers: (1) the endocardium as the innermost layer, (2) the myocardium as the central portion, and (3) the epicardium as the heart’s protective sac.
Blood vessels. Consist of three types: (1) Arteries that carry oxygenated blood away from the heart (except pulmonary arteries), (2) Capillaries which connect the arteries and veins, facilitating the exchange of oxygen-rich and poor blood, and (3) veins that carry deoxygenated blood towards the heart.
Signs and Symptoms of Impaired Cardiovascular Function
- fatigue
- diaphoresis
- dyspnea
- dysrhythmias
- chest pain
- sweating
- lightheadedness
- palpitations
- heart murmur
- heartburn
- lethargy
- nausea or vomiting
- edema
- activity intolerance
- confusion
- slurred speech
- severe headache
- fainting
Diseases Related to Impaired Cardiovascular Function
- Diseases of the Cardiac Muscles
- Congenital heart disease (CHD). A genetic defect that causes structural or functional cardiac dysfunction.
- Heart failure (HF). A chronic condition wherein the heart cannot contract, relax, or pump blood normally to meet the demands of the body.
- Angina. Caused by the inadequate supply of oxygenated blood to the heart.
- Arrhythmia. A condition caused by a defect in the heart’s conduction system, resulting in an abnormal heart rate and rhythm.
- Atrial fibrillation. Marked by an abnormal rhythm in the atria. This condition is also associated with an increased risk of stroke.
- Dilated cardiomyopathy. This type of heart failure causes the heart’s chambers to thin and expand, making it difficult for the heart to pump blood properly.
- Pulmonary stenosis. Occurs when the pulmonary valve obstructs or restricts blood flow from the right ventricle to the pulmonary arteries (which carry deoxygenated blood to the lungs). As a result, the right ventricle pumps blood more vigorously, causing cardiac muscle damage over time.
- Mitral valve prolapse. Type of cardiac valve disease where a portion of the mitral valve protrudes backward into the left atrium, causing backflow of blood and mitral regurgitation.
- Hypertrophic cardiomyopathy. A congenital cardiovascular disease that results in the thickening (hypertrophy) of the heart’s muscles, causing electrical instability and a decreased ability to pump blood.
- Aortic stenosis. Occurs when the heart valve doesn’t open fully, reducing blood flow from the heart and into the rest of the body.
- Rheumatic heart disease (RHD). A disorder in which inflammation of the heart impairs the integrity of the heart valves. It is commonly a complication of untreated or inadequately managed streptococcal infection.
- Coronary artery disease (CAD). A disease that affects the arteries (via occlusion or plaque) that supplies oxygen-rich blood to the heart muscles.
- Vascular Diseases
- Aneurysm. Characterized by an abnormal swelling, enlargement, or bulging in the wall of a blood vessel (due to weakening), which can rupture and cause bleeding.
- Ischemic stroke. Associated with the formation of blood clots in the artery leading to the brain, resulting in diminished blood flow.
- Peripheral artery disease. Caused by the buildup of plaques in the arteries resulting in constriction or obstruction of the blood vessels that supply blood to the lower extremities.
- Raynaud’s disease. A condition that causes spasms in the arteries, disrupting the blood supply to certain body parts, notably the fingers and toes.
- Blood clotting disorders (e.g., hemophilia, von Willebrand disease). Increase the chance of blood clot formation.
- Peripheral venous disease. A circulatory disorder marked by constriction, obstruction, or spasm of the blood arteries that return blood from the extremities to the heart.
- Atherosclerosis. Caused by the accumulation of fatty plaque, thereby inhibiting oxygen-rich blood flow.
- Venous thromboembolism. Occurs when a detached thrombus or blood clot enters the pulmonary circulation.
- Superior vena cava syndrome (SVCS). Occurs when the superior vena cava is continuously obstructed, resulting in venous distention and decreased blood flow to the upper extremities and head.
Causes of Impaired Cardiovascular Function
- Pre-existing cardiovascular disease (CVD). Predisposition to CVD (e.g., RHD, HF, CAD), whether inherited or acquired, is a pre-condition for cardiovascular events. It affects the heart and blood vessel system, resulting in substantial cardiovascular system dysfunction. Structural defects may also cause impaired cardiovascular function. Abnormal cardiac valves due to infections (e.g., myocarditis, endocarditis) or birth defects (congenital heart disease) can impair their control and prevent them from opening and closing normally. This would impede regular blood flow, thereby increasing the heart’s workload. Other diseases contributing to CVD include:
- Cardiomyopathy – a condition of the cardiac muscle that impairs the heart’s ability to properly pump blood to the rest of the body
- Congenital heart deficits
- Severe anemia – causes increased heart rate and increased cardiac workload due to insufficient red blood cells
- Viral infections
- High cholesterol – causes a buildup of plaque in the walls of arteries
- Hyperthyroidism
- Hypertension
- Autoimmune conditions
- Underlying conditions. Diseases such as diabetes and anemia can impair the circulatory system. Diabetes causes an increase in blood sugar levels, which weakens and narrows blood vessels. Patients with this condition are at risk of developing heart failure, hypertension, and atherosclerosis. Moreover, diabetic individuals may suffer from obesity, a risk factor for impaired cardiovascular function and CVDs.
Risk Factors to Impaired Cardiovascular Function
- Age
- Obesity
- Sedentary lifestyle
- Inactivity
- Hypercholesterolemia
- Genetics
- Stress
- Smoking
- Alcohol use
Diagnosis of Impaired Cardiovascular Function
- Chest x-ray examination. Used to assess the function of the heart and chest wall. It may reveal cardiomegaly and Kerley B lines, both of which are indicative of heart failure. It can also be used to aid in the diagnosis of several cardiovascular symptoms, including shortness of breath, persistent cough, fever, chest pain, and damage.
- Electrocardiogram (ECG). Identifies dynamic alterations in the presence of ischemia, hypertrophy of the left ventricle, conduction abnormalities, and arrhythmias. It may also signal the presence of coronary artery diseases. When an ECG is conducted on a patient with chest discomfort, an ST-segment spike or depression higher than 0.05 mV in leads over the ischemia zone may be observed.
Other indications include detection of myocardial injury, rheumatic heart disease, assessment of blunt cardiac trauma, perioperative anesthesia, exclusion of cardiomyopathy, and investigation of signs and symptoms of cardiac diseases, such as shock, hypotension, syncope, hypothermia, tachycardia, bradycardia, hypertension, and murmur. In addition, it can detect defibrillator and pacemaker malfunctions, validate arrhythmia analyses, and monitor adverse drug reactions.
- Echocardiogram. Most commonly utilized to evaluate the ventricular function, wall motion, valve function, left and right-sided systolic performance, presence of thrombus, pericardial effusion, and ejection fraction. In order to determine the level of ventricular synchrony and the efficacy of ventricular resynchronization therapy, tissue doppler echocardiography can be used.
- Electrolyte panel. Affected by a variety of cardiac and renal problems. Calcium, phosphorus, magnesium, and sodium levels that are above or below the normal reference range can cause or contribute to arrhythmias and cardiac arrests. Therefore, continuous monitoring is necessary to prevent cardiac arrest caused by dysrhythmias. In addition, both hyperkalemia and hypokalemia result in substantial cardiac conduction problems.
- Left ventricular ejection fraction (LVEF). Determines the amount of blood expelled by the left ventricle during each contraction. The normal ejection fraction of the heart, or LVEF, is between 50 and 70 percent. Less than 40 percent ejection fraction (systolic dysfunction) implies decreased myocardial contractility, and anything below this signals an increased risk for heart failure and dysrhythmias.
- Exercise stress testing. Determines the cardiac response to physical activity and exercise. Exercise and intravenous pharmacological stimulation both trigger the stress response. This test is employed for the identification of premature ventricular contraction and aids in the evaluation of exercise capacity in patients with valvular heart disease. Other indications include myocardial ischemia-related symptoms, coronary revascularization, and cardiac arrhythmias. Readings of the patient’s ECG and blood pressure are taken during the test as the patient walks on a treadmill or cycles a stationary bicycle in order to observe their reaction to a constant or rising exertion.
Treatment for Impaired Cardiovascular Function
- Stent
- Cholesterol-lowering medications
- By-pass surgery. Blood vessels are taken from a limb and stitched to the heart to reroute (shunt) blood around a blocked artery.
- Cardiac transplant
- Cardiac rehab. Utilizes a controlled exercise regimen to strengthen the heart.
- Angioplasty. Involves catheterization, which compresses the plaque against the vessel wall.
- Artificial heart placement/operation
- Heart valve repair/replacement
Prevention of Impaired Cardiovascular Function
- Smoking cessation
- Dietary adjustments, including sodium and cholesterol intake reductions
- Alcohol cessation or moderation in alcohol consumption
- Regular exercise
- Seek prompt medical treatment for underlying conditions
Impaired Cardiovascular Function Nursing Diagnosis
Impaired Cardiovascular Function Nursing Care Plan 1
Nursing Diagnosis: Decreased cardiac output related to compromised regulatory mechanisms, secondary to impaired cardiovascular function, as evidenced by angina, changes in the level of consciousness, dysrhythmias, fatigue, hypotension, tachycardia, and restlessness.
Desired Outcome: The patient will exhibit an increase in cardiac output as shown by normal blood pressure, pulse rate, and rhythm, with the absence of dyspnea and angina.
| Nursing Interventions for Risk for Impaired Cardiovascular Function | Rationale |
| Take the patient’s heart rate (HR) and blood pressure (BP). Examine for any indications of reduced cardiac output. | Hypotension leads to a decrease in cardiac output, which results in compensatory tachycardia. Additional symptoms of decreased cardiac output include prolonged palpitations, angina, shortness of breath, a weak and rapid pulse, dizziness, and syncope. |
| Assess the patient’s peripheral pulses and capillary refill test. | Reduced stroke volume and cardiac output are associated with weak pulses, while capillary refill is slow or nonexistent. These assessments demonstrate the integrity of peripheral perfusion. Symptoms such as decreased urine output, pallor or cyanosis, and decreased amplitude of pulses should be reported immediately for prompt treatment. |
| Auscultate abnormal heart sounds (e.g., gallops). | An increase in the S3 heart sound or triple rhythm in diastole (gallop) in conjunction with hypertension, cackles, and tachycardia may be indicative of impending heart failure. Severe heart failure or fatal arrhythmias can be caused by a lower-than-normal ejection fraction of the left ventricle. |
| Review the patient’s cardiac status and install a cardiac monitor or telemetry to detect dysrhythmias and atrial fibrillation. | Thrombus formation is a common consequence of atrial fibrillation, which happens when there is an irregular blood flow within the heart chamber. |
| Assess reports of chest pain, and if present, quickly recline the patient. Monitor the patient’s heart rhythm and, if necessary, offer oxygen and pain medications. | Complaints of chest pain or discomfort may signal the onset of pulmonary edema or heart failure. Angina-like symptoms may indicate myocardial ischemia and should be reported immediately to a physician. Moreover, these measures can enhance patient prognosis by increasing oxygen delivery to the coronary arteries. This will also prevent heart failure from progressing to cardiac arrest. |
| Balance activity with sufficient rest and maintain adequate ventilation by positioning the patient in semi-Fowler’s to high-Fowler’s. | Rest reduces the cardiac workload. It is advised to assume an upright position to minimize preload and ventricular filling. In contrast, the supine position improves ventricular function by enhancing venous return and promoting diuresis. |
Impaired Cardiovascular Function Nursing Care Plan 2
Nursing Diagnosis: Acute Pain related to reduced myocardial blood flow, secondary to impaired cardiovascular function, as evidenced by disruptive conduct, varying frequency, length, and intensity of reported pain, alterations in autonomic responses, and narrowed focus.
Desired Outcome: The patient will demonstrate pain reduction as shown by stable vital signs.
| Nursing Interventions for Risk for Impaired Cardiovascular Function | Rationale |
| Determine the location and character of pain. Record intensity on a subjective scale from 0 to 10. | This assessment records the intensity, character, precipitant, and pattern of pain for subsequent comparisons. Pain that is intolerable may trigger a vasovagal response, leading to a decline in BP and HR. |
| Instruct the patient to promptly notify the nurse of any chest pain. | Pain and decreased cardiac output may result in stimulation of the sympathetic nervous system (SNS) or sympathetic activity. Increased SNS activity has been associated with heart failure and hypertension since it stimulates platelet aggregation and activation through the release of thromboxane 2. Its vasoconstrictive qualities can cause coronary artery spasms, which can induce, exacerbate, or prolong an anginal attack. |
| During angina attacks, stay with the patient and reassure them. | These measures decrease anxiety, which could otherwise exacerbate angina. Anxiety causes the release of catecholamines, which increase myocardial strain and may exacerbate or prolong ischemia pain. During panic attacks, hyperventilation may cause chest wall (musculoskeletal) pain. The presence of a nurse might help alleviate emotions of fear and anxiety. |
| Evaluate and record the patient’s drug reaction. | Provides information regarding the progression of the disease. Assists in evaluating the efficacy of therapies and may signal the need for a modification in the therapy regimen. |
| Examine for symptoms of decreased cardiac output (e.g., dizziness, nausea, rapid breathing) and symptoms of compromised cardiovascular function (e.g., palpitations, fatigue, nausea, cold sweats, vomiting, desire to micturate). Arrange the patient for transfer to intensive care | Due to the life-threatening nature of the decreased cardiac output, rapid reporting and identification are required for prompt intervention. Transfer to a specialized intensive care unit for continuous observation may be necessary. |
| If the patient has difficulty breathing, raise the head of the bed (HOB). | Reduces hypoxia and results in shortness of breath by facilitating gas exchange. |
| Maintain a peaceful and relaxing atmosphere. Limit visitors as needed. | Mental and emotional stress raises the workload of the heart. In addition, it can heighten sympathetic tone and induce dysrhythmias. |
| Provide non-pharmacologic methods to promote circulation | These measures enhance circulation to ischemic extremities. |
| Offer light meals. After a meal, have the patient rest for an hour. | Reduces cardiac workload related to digestion, hence lowering the risk of angina |
Impaired Cardiovascular Function Nursing Care Plan 3
Nursing Diagnosis: Activity Intolerance related to an imbalance between oxygen supply and demand, secondary to impaired cardiovascular function, as evidenced by generalized weakness, dyspnea, pallor, fatigue, changes in vital signs, and presence of dysrhythmias.
Desired Outcome: The patient will demonstrate an increase in activity tolerance as evidenced by the ability to meet his or her own self-care needs, a decrease in fatigue, and normal vital signs.
| Nursing Interventions for Risk for Impaired Cardiovascular Function | Rationale |
| Assess the patient’s degree of physical activity. | Provides baseline data for formulating nursing goals and interventions centered on the patient. Identifying activity intolerance involves observing the patient’s response to varying forms of physical exertion. |
| Record the patient’s cardiopulmonary response to activities. Note associated signs and symptoms such as tachycardia, dysrhythmias, dyspnea, diaphoresis, and pallor. | During physical exertion, a compromised myocardium may induce an increase in heart rate and oxygen demand, which may aggravate weakness and fatigue. |
| Examine other sources of fatigue (e.g., pain, medications) | Medications such as beta-blockers, sedatives, and tranquilizers can cause fatigue as a side effect. In addition, pain and subsequent treatment procedures might deplete the patient’s energy, resulting in fatigue. |
| Determine the factors that may have an impact on the intended level of activity and motivation. | The presence of cardiovascular disorders or impairments and their associated symptoms (e.g., fatigue) may hinder the patient’s ability to participate in care activities. |
| Document the patient’s responsiveness to the activities. | To assess whether vital signs and oxygen saturation levels are within the acceptable range, they should be checked before, during, and shortly after activity. This information can also be used to set goals for increasing the intensity and duration of activity according to the patient’s tolerance. |
| Assist patients with activities of daily living (ADLs) while gradually decreasing the level of assistance required for each given activity. | To enhance the patient’s activity tolerance and self-esteem and to aid in energy conservation. |
| Discourage the patient from participating in activities that are detrimental to their physical and emotional health. | Overexertion and straining may aggravate symptoms. Pain, disorientation, or shortness of breath suggest that all activity must be ceased. Also, educate the patient or significant other/s to recognize signs of overexertion. |
| After completing a part of the exercise, ensure the patient receives adequate rest. | Reduces tension, agitation, and anxiety. |
Impaired Cardiovascular Function Nursing Care Plan 4
Nursing Diagnosis: Excess Fluid Volume related to compromised regulatory mechanisms, secondary to impaired cardiovascular function, as evidenced by oliguria, hypertension, weight gain, respiratory distress, and abnormal breath sounds.
Desired Outcome: The patient will exhibit a balanced fluid volume with absent edema.
| Nursing Interventions for Risk for Impaired Cardiovascular Function | Rationale |
| Observe urine output and note its features (e.g., color, volume) and the time of day when diuresis occurs. | A urine output of >200 ml each two consecutive hours and >500 ml in any two hours are indicators of excessive diuresis, which can lead to hypotension, hypokalemia, and dehydration. In this case, hypovolemic shock, stroke, dysrhythmias, and heart attack are all possible complications. When diuresis develops, it’s crucial to keep track of the time of day since recumbency induces diuresis. |
| Observe for peripheral edema and jugular vein distention. Do not raise the patient’s legs if they are dyspneic. | Indicates fluid overload. The decrease in systemic blood pressure results in a decrease in renal perfusion and an increase in the reabsorption of salt and water. A low-sodium diet aids in the prevention of increased sodium retention. Additionally, it may be indicated if heart failure symptoms are present. Uncontrolled increases in sodium concentration may lead to hypertension and increased central venous pressure. |
| Encourage the expression of feelings about limitations. | Emotional expression may reduce anxiety. |
| Unless contraindicated, limit fluid and sodium consumption and offer ice pops instead. Administer oral care to prevent dry mucous membranes. | Since the body perceives dehydration, these strategies help the patient control thirst while providing minimal fluids. |
| Recommend that the patient frequently shift positions. When seated, elevate his/her feet. Observe the skin surface, keep it dry, and provide cushioning as needed. | A supine position may help reduce angina by increasing blood flow to the heart and head, although the increased blood flow to the head may exacerbate headaches. A semi-Fowler’s position reduces cardiac workload and inhibits tachycardia. Decreased cardiac contractility can lead to decreased urine output and weight gain due to fluid retention and decreased renal perfusion. In the presence of edema, reduced venous return, altered nutritional intake, and prolonged immobility, the integrity of the skin may be compromised, necessitating close monitoring or preventive measures. |
| Refer to a dietitian. | Helps provide the patient with a sodium-restricted diet that meets their caloric needs |
| Administer diuretics as directed and document the patient’s response. | Helps maintain normal blood volume levels. |
Impaired Cardiovascular Function Nursing Care Plan 5
Nursing Diagnosis: Ineffective Tissue Perfusion related to decreased cardiac output, secondary to impaired cardiovascular function, as evidenced by generalized weakness, difficulty breathing, bradycardia, abnormal BP readings, chest pain, and abnormal pulse rate.
Desired Outcome: The patient will demonstrate actions that enhance circulation and maintain vital signs within normal ranges.
| Nursing Interventions for Risk for Impaired Cardiovascular Function | Rationale |
| Examine pain reports using a subjective scale and take note of their causes and characteristics (e.g., location, intensity) | Assessment of pain perception and selection of the most effective analgesic with respect to dose are two key components of this intervention. Pain in the lower extremities and localized warmth are early signs of peripheral thrombus development (DVT), which requires bed rest and prompt medical treatment to prevent embolization. |
| Evaluate the patient’s vital signs, particularly blood pressure and pulse. Be cautious for drops in blood pressure greater than 20 mm Hg compared to the patient’s baseline. Observe for related symptoms, such as dizziness and impaired mental status. | Constant monitoring is necessary to prevent ineffective tissue perfusion damage. Preventing limb injury or embolization requires prompt recognition of a weakened or absent pulse, the coolness of extremities, a decrease in capillary refill, and pain complaints. |
| Monitor ST-segment elevations and evaluate 12 lead ECG readings. | Identifies aberrant tracings indicative of ischemia. ST-segment elevations may indicate thrombotic occlusion of one of the heart’s arteries. |
| Examine laboratory tests as ordered by the physician (e.g., creatinine, lactate dehydrogenase, phosphokinase, troponin, and myoglobin). | At various stages following myocardial infarction (MI), several enzymes are increased. This measure helps to exclude MI as a cause of angina. |
| If there are no signs of embolus or thrombus formation, instruct the patient to periodically change positions, move the fingers, and rotate the wrist and ankle. Lower the HOB and monitor blood pressure changes. | A decrease in blood pressure may indicate an imminent shock. Lowering the HOB improves circulation to the heart and brain and increases oxygenation and chest expansion. Also, mobilizing affected limbs improves circulation. |
| Educate the patient about the distinction between anginal pain and the symptoms of myocardial infarction. | In certain instances, chest pain may be more severe than stable angina. The patient must comprehend the differences in order to seek emergency care in a timely manner. |
| Administer supplemental oxygen | Increases the amount of available oxygen to the myocardium. |
| In the absence of embolus, encourage range-of-motion exercises. | These activities stimulate tissue perfusion by increasing circulation. |
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. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
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. 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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