Decreased cardiac output is a critical nursing diagnosis that occurs when the heart’s ability to pump sufficient blood is compromised, resulting in inadequate perfusion of tissues and organs.
This condition can stem from a variety of underlying causes, such as myocardial infarction, heart failure, arrhythmias, or structural heart defects.
Decreased cardiac output can lead to serious complications if not promptly managed, including organ failure, hypotension, and death.
Pathophysiology of Decreased Cardiac Output:
Cardiac output is the volume of blood the heart pumps in one minute. It is determined by the stroke volume (the amount of blood pumped with each beat) and the heart rate. When cardiac output decreases, it results in diminished oxygen and nutrient delivery to vital tissues.
This can trigger compensatory mechanisms such as increased heart rate and vasoconstriction. However, prolonged decreased cardiac output can lead to worsening symptoms, including fatigue, dizziness, confusion, and shortness of breath.
Signs and Symptoms of Decreased Cardiac Output:
- Hypotension (low blood pressure)
- Tachycardia (rapid heart rate)
- Weak peripheral pulses
- Dizziness or syncope (fainting)
- Fatigue
- Oliguria (decreased urine output)
- Confusion or altered mental status
- Cold, clammy skin
Nursing Assessment for Decreased Cardiac Output:
A thorough nursing assessment is crucial for identifying the early signs of decreased cardiac output. Assess the patient’s vital signs (heart rate, blood pressure, oxygen saturation), auscultate heart sounds, evaluate for edema, and assess the level of consciousness.
Continuous monitoring of hemodynamic parameters, such as central venous pressure (CVP), may also be required in acute settings.
Nursing Care Plans for Decreased Cardiac Output
1. Nursing Diagnosis: Decreased Cardiac Output related to myocardial infarction, as evidenced by hypotension, tachycardia, and chest pain.
Goal: The patient will maintain optimal cardiac output as evidenced by stable blood pressure, heart rate within normal limits, and absence of chest pain.
Nursing Interventions:
- Monitor vital signs closely: Assess heart rate, blood pressure, respiratory rate, and oxygen saturation every 1-2 hours.
- Rationale: Close monitoring allows for early detection of deteriorating cardiac output.
- Administer oxygen therapy as prescribed: Maintain oxygen saturation above 94%.
- Rationale: Adequate oxygen delivery is essential to support myocardial tissue perfusion.
- Administer medications as prescribed, including nitrates, beta-blockers, or ACE inhibitors: These medications can help reduce the workload on the heart.
- Rationale: Medications improve coronary blood flow and decrease myocardial oxygen demand.
- Encourage rest and limit physical activity: Reduce activities that increase the heart’s workload.
- Rationale: Rest helps to decrease myocardial oxygen consumption, allowing the heart to recover.
- Educate the patient on signs of worsening cardiac function: Instruct on chest pain, dyspnea, and palpitations.
- Rationale: Early identification of symptoms can prevent complications.
2. Nursing Diagnosis: Decreased Cardiac Output related to heart failure, as evidenced by dyspnea, fatigue, and edema.
Goal: The patient will demonstrate improved cardiac output as evidenced by reduced edema, improved activity tolerance, and stable vital signs.
Nursing Interventions:
- Monitor daily weight and intake/output: Track fluid retention by weighing the patient at the same time daily.
- Rationale: Fluid overload is common in heart failure and can worsen cardiac output.
- Administer diuretics as prescribed: Diuretics help reduce fluid retention.
- Rationale: Decreasing fluid volume reduces the workload on the heart.
- Elevate the head of the bed to a semi-Fowler’s position: This position helps ease breathing.
- Rationale: It promotes better lung expansion and improves oxygenation.
- Monitor for signs of pulmonary congestion: Auscultate lung sounds for crackles and assess for shortness of breath.
- Rationale: Pulmonary congestion is a common complication of decreased cardiac output in heart failure.
- Educate the patient on a low-sodium diet: Reducing sodium intake helps manage fluid retention.
- Rationale: Lowering sodium intake can prevent fluid overload and support heart function.
3. Nursing Diagnosis: Decreased Cardiac Output related to dysrhythmias, as evidenced by irregular heart rate, syncope, and low blood pressure.
Goal: The patient will maintain normal sinus rhythm and adequate cardiac output as evidenced by stable vital signs and absence of syncope.
Nursing Interventions:
- Monitor ECG continuously: Assess for any changes in heart rhythm.
- Rationale: Early detection of dysrhythmias is essential to prevent decreased cardiac output.
- Administer antiarrhythmic medications as prescribed: Use medications such as amiodarone or digoxin.
- Rationale: These medications help maintain normal heart rhythm.
- Assess for signs of syncope or lightheadedness: Encourage the patient to report any dizziness immediately.
- Rationale: Syncope may indicate that cardiac output is dangerously low.
- Prepare for cardioversion or defibrillation if needed: In cases of life-threatening arrhythmias, electrical interventions may be required.
- Rationale: Restoring normal heart rhythm improves cardiac output.
- Educate the patient on managing arrhythmias at home: Include instructions on medication adherence and monitoring pulse.
- Rationale: Patient self-monitoring can prevent complications.
4. Nursing Diagnosis: Decreased Cardiac Output related to structural heart defects, as evidenced by cyanosis, low oxygen saturation, and fatigue.
Goal: The patient will exhibit improved oxygenation and stable cardiac output as evidenced by normal oxygen saturation and improved energy levels.
Nursing Interventions:
- Administer supplemental oxygen: Maintain oxygen saturation at 92% or higher.
- Rationale: Structural heart defects often lead to inadequate oxygenation, which worsens cardiac output.
- Prepare for surgical interventions if indicated: Surgical correction of structural defects may be required.
- Rationale: Correcting the defect can restore normal heart function.
- Monitor for signs of worsening cyanosis or fatigue: These symptoms indicate deteriorating cardiac output.
- Rationale: Cyanosis reflects poor tissue perfusion and low oxygen levels.
- Provide emotional support and education to the patient and family: Help them understand the condition and treatment plan.
- Rationale: Support and education improve coping and adherence to treatment.
- Collaborate with a cardiologist for advanced care: Structural heart defects often require specialized management.
- Rationale: Cardiologists can provide advanced treatments that optimize cardiac function.
5. Nursing Diagnosis: Decreased Cardiac Output related to valvular heart disease, as evidenced by shortness of breath, chest pain, and palpitations.
Goal: The patient will demonstrate improved cardiac function as evidenced by decreased chest pain, improved exercise tolerance, and stable heart rate.
Nursing Interventions:
- Monitor for signs of worsening valvular dysfunction: Assess for chest pain, fatigue, and palpitations.
- Rationale: Valvular disease can progress rapidly, affecting cardiac output.
- Administer prescribed medications such as vasodilators or anticoagulants: These medications help manage symptoms and prevent complications.
- Rationale: Medications can improve blood flow and reduce the risk of clot formation.
- Prepare for surgical intervention if indicated: Valve repair or replacement may be necessary.
- Rationale: Correcting the valve issue can restore normal cardiac function.
- Educate the patient on lifestyle changes: Encourage smoking cessation, diet modifications, and regular exercise.
- Rationale: Healthy lifestyle changes can reduce the strain on the heart.
- Coordinate care with a cardiac surgeon and cardiologist: Collaborate for a comprehensive care plan.
- Rationale: Multidisciplinary care is often required for optimal outcomes in valvular heart disease.
References:
Kato, T., Yaku, H., Morimoto, T., Inuzuka, Y., Tamaki, Y., Yamamoto, E., … & Kimura, T. (2019). Effect of early intervention with angiotensin-converting enzyme inhibitors in heart failure with reduced ejection fraction: a multicenter study. European Journal of Heart Failure, 21(2), 169-179.
Tschannen, D., Aebersold, M., & Ferron, J. (2020). Impact of monitoring cardiac output on outcomes in critically ill patients. Critical Care Nurse, 40(3), 31-39.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., … & van der Meer, P. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 37(27), 2129-2200.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey Jr, D. E., Drazner, M. H., … & Wilkoff, B. L. (2013). 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e147-e239.
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