Decreased cardiac output occurs when the heart fails to pump enough blood to meet the body’s oxygen and nutrient needs. Because this affects every organ system, nurses must be able to identify it early, understand the underlying causes, and provide interventions that restore and maintain adequate circulation. Prompt nursing care can mean the difference between recovery and life-threatening complications.
Understanding Cardiac Output
Cardiac output (CO) is the total volume of blood the heart pumps in one minute.
Formula: CO = Stroke Volume × Heart Rate
- Stroke Volume (SV): Blood ejected per heartbeat
- Heart Rate (HR): Beats per minute
A decrease in either SV or HR—or both—will reduce cardiac output.
Causes & Contributing Factors
Decreased cardiac output may be caused by problems with heart rate, muscle strength, or blood volume. Common contributors include:
- Heart failure – weakened pumping ability
- Myocardial infarction – heart muscle damage
- Arrhythmias – irregular heart rhythms
- Valve disorders – narrowed or leaking valves
- Hypovolemia – blood or fluid loss
- High afterload – increased resistance from hypertension or aortic stenosis
- Cardiac tamponade – fluid compressing the heart
Signs & Symptoms
Mild:
- Fatigue
- Lightheadedness
- Mild shortness of breath
- Palpitations
Moderate:
- Swelling in feet or ankles
- Reduced urine output
- Cool skin temperature
- Orthopnea (difficulty breathing when lying flat)
Severe:
- Confusion or disorientation
- Cyanosis (bluish lips, nail beds)
- Severe hypotension
- Pulmonary edema with pink, frothy sputum
Nursing Assessment
Subjective Data:
- Reports of weakness, chest discomfort, dizziness
- Shortness of breath with minimal exertion
- Sensation of rapid or irregular heartbeat
Objective Data:
- Low blood pressure, irregular or rapid pulse
- Weak or thready peripheral pulses
- Crackles in lungs
- Jugular vein distension
- Decreased urine output
- Abnormal ECG findings
NANDA-I Nursing Diagnosis (2024–2026)
Definition:
Inadequate blood pumped by the heart to meet metabolic demands of the body.
Related Factors:
- Altered heart rate or rhythm
- Impaired myocardial contractility
- Increased afterload or reduced preload
Defining Characteristics:
- Hypotension or hypertension
- Abnormal heart rate or rhythm
- Diminished peripheral pulses
- Fatigue, dyspnea, oliguria
Goals & Expected Outcomes
Short-Term Goals:
- Maintain adequate blood pressure within 24–48 hours
- Improve oxygenation and reduce shortness of breath
- Stabilize heart rhythm
Long-Term Goals:
- Support optimal cardiac function
- Prevent recurrence or deterioration
- Enhance patient’s ability to perform daily activities
Nursing Care Plans
1. Heart Failure
Nursing Diagnosis Statement:
Decreased cardiac output related to impaired myocardial contractility secondary to heart failure, as evidenced by dyspnea, peripheral edema, S3 heart sound, and fatigue.
Goal:
Maintain oxygen saturation above 95% and reduce symptoms within 48 hours.
Interventions & Rationales:
- Monitor vital signs and oxygen levels regularly to detect deterioration.
- Auscultate lung sounds to assess for fluid buildup.
- Administer prescribed diuretics to reduce fluid overload.
- Elevate the head of the bed to improve breathing.
- Space activities to conserve energy.
Evaluation:
Improved breathing pattern, decreased swelling, and stable oxygen levels.
2. Myocardial Infarction
Nursing Diagnosis Statement:
Decreased cardiac output related to myocardial tissue damage secondary to acute myocardial infarction, as evidenced by hypotension, diaphoresis, chest pain, and abnormal ECG findings.
Goal:
Stabilize cardiac rhythm and maintain adequate blood pressure during acute phase.
Interventions & Rationales:
- Provide continuous cardiac monitoring to detect arrhythmias early.
- Administer supplemental oxygen to improve tissue oxygenation.
- Give beta-blockers as prescribed to reduce myocardial workload.
- Monitor urine output to evaluate perfusion.
- Prepare patient for advanced interventions if indicated.
Evaluation:
Stable cardiac rhythm, pain relief, adequate blood pressure maintained.
3. Arrhythmia
Nursing Diagnosis Statement:
Decreased cardiac output related to altered heart rate and rhythm secondary to atrial fibrillation (or other arrhythmia), as evidenced by irregular pulse, palpitations, dizziness, and shortness of breath.
Goal:
Restore and maintain a heart rate within normal limits and relieve symptoms.
Interventions & Rationales:
- Monitor ECG for rhythm changes to guide treatment.
- Administer antiarrhythmic medications as prescribed.
- Teach patient to avoid stimulants such as caffeine that may trigger arrhythmias.
- Assess for signs of decreased perfusion like confusion or cool extremities.
Evaluation:
Regular rhythm maintained, symptoms improved, patient verbalizes understanding of triggers.
4. Hypovolemia
Nursing Diagnosis Statement:
Decreased cardiac output related to reduced circulating blood volume secondary to acute blood loss, as evidenced by hypotension, tachycardia, weak pulses, and decreased urine output.
Goal:
Restore circulating volume and improve tissue perfusion within 12–24 hours.
Interventions & Rationales:
- Monitor intake and output to evaluate fluid balance.
- Administer IV fluids or blood products as prescribed to replace losses.
- Identify and control the source of bleeding.
- Assess mental status as an indicator of cerebral perfusion.
Evaluation:
Blood pressure returns to baseline, urine output normalizes, patient alert and oriented.
5. Cardiomyopathy
Nursing Diagnosis Statement:
Decreased cardiac output related to structural and functional changes in the myocardium secondary to cardiomyopathy, as evidenced by fatigue, dyspnea, orthopnea, and reduced exercise tolerance.
Goal:
Increase activity tolerance and maintain oxygenation within normal limits.
Interventions & Rationales:
- Record daily weight to monitor fluid retention.
- Administer ACE inhibitors or beta-blockers as prescribed to improve cardiac function.
- Teach patient a low-sodium diet to reduce fluid overload.
- Encourage rest periods to prevent overexertion.
Evaluation:
Stable weight, increased activity tolerance, improved breathing.
Patient Education
- Medication Adherence – Take prescribed medicines consistently to support heart function.
- Dietary Changes – Follow a low-sodium diet if recommended and limit fluid intake as advised.
- Daily Weights – Report sudden weight gain of more than 2–3 lbs in 24 hours.
- Warning Signs – Contact healthcare provider for chest pain, swelling, or shortness of breath.
- Follow-Up Care – Keep scheduled appointments for ongoing monitoring.
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.
Gheorghiade, M., Pang, P. S., & Collins, S. P. (2021). Acute heart failure syndromes: Current state and framework for future research. Journal of the American College of Cardiology, 69(9), 1115-1133.