Care Plan For Decreased Cardiac Output

Nursing diagnosis for decreased cardiac output may be related to altered myocardial contractility, inotropic changes; alterations in rate, rhythm, electrical conduction; or structural changes, such as valvular defects and ventricular aneurysm.

It is possibly evidenced by increased heart rate (tachycardia), dysrhythmias, ECG changes; changes in BP (hypotension, hypertension); extra heart sounds (S3, S4); decreased urine output; diminished peripheral pulses; cool, ashen skin and diaphoresis; orthopnea, crackles, JVD, liver engorgement, edema; or chest pain

Desired outcomes for this nursing diagnosis are, client will have Cardiac Pump Effectiveness-NOC by evaluation criteria

• Display vital signs within acceptable limits, dysrhythmias absent or controlled, and no symptoms of failure, for example, hemodynamic parameters within acceptable limits and urinary output adequate.

• Report decreased episodes of dyspnea and angina.

Client also will have Cardiac Disease Self-Management-NOC by evaluation criteria Participate in activities that reduce cardiac workload.

Possible intervention : Hemodynamic Regulation-NIC by action such as

• Auscultate apical pulse; assess heart rate, rhythm, and document dysrhythmia if telemetry available. Tachycardia is usually present, even at rest, to compensate for decreased ventricular contractility. Premature atrial contractions (PACs), paroxysmal atrial tachycardia (PAT), PVCs, multifocal atrial tachycardia (MAT), and AF are common dysrhythmias associated with HF, although others may also occur. Note: Intractable ventricular dysrhythmias unresponsive to medication suggest ventricular aneurysm.

• Note the heart sounds. S1 and S2 may be weak because of diminished pumping action. Gallop rhythms are common (S3 and S4), produced as blood flows into noncompliant, distended chambers.

• Palpate peripheral pulses. Decreased cardiac output may be reflected in diminished radial, popliteal, dorsalis pedis, and post-tibial pulses. Pulses may be fleeting or irregular to palpation, and pulsus alternans may be present.

• Inspect skin for pallor and cyanosis. Pallor is indicative of diminished peripheral perfusion secondary to inadequate cardiac output, vasoconstriction, and anemia. Cyanosis may develop in refractory HF. Dependent
  areas are often blue or mottled as venous congestion increases.

• Monitor urine output, noting decreasing output and dark or concentrated urine. Kidneys respond to reduced cardiac output by retaining water and sodium. Urine output is usually decreased during the day because of fluid shifts into tissues, but may be increased at night because fluid returns to circulation when client is recumbent.

• etc.