Nursing Care Plan (NCP) for Decreased Cardiac Output

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Included In This Lesson

Study Tools

Outline

Pathophysiology

Normal cardiac output is typically between 4 and 8 liters per minute, and decreased cardiac output means the output is lower than 4 liters/minute. Cardiac output depends primarily on four factors; Heart rate, contractility, preload and afterload.

Etiology

Decreased cardiac output occurs when the cardiac output reaches a level of less than 4 liters per minute.

Desired Outcome

Patient demonstrates adequate cardiac output; The patient will also be able to tolerate activity without symptoms of dyspnea, syncope, or chest pain.

Subjective Data

  • Fatigue
  • Exhaustion progressing throughout the day
  • Exercise intolerance
  • Difficulty Sleeping
  • Chest pain with activity
  • Shortness of breath at rest or with exertion

Objective Data

  • Decreased urine output
  • Diminished peripheral pulses
  • Cool, pallor skin; diaphoresis
  • Wheezes
  • Change in LOC (level of consciousness)
  • ↑HR; ↑RR
  • Hypotension

Nursing Interventions

Intervention

Rationale

Physical Assessment

Assess for edema, difficulty breathing. Assess cardiac status by performing EKG. Look for  any distended jugular veins. Auscultate for abnormal heart tones

Monitor vital signs; capillary refill; peripheral pulses. Monitor I&O.

Most patients have compensatory tachycardia and significantly low blood pressure in response to reduced cardiac output. UOP may be decreased.

Assess for chest pain and exacerbating factors

Low cardiac output can further decrease myocardial perfusion, resulting in chest pain.

Assess for reports of fatigue and reduced activity tolerance.

Fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of the patient’s response serves as a guide for optimal progression of activity.

Educate family and patient about the disease process

Early recognition of symptoms facilitates early problem solving and prompt treatment.

Lesson Details

Writing a Nursing Care Plan (NCP) for Decreased Cardiac Output

A Nursing Care Plan (NCP) for Decreased Cardiac Output starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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Transcript

This is a nursing care plan for decreased cardiac output. So, the pathophysiology. Normal cardiac output is typically between four and eight liters per minute, and decreased cardiac output means anything less than four liters per minute. Cardiac output depends primarily on four factors: heart rate; contractility; preload; and afterload. Remember, preload is just how much the ventricles stretch when the heart muscle relaxes and allows the chambers to fill. And afterload is the force that the ventricles must act against to pump blood.

Some nursing considerations that we want to think of are we want to monitor those vital signs. We want to assess that cardiac and respiratory status. We want to obtain an EKG to see the depth of the cardiac involvement. We want to monitor eyes and nose, and we want to manage any chest pain. The desired outcome for this patient: that this patient will demonstrate adequate cardiac output. The patient is going to be able to tolerate activity without symptoms of dyspnea, syncope, or chest pain.

So when this patient comes in and presents with decreased cardiac output, remember: This is a symptom. So this is going to be caused by something else. We want to know what is causing this decreased cardiac output, but until we can get to that point, they’re going to have some subjective data that they’re going to tell us. What are some things? Okay, they’re going to have some fatigue. They’re going to have some exhaustion. Exhaustion. And exhaustion is going to progress throughout the day. They’ll have some exercise intolerance. They’re also going to have some difficulty sleeping. They may have some chest pain with activity. They’re going to have some shortness of breath, and that’s going to be at rest or with activity or exertion.

Okay, some things that we are going to assess or observe from this patient with the objective data is we are going to want to notice that they’re going to have diminished peripheral pulses. They’re going to have cool, ashy skin. They may have some diaphoresis, some sweating. When we auscultate, we will listen and we will hear wheezes. We may notice that they have decreased urinary output. They may have increased heart rate, increased respiratory rate, and they may also have some low BP or some hypotension.

So what do we want to do first with this patient? Well, the first thing I think we want to do is we want to do a good physical assessment. We want to assess this patient. We want to assess for edema, difficulty breathing. We want to assess their cardiac status by performing an EKG. We want to look for any distended jugular veins. We want to auscultate to see if there are any abnormal heart tones. Their lungs may sound wet. We may hear crackles or wheezes.

Next, we want to monitor their vital signs. So let’s monitor vitals, and we want to also check their capillary refill. We want to check their peripheral pulses, and we want to monitor their eyes and nose. Most patients with decreased cardiac output have compensatory tachycardia, and they have significantly low blood pressure in response to the reduced cardiac output. The urinary output may also be decreased.

We want to assess the chest pain. So we want to assess the chest pain, and we also want to learn any exacerbating factors. Is it just with movement? Are they having chest pain at rest? Remember, low cardiac output can further decrease myocardial perfusion, resulting in chest pain. We want to assess any reports of fatigue and reduced activity tolerance. So we want to see about decreased activity tolerance. Because fatigue and exertional dyspnea are common problems to those with low cardiac output, close monitoring of the patient’s response serves as a guide for optimal progression of activity.

Finally, we want to give some education. We want to make sure we give a good education. We want to educate these patients and their families on the disease process. It’s very important that we have early recognition of symptoms that facilitate early problem-solving and proper treatment. So we want early education.

So here’s the completed care plan. Here are key points. So remember that decreased cardiac output means that the output is lower than four liters per minute. Some of the subjective data that they are going to tell us is they are going to tell us that there is fatigue. They are tired. Exhaustion, especially, progresses throughout the day. They’re going to have some chest pain and shortness of breath.

These patients are going to present to us with low blood pressure. We’re going to see low BP, and that’s primarily because of the low cardiac output. They may have some decreased urinary output. They’re going to have increased heart rate or tachycardia. They’re going to be tachypneic, with an increased respiratory rate. Their skin is going to be cool and ashy, and they are going to have decreased peripheral pulses.

So what can we do for these patients? Well, the first thing we need to do is we need to treat the underlying cause. What is causing this low cardiac output? Remember, low cardiac output is not normal. We want to get back to normal, if at all possible. And if for some reason, it is a new way of living for this patient, we’re going to educate them on their new baseline. We’re going to educate them on implementing exercise, diet management. All of these things can get them back to a new baseline.

We’re going to also want to monitor and collect accurate eyes and nose. Low cardiac output can lead to kidney involvement, and that equals poor perfusion. We want that profusion to be up, so we’re going to monitor that kidney function through the eyes and nose.

We love you guys. Go out and be your best selves today, and as always, happy nursing.

 

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