Decreased Cardiac Output – Nursing Diagnosis & Care Plan

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Decreased Cardiac Output

Good blood circulation indicates a good cardiac function. The heart or the cardiovascular system is the one responsible in providing normal blood circulation all throughout the body. In order for all the systems and organs to function, it needs blood which carries oxygen to have a better functioning of all the body systems. The heart is known to supply blood all over the body systems and returning blood towards the heart itself. This is the normal blood circulation. It needs a normal amount of blood or the cardiac output that should be pumped out in order to supply all the body needs.

On the contrary, there are times that the heart is affected wherein it will result to a decreased cardiac output. In this case, the body’s needs for oxygenation is not met due to decreased blood circulation to all the areas of the body.

There are several heart diseases that can result to a decrease cardiac output. These are the following: myocardial infarction, hypertension, valvular heart disease, congenital heart disease, cardiomyopathy, pulmonary disease, arrhythmias, drug effects, fluid overload, decrease fluid volume, and electrolyte imbalance.

Cardiac output is the amount of blood that is being pumped out by the heart. The amount of cardiac output is being computed by multiplying the heart rate (beats per minute) and the stroke volume (amount pumped per heart beat). It is usually expressed in liters/minute.

There is a need to maintain a person’s cardiac output in order to maintain the normal blood circulation and body’s well-being.

Causative/Related Factors

Decreased Cardiac Output Related to:

  • Alteration in the heart’s functioning (heart rate, rhythm, and conduction)
  • Cardiac muscle disease
  • Decreased oxygenation
  • Impaired contractility of the heart
  • Increased afterload
  • Increased or decreased ventricular filling (preload)

Defining Characteristics

Decreased Cardiac Output is characterized by the following signs and symptoms:

  • Abnormal heart sounds (S3, S4)
  • Angina or chest pain
  • Anxiety
  • Restlessness
  • Change in level of consciousness
  • Decreased activity
  • Easy fatigability
  • Decreased cardiac output
  • Decreased venous and arterial oxygen saturation
  • Dysrhythmias
  • Hypotension
  • Tachycardia

Desired Outcomes

  • Patient demonstrates adequate cardiac output as manifested by normal blood pressure and pulse rate; strong peripheral pulses; and increase activity without reported symptoms
  • Patient increased his/her knowledge on how to manage underlying cardiac diseases.
  • Patient does not report any signs of complications

Nursing Assessment

Assessment Rationale
1. Assess the patient’s vital signs (blood pressure, heart rate, and respiratory rate) ·       It will serve as a baseline data in determining any signs of decreased cardiac output
2. Note the patient’s skin color and moisture. ·       It will help in further determination of an impending decrease cardiac output. Cold, clammy skin can indicate hypotension and decrease cardiac output.
3. Assess the patient’s level of consciousness. ·       Changes is one’s level of consciousness may indicate decrease oxygenation and circulation going towards the brain.
4. Check for patient’s peripheral pulses and capillary refill. ·       Presence of weak pulses and slow capillary refill can indicate decrease cardiac output which may need a specific intervention.
5.  Weigh patient regularly prior to breakfast. ·       Weight gain can indicate an alteration in the blood circulation of the body. It can show extreme fluid retention which is the cause of gaining weight.
6. Record the urine output of the patient. ·       Decreased urine output can be a sign of decreased perfusion going to the kidneys.
7. Assess oxygen saturation with pulse oximetry both at rest and during and after ambulation. ·       It will detect the possible signs of decrease cardiac output through a decrease oxygen saturation level.
8. Check symptoms for chest pain with or without undergoing an activity or exercise. . ·       Chest pain often occurs if the heart is unable to meet the body’s needs of sufficient blood perfusion.
9. Assess patient for easy fatigability and reduced activity tolerance. ·       It indicates that a person do not have sufficient blood circulation needed by the body as it exerts effort to do such activities. It can result to difficulty of breathing.
10. Ascertain contributing factors so an appropriate care plan can be initiated. ·       Specific causes guide treatment.
11. Assess patient for understanding and compliance with medical regimen activity, and diet. ·       This promotes cooperation of patient in his or her own medical situation.

 

 

Nursing Interventions/Rationale

 

Interventions Rationale
1. Monitor the patient’s vital signs (blood pressure, heart rate, and respiratory rate) ·       Frequent monitoring of the patient’s vital signs can prevent worsening of underlying cardiac problems.
2. Record patient’s intake and output ·       It will serve as a baseline data to monitor any imbalances that may indicate decrease cardiac output.
3. Closely monitor the patient’s fluid intake such as the IV lines and oral fluids. ·       Be cautious on the fluid intake and restrictions for patients with decrease cardiac output. It may not be beneficial to them.
4. Note patient who are experiencing chest pain. Identify location, radiation, severity, quality, and duration ·       Chest pain/discomfort can indicate presence  of an inadequate blood supply to the heart, which can compromise cardiac output.
5. Place on cardiac monitor; monitor for dysrhythmias, especially atrial fibrillation. ·       Atrial fibrillation is common in heart failure.
6. Check the arterial blood gases and electrolytes levels, including potassium. ·       Low or high levels of potassium is harmful to the heart. So there is a need to closely monitor abnormal laboratory findings.
7. Monitor laboratory tests such as complete blood count, sodium level, and serum creatinine and refer to attending physician as needed. ·       It will determine causes of a decrease cardiac output and will initiate immediate intervention as necessary and as prescribed.
8. Review results of EKG and chest Xray. ·       These will determine underlying problems of the heart and lungs.
9. Monitor bowel function. Provide stool softeners as ordered. ·       Straining when defecating can lead to dysrhythmia, decreased cardiac function, and sometimes death.
10. advise patient to limit activities as needed ·       Too much activities increases workload of the heart which needs more cardiac output and circulation going to all parts of the body.
11. Associate patient to heart failure program or cardiac rehabilitation program for education, evaluation, and guided support to increase activity and rebuild life. ·       A thoroughly monitored exercise program can improve both functional capacity, and left ventricular function.
12. Explain importance of smoking cessation and avoidance of alcohol intake. ·       Vices do not give benefits to the heart and overall well-being of the patient.

 

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