- Gain a comprehensive understanding of the concept of decreased cardiac output, including its definition, contributing factors, and impact on overall cardiovascular function.
- Develop the ability to recognize and identify the clinical signs and symptoms associated with decreased cardiac output, enabling prompt assessment and intervention.
- Understand the various factors that can contribute to decreased cardiac output, including cardiac conditions, fluid imbalances, and systemic factors, to facilitate targeted nursing interventions.
- Acquire proficiency in conducting a thorough cardiovascular assessment, including the assessment of vital signs, heart sounds, peripheral perfusion, and other relevant parameters to evaluate cardiac output.
- Learn and apply appropriate nursing interventions to improve and manage decreased cardiac output, with a focus on collaborative care, patient education, and monitoring outcomes.
Pathophysiology of Decreased Cardiac Output
- Impaired Myocardial Contractility:
- Reduced ability of the myocardium to contract efficiently, often due to conditions like myocardial infarction, cardiomyopathy, or myocarditis, leading to a decrease in the amount of blood ejected from the heart.
- Elevated systemic vascular resistance, commonly associated with conditions such as hypertension, makes it more challenging for the heart to pump blood into the systemic circulation, contributing to decreased cardiac output.
- Malfunctioning heart valves, either through stenosis (narrowing) or regurgitation (leakage), disrupt the normal flow of blood within the heart, affecting cardiac output.
- Inadequate blood volume, resulting from conditions like dehydration, hemorrhage, or severe burns, leads to decreased preload, limiting the amount of blood available for the heart to pump.
- Accumulation of fluid or blood in the pericardial sac, as seen in pericardial effusion or cardiac tamponade, exerts pressure on the heart, impairing its ability to fill and pump effectively.
Etiology of Decreased Cardiac Output
- Myocardial Infarction:
- Ischemic damage to the myocardium, commonly occurring during a heart attack, can impair the heart’s contractility and overall pump function.
- Chronic conditions like heart failure, whether systolic or diastolic, result in the heart’s inability to pump blood effectively, leading to decreased cardiac output.
- Prolonged elevated blood pressure increases afterload, making it more difficult for the heart to eject blood into the systemic circulation, contributing to decreased cardiac output.
- Conditions affecting heart valves, such as stenosis or regurgitation, can disrupt the normal flow of blood within the heart, impacting cardiac output.
- Conditions causing a decrease in blood volume, including dehydration, hemorrhage, or fluid loss from severe burns, reduce preload and contribute to decreased cardiac output.
Desired Outcome for Decreased Cardiac Output
- Improved Cardiac Output:
- Achieve and maintain a cardiac output within the normal range, ensuring adequate blood circulation to meet the body’s metabolic demands.
- Alleviate symptoms associated with decreased cardiac output, such as fatigue, dyspnea, and peripheral edema, leading to an improved quality of life for the patient.
- Ensure optimal perfusion to vital organs and tissues, preventing complications associated with inadequate oxygen and nutrient delivery.
- Stabilize and maintain hemodynamic parameters, including blood pressure, heart rate, and central venous pressure, within acceptable ranges to support cardiovascular function.
- Improve the patient’s exercise tolerance and overall functional capacity, allowing for increased physical activity without experiencing symptoms of decreased cardiac output.
Subjective Data for Nursing Care Plan (NCP) for Decreased Cardiac Output
- Fatigue and Weakness:
- Patient reports experiencing persistent fatigue and weakness, especially during physical activities or daily routines.
- Patient describes episodes of shortness of breath, both at rest and during exertion, indicating potential respiratory distress.
- Patient communicates sensations of chest pain or discomfort, providing details on the location, duration, and intensity of the symptoms.
- Patient reports episodes of dizziness or lightheadedness, particularly upon standing or with sudden movements.
- Patient notes the presence of swelling, particularly in the lower extremities, which may be accompanied by feelings of tightness or discomfort.
- Patient mentions changes in urinary patterns, such as increased frequency or changes in color, which may indicate fluid retention.
Objective Data for Nursing Care Plan (NCP) for Decreased Cardiac Output
- Vital Signs:
- Blood pressure measurements consistently below the patient’s baseline, indicating potential inadequate perfusion.
- Tachycardia or irregular heart rhythm noted during assessments, revealing disruptions in the normal cardiac cycle.
- Elevated respiratory rate, especially at rest or with minimal exertion, indicating increased effort to maintain oxygenation.
- Observable swelling in the extremities, particularly the ankles and lower legs, suggesting fluid retention and impaired venous return.
- Pallor or mottled skin, particularly in the extremities, along with coolness, indicating potential peripheral vasoconstriction.
- Prolonged capillary refill time (>2 seconds) when assessing nail beds, indicating potential circulatory compromise.
Nursing Assessment for Decreased Cardiac Output
- Cardiovascular Assessment:
- Monitor vital signs, including heart rate, blood pressure, and peripheral pulses, to assess for signs of decreased cardiac output and response to interventions.
- Evaluate fluid balance by assessing input and output, monitoring for signs of dehydration or fluid overload, which can impact preload and cardiac output.
- Assess respiratory rate, rhythm, and effort to identify signs of respiratory distress or inadequate oxygenation, which may be indicative of decreased cardiac output.
- Examine peripheral perfusion by assessing skin color, temperature, and capillary refill time to identify signs of poor tissue perfusion.
- Investigate and document symptoms related to decreased cardiac output, such as fatigue, dyspnea, dizziness, or syncope, to guide ongoing management.
- Auscultate heart sounds and identify any abnormal murmurs or additional sounds that may indicate valvular dysfunction or impaired cardiac function.
- Evaluate for the presence of edema, particularly in dependent areas, as it can be a manifestation of fluid imbalance and decreased cardiac output.
- Order and interpret relevant laboratory tests, including cardiac enzymes, electrolytes, and hemoglobin levels, to assess cardiac function, fluid balance, and oxygen-carrying capacity.
Interventions and Rationales for Nursing Care Plan (NCP) for Decreased Cardiac Output
- Administer Medications:
- Rationale: Medications such as diuretics, beta-blockers, and inotropes can help optimize cardiac function, reduce fluid volume, and improve contractility.
- Rationale: Maintaining a balance of electrolytes is crucial for proper cardiac function. Regular monitoring helps identify and address any imbalances promptly.
- Rationale: Elevating the patient’s legs promotes venous return and reduces peripheral edema, improving overall cardiac output.
- Rationale: Supplemental oxygen helps increase oxygenation and relieve the workload on the heart, especially in cases of decreased cardiac output.
- Rationale: Restricting fluid intake helps manage fluid overload, reducing the workload on the heart and preventing further deterioration in cardiac output.
- Rationale: Continuous monitoring allows early detection of arrhythmias, changes in heart rate, or other abnormalities, enabling prompt intervention.
- Rationale: Providing assistance with ADLs reduces the patient’s energy expenditure, conserving energy for essential physiological processes.
- Rationale: Nutritional support ensures the patient receives essential nutrients to support cardiac function and prevent malnutrition-related complications.
- Rationale: Patient understanding and adherence to medication regimens are crucial for managing cardiac conditions and preventing exacerbations.
- Rationale: Collaboration with physicians, cardiologists, and other healthcare professionals ensures a comprehensive approach to care, optimizing outcomes for the patient.
Evaluation for Decreased Cardiac Output
- Monitoring Hemodynamic Parameters:
- Regularly assess and compare hemodynamic parameters, including blood pressure, heart rate, and central venous pressure, to evaluate the effectiveness of interventions and the stability of cardiovascular function.
- Evaluate the resolution of symptoms associated with decreased cardiac output, such as fatigue, dyspnea, and edema, to gauge the impact of interventions on the patient’s well-being.
- Assess improvements in exercise tolerance and functional capacity, noting the patient’s ability to engage in physical activities without experiencing undue symptoms.
- Monitor changes in fluid balance, including weight fluctuations and clinical signs of fluid overload or dehydration, to ensure an appropriate balance is maintained.
- Evaluate the patient’s adherence to prescribed medications, dietary restrictions, and lifestyle modifications, as non-compliance can impact the effectiveness of the overall care plan.
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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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