DECREASED CARDIAC OUTPUT
Definition:
Inadequate blood pumped by the heart to meet
the metabolic demands of the body. [Note: In a hypermetabolic state, although
cardiac output may be within normal range, it may still be inadequate to meet
the needs of the body’s tissues. Cardiac output and tissue perfusion are
interrelated, although there are differences. When cardiac output is decreased,
tissue perfusion problems will develop; however, tissue perfusion problems can
exist without decreased cardiac output.]
Related
factors:
·
Altered afterload
·
Altered contractility
·
Altered heart rate
·
Altered heart rhythm
·
Altered preload
·
Altered stroke volume
Defining
characteristics:
Subjective
·
Altered Heart Rate/Rhythm: Palpitations
·
Altered Preload: Fatigue
·
Altered Afterload: Shortness of
breath/dyspnea
·
Altered Contractility:
Orthopnea/paroxysmal nocturnal dyspnea [PND]
·
Behavioral/Emotional: Anxiety
Objective
·
Altered Heart Rate/Rhythm:
[Dys]arrhythmias (tachycardia, bradycardia); EKG [ECG] changes
·
Altered Preload: Jugular vein distention
(JVD); edema; weight gain; increased/decreased central venous pressure (CVP);
increased/decreased pulmonary artery wedge pressure (PAWP); murmurs
·
Altered Afterload: Cold, clammy skin; skin
[and mucous membrane] color changes [cyanosis, pallor]; prolonged capillary
refill; decreased peripheral pulses; variations in blood pressure readings;
increased/decreased systemic vascular resistance (SVR)/pulmonary vascular
resistance (PVR); oliguria; [anuria]
·
Altered Contractility: Crackles; cough;
cardiac output, 4 L/min; cardiac index, 2.5 L/min; decreased ejection fraction,
stroke volume index (SVI), left ventricular stroke work index (LVSWI); S3 or S4
sounds [gallop rhythm] Behavioral/Emotional: Restlessness
Expected
outcomes:
The patient will
·
Maintain pulse within predetermined
limits.
·
Maintain blood pressure within
predetermined limits.
·
Exhibit no arrhythmias.
·
Maintain warm and dry skin.
·
Exhibit no pedal edema.
·
Maintain acceptable cardiac output.
·
Verbalize understanding of reportable
signs and symptoms.
·
Understand diet, medication regimen, and
prescribed activity level
Interventions
and Rationales:
Determine:
Monitor patient at least
every 4 hr for irregularities in heart rate, rhythm, dyspnea, fatigue, crackles
in lungs, jugular venous distension, or chest pain. Any or all of these may indicate impending cardiac failure or other
complications. Report changes immediately.
Perform:
Administer oxygen as ordered to increase supply to myocardium.
Turn and reposition patient at least every 2
hr. Establish a turning schedule for the dependent patient. Post schedule at
bedside and monitor frequency. Turning
and repositioning prevent skin breakdown and improve lung expansion and prevent
atelectasis.
Administer antiarrhythmic
drugs, as ordered, to reduce or eliminate
rhythm disturbances. Monitor for adverse effects.
Administer stool softeners,
as prescribed, to reduce straining during
bowel movements.
Measure and record intake and
output. Decreased urinary output without
decreased fluid intake may indicate decreased renal perfusion resulting from
decreased cardiac output.
Weigh patient daily before
breakfast to detect fluid retention. Perform active or passive ROM exercises to all extremities every 2–4 hr.
ROM exercises foster muscle strength and tone, maintain joint mobility, and
prevent contractures.
Inspect legs and feet for pedal edema.
Maintain dietary
restrictions, as ordered, to prevent
fluid retention, dehydration, weight gain or loss.
Gradually increase levels of
activity within prescribed limits of cardiac rate to allow heart to adjust to increased cardiac demands.
Inform:
Educate patient and his or
her family about chest pain and other reportable symptoms, prescribed diet,
medications (name, dosage, frequency, and therapeutic and adverse effects),
prescribed activity level, simple methods of lifting and bending, and
stressreduction techniques. Education
promotes remembering of and compliance with techniques to reduce energy
consumption.
Attend:
Provide emotional support and
encouragement to help improve patient’s
self-concept.
Involve patient in planning and decision
making. Having the ability to participate
will encourage greater compliance with the plan of treatment.
Have patient perform
self-care activities. Begin slowly and increase daily, as tolerated. Performing self-care activities will assist
patient to regain independence and enhance self-esteem.
Manage:
Refer to case manager/social worker to ensure that a home assessment has been
done and that whatever modifications are needed to accommodate the patient’s
ongoing care have been made. Refer to cardiac program for exercise when the
time is appropriate.
Reference:
Kodiath, K., et al. (2005). Improving quality
of life in patients with heart failure: An innovative behavioral intervention.
Journal of Cardiovascular Nursing, 20(1), 43–48.
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