CPR in Nursing Diagnosis: Comprehensive Guide to Decreased Cardiac Output

Effective nursing care is paramount in enhancing cardiac function, ensuring hemodynamic stability, and preventing complications such as organ failure and inadequate tissue perfusion stemming from reduced cardiac output. This guide equips nurses with essential knowledge and skills for conducting thorough assessments, formulating precise nursing diagnoses, setting clear goals, and implementing evidence-based interventions, with a crucial focus on cardiopulmonary resuscitation (CPR) preparedness within the broader context of cardiac nursing.

Understanding Cardiac Output

Cardiac output (CO) represents the volume of blood the heart pumps each minute. It is calculated as the product of heart rate (HR), the number of heartbeats per minute, and stroke volume (SV), the amount of blood ejected with each beat (CO = HR x SV). Cardiac output is typically measured in liters per minute (L/min).

In a healthy adult at rest, normal cardiac output typically ranges from 4 to 6 liters per minute (L/min) (King and Lowery, 2022). It’s important to note that this range can vary based on individual factors like age, body size, and activity level. For instance, highly trained athletes can achieve cardiac outputs exceeding 35 L/min during intense exercise.

Heart rate adjustments are governed by the autonomic nervous system’s parasympathetic and sympathetic branches, which influence the sinoatrial (SA) node. The central nervous system and baroreceptor activity also play a role in heart rate regulation. Baroreceptors, specialized nerve cells located in the aortic arch and carotid arteries, are sensitive to blood pressure fluctuations. Compensatory mechanisms triggered by blood pressure changes include:

Stroke volume is determined by three key factors:

Preload: This is the extent of ventricular cardiac muscle fiber stretch at the end of diastole. Preload, determined by the volume of blood in the ventricle at the end of diastole, directly influences stroke volume.
Afterload: This is the resistance the ventricle must overcome to eject blood. Afterload and stroke volume have an inverse relationship. Increased arterial vasoconstriction raises afterload, leading to decreased stroke volume. Conversely, arterial vasodilation reduces afterload, increasing stroke volume.
Contractility: This refers to the force of myocardial contraction. Increased contractility results in a greater stroke volume.

Methods for Measuring Cardiac Output

Several techniques are available to measure cardiac output. The choice of method depends on factors like invasiveness, measurement accuracy, the need for continuous real-time readings, calibration requirements, and the need for additional hemodynamic data.

Invasive Methods

Pulmonary Artery Catheterization (Swan-Ganz Catheter): This is the gold standard for measuring cardiac output. It involves inserting a catheter into the pulmonary artery to directly measure pressures and calculate CO using the Fick method or thermodilution.

Minimally Invasive Methods

Invasive Pulse Wave Analysis: This technique continuously estimates stroke volume and cardiac output from the arterial pressure waveform using algorithms that analyze waveform characteristics.
Esophageal Doppler: This method estimates stroke volume by measuring blood flow velocity in the descending aorta using a Doppler transducer on a probe placed in the esophagus. Stroke volume is calculated from stroke distance and aortic cross-sectional area.

Non-invasive Methods

Doppler Ultrasound: This method utilizes ultrasound and the Doppler effect to measure cardiac output. Blood velocity through the heart causes a frequency shift in returning ultrasound waves, used to calculate flow velocity and volume, and subsequently cardiac output.
Fick Method: This technique measures overall oxygen consumption and oxygen delivery to the body. Based on Fick’s principle, oxygen consumption equals cardiac output multiplied by the difference in arterial and venous blood oxygen content.
Arterial Pulse Contour Analysis: This technique uses a device to measure the arterial pulse wave’s shape and strength. Cardiac output is calculated using an algorithm based on the pulse waveform (Saugel & Vincent, 2018).

Decreased cardiac output occurs when the heart’s pumping action is insufficient to meet the body’s metabolic demands. Various cardiovascular conditions, including myocardial infarction, heart failure, dysrhythmias, and fluid volume imbalances, can lead to reduced cardiac output.

Causes of Decreased Cardiac Output

Conditions such as myocardial infarction, hypertension, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary disease, arrhythmias, medication side effects, fluid overload, dehydration, and electrolyte imbalances are common causes of decreased cardiac output. Additional contributing factors include:

Alterations in Heart Rate, Rhythm, and Conduction: Any disruption in the heart’s electrical system can impair coordinated muscle contraction and relaxation, leading to decreased cardiac output.
Cardiac Muscle Disease: Conditions affecting heart muscle structure and function, such as cardiomyopathy or myocarditis, can reduce the heart’s pumping effectiveness, resulting in decreased cardiac output.
Decreased Oxygenation: Insufficient oxygen supply to the heart muscle, often due to coronary artery disease or respiratory disorders, can impair cardiac function and decrease cardiac output.
Impaired Contractility: Damage to the heart muscle from myocardial infarction or heart failure can weaken the heart’s contractile force, leading to reduced cardiac output.
Increased Afterload: Elevated resistance against which the heart must pump, as seen in hypertension or aortic stenosis, forces the heart to work harder, decreasing cardiac output.
Ventricular Filling Issues (Preload): Both excessively high and low preload (blood volume entering the heart) can affect the amount of blood pumped out, leading to decreased cardiac output.

Understanding factors affecting cardiac output is crucial for effective nursing diagnosis and intervention in patients with decreased cardiac output.

Nursing Care Plans and Management for Decreased Cardiac Output

Cardiovascular diseases and conditions causing decreased cardiac output present significant health challenges. Nursing management for patients with decreased cardiac output is essential to optimize outcomes and improve quality of life. Nursing care plans focus on enhancing cardiac function, managing symptoms, educating patients and caregivers, and preventing complications, always keeping in mind the potential need for CPR in critical situations.

Nursing Problem Priorities

Nursing priorities for patients with decreased cardiac output include:

Optimize Oxygenation and Tissue Perfusion: Adequate tissue perfusion is critical as it ensures sufficient oxygen and nutrient supply to all organs and tissues for proper function. CPR readiness becomes a vital component of this priority, as severe decreases in cardiac output can lead to cardiac arrest, necessitating immediate CPR interventions.
Assess the Effects of Decreased Perfusion: Reduced cardiac output impairs blood flow throughout the body, potentially leading to serious complications if not promptly addressed. Nurses must be vigilant in assessing and recognizing these effects to ensure timely interventions, including CPR if the situation deteriorates rapidly.
Address Nutrition and Fluid Imbalance: Decreased cardiac output can cause fluid retention or inadequate blood volume, contributing to heart failure or hypovolemia. Dietary restrictions, especially sodium, may be necessary. Managing fluid balance is critical to prevent further cardiac compromise and potential cardiac arrest scenarios where CPR might be needed.

Nursing Assessment for Decreased Cardiac Output

Thorough assessment is crucial to identify potential causes of decreased cardiac output and guide nursing care. Key subjective and objective manifestations include:

Abnormal heart sounds (S3, S4)
Angina
Anxiety, restlessness
Change in level of consciousness
Crackles, dyspnea, orthopnea, tachypnea
Decreased activity tolerance
Decreased cardiac output (measured or estimated)
Decreased peripheral pulses; cold, clammy skin/poor capillary refill
Decreased venous and arterial oxygen saturation
Dysrhythmias
Ejection fraction less than 40%
Fatigue
Hypotension
Increased central venous pressure (CVP)
Increased pulmonary artery pressure (PAP)
Tachycardia
Weight gain, edema, decreased urine output

Nursing Diagnosis: Decreased Cardiac Output

Nursing diagnoses for decreased cardiac output are formulated based on comprehensive assessment and clinical judgment, tailored to individual patient conditions. While their specific use varies by setting, the nurse’s expertise shapes the care plan to prioritize patient needs, including anticipation of CPR needs in severe cases. Common nursing diagnoses include:

Decreased Cardiac Output related to altered heart rate and rhythm secondary to atrial fibrillation as evidenced by irregular pulse, palpitations, and fluctuating blood pressure.
Decreased Cardiac Output related to decreased stroke volume secondary to myocardial infarction as evidenced by weak peripheral pulses, delayed capillary refill, and cool extremities.
Decreased Cardiac Output related to increased afterload secondary to systemic hypertension as evidenced by diminished pulse pressure, cyanosis, and fluid retention.
Decreased Cardiac Output related to reduced contractility secondary to cardiomyopathy as evidenced by poor tissue perfusion, lethargy, and complaints of dizziness.
Decreased Cardiac Output related to ineffective ventricular filling secondary to pericardial effusion as evidenced by jugular vein distension, shortness of breath, and reduced endurance during physical activities.
Decreased Cardiac Output related to impaired myocardial function secondary to congestive heart failure as evidenced by cyanotic nail beds, cold and clammy skin, and decreased oxygen saturation levels.

Recognizing these diagnoses is the first step in providing targeted care, which in critical scenarios, includes being prepared to initiate CPR if cardiac output deteriorates to cardiac arrest.

Nursing Goals and Expected Outcomes

Common goals and expected outcomes for the nursing diagnosis of decreased cardiac output are:

The patient will demonstrate adequate cardiac output as evidenced by blood pressure and pulse rate and rhythm within normal limits for the individual; strong peripheral pulses; and the ability to tolerate activity without dyspnea, syncope, or chest pain.
The patient will exhibit warm, dry skin and eupnea without pulmonary crackles.
The patient will remain free from medication side effects used to achieve adequate cardiac output.
The patient will articulate actions and precautions for managing cardiac disease.

These goals are crucial for guiding nursing interventions, with the overarching aim of stabilizing the patient and preventing progression to situations requiring CPR.

Nursing Interventions and Actions for Decreased Cardiac Output

Therapeutic nursing interventions and actions for patients with decreased cardiac output are multifaceted and include:

1. Assessment and Monitoring of Cardiac Output

Accurate and continuous assessment is vital for early detection of complications and timely intervention, including CPR readiness assessment.

Assess heart rate and rhythm. Compensatory tachycardia is common in patients with low blood pressure due to decreased cardiac output. Auscultate the apical pulse for a full minute and palpate the radial pulse simultaneously. Detect dysrhythmias, which can further compromise cardiac output and potentially lead to cardiac arrest requiring CPR.

Auscultate blood pressure and monitor for orthostatic hypotension. Orthostatic hypotension indicates reduced preload, compromising cardiac output. Measure blood pressure and heart rate in supine, sitting, and standing positions to assess for orthostatic changes. Severe orthostatic hypotension can be a precursor to more critical conditions where CPR might be necessary.

Check peripheral pulses. Weak pulses indicate reduced stroke volume and cardiac output. Evaluate all peripheral pulses bilaterally for quality and strength. Diminished or absent pulses signal compromised perfusion, increasing the risk of cardiac arrest and the need for CPR.

Assess for jugular vein pulsations. Jugular vein distension with the head elevated at 45° to 90° suggests increased CVP and right-sided heart failure, indicating significant cardiac dysfunction that may progress to a point requiring CPR.

Perform capillary refill test (CRT). Prolonged capillary refill time indicates inadequate arterial perfusion to the extremities. While not definitive on its own, it contributes to the overall assessment of perfusion status and potential CPR needs.

Auscultate heart sounds for gallops (S3, S4); auscultate breath sounds. New onset gallop rhythm, tachycardia, and lung crackles can indicate heart failure. Coarse crackles and severe dyspnea suggest pulmonary edema. S3 indicates reduced left ventricular ejection, and S4 indicates reduced left ventricular compliance. These signs highlight worsening cardiac function and increasing CPR preparedness.

Note skin color, temperature, and moisture. Cool, clammy skin and diaphoresis suggest low cardiac output and sympathetic nervous system stimulation, potentially indicating cardiogenic shock or acute myocardial infarction, conditions that may necessitate CPR.

Check for alterations in the level of consciousness. Decreased cerebral perfusion and hypoxia manifest as irritability, restlessness, and confusion. Changes in mental status can indicate inadequate brain perfusion due to compromised cardiac output, a critical sign warranting close monitoring and potential CPR readiness.

Note respiratory rate, rhythm, and breath sounds. Shallow, rapid respirations are characteristic of decreased cardiac output. Crackles indicate fluid buildup. Assess for dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND), all signs of respiratory distress secondary to cardiac dysfunction and potential indicators for CPR readiness.

Assess oxygen saturation with pulse oximetry at rest and during activity. Decreased oxygen saturation is an early sign of reduced cardiac output, especially during exertion or recumbency. Hypoxemia is common and signals the need for oxygen support and heightened CPR vigilance.

Determine the pattern of sleep and rest. Sleep disturbances like paroxysmal nocturnal dyspnea (PND) and sleep-disordered breathing are associated with worsening cardiac disease. Assess sleep patterns to identify exacerbations and increased CPR risk.

Note chest pain. Assess location, radiation, severity, quality, duration, and associated symptoms. Chest pain suggests myocardial ischemia, which can compromise cardiac output and potentially lead to cardiac arrest and the need for CPR.

Place on a cardiac monitor; monitor for dysrhythmias, especially atrial fibrillation. Continuous ECG monitoring is crucial to detect dysrhythmias that can further reduce cardiac output and increase the risk of cardiac arrest. Atrial fibrillation is common in heart failure and can lead to thromboembolic events.

Monitor bowel function. Provide stool softeners as ordered. Instruct the patient to avoid straining during defecation. Constipation and straining (Valsalva maneuver) can lead to dysrhythmias and decreased cardiac function, particularly in patients with pre-existing cardiac conditions.

Observe the patient for understanding and adherence to the medical regimen. Nonadherence to diet and medications can rapidly worsen the patient’s condition. Close observation and follow-up are essential.

Monitor blood pressure, pulse, and condition before administering cardiac medications. Assess patient tolerance to current medications before administering cardiac medications like ACE inhibitors, digoxin, and beta-blockers. Hold medications and notify the healthcare provider if heart rate or blood pressure is too low.

Inspect fluid balance and weight gain. Weigh the patient regularly. Fluid retention and weight gain indicate compromised regulatory mechanisms and increased fluid volume. Daily weights are more sensitive indicators of fluid retention than intake and output measurements.

Check for pedal and sacral edema. Edema is a hallmark of heart failure. Assess for pitting edema in peripheral and dependent areas.

Monitor urine output. Reduced urine output indicates decreased renal perfusion due to decreased cardiac output. Hourly urine output monitoring is crucial for acutely ill patients.

Assess beta-type natriuretic peptide (BNP). Elevated BNP levels indicate ventricular wall expansion due to increased pressure, making it a useful diagnostic and prognostic tool in heart failure.

If hemodynamic monitoring is in place, assess CVP, PADP, PCWP, cardiac output, and cardiac index. Hemodynamic monitoring provides objective data to guide therapy. CVP reflects right-sided filling pressures, while PADP and PCWP reflect left-sided volumes.

Closely monitor for symptoms of heart failure and decreased cardiac output. Recognize and document signs and symptoms of heart failure, including venous congestion, edema, and low cardiac output manifestations like fatigue and breathlessness.

Assess for reports of fatigue and reduced activity tolerance. Fatigue and exertional dyspnea are common with low cardiac output. Monitor patient response to activity to guide activity progression.

Ascertain contributing factors to guide care planning. Identify underlying causes of decreased cardiac output, such as hypertension, coronary disease, or heart failure, to tailor treatment.

Monitor electrocardiogram (ECG) for rate, rhythm, and ectopy. Detect cardiac dysrhythmias that may arise from low perfusion, acidosis, or hypoxia, and further compromise cardiac output.

Review results of EKG and chest X-ray. EKG can reveal previous MI or left ventricular hypertrophy. Chest X-ray can show pulmonary edema, pleural effusions, or cardiomegaly.

Examine laboratory data, especially ABGs and electrolytes, including potassium. Monitor for electrolyte imbalances, especially hypokalemia, which can increase the risk of cardiac glycoside toxicity. ABG analysis is indicated for respiratory distress or hypoxemia.

Monitor laboratory tests such as CBC, sodium level, BUN, and serum creatinine. Routine blood work provides insights into heart failure etiology and decompensation. Hyponatremia, elevated BUN and creatinine can indicate advanced heart failure and renal insufficiency.

Assess the availability of social support. Adequate social support systems can improve self-care and positive cardiovascular outcomes, especially for patients managing complex cardiac conditions at home, and ensure better adherence to long-term management plans that reduce the risk of cardiac emergencies requiring CPR.

2. Promoting Adequate Tissue Perfusion and Venous Return

Improving tissue perfusion and venous return is essential to combat hypoxia and organ dysfunction resulting from decreased cardiac output.

Instruct the patient in performing a 6-minute walk test. Assess exercise tolerance and identify the ventricular rate associated with activity to guide activity recommendations.

Place the patient in a comfortable position that facilitates breathing. Position the patient in semi-Fowler’s or high-Fowler’s position to reduce preload and pulmonary congestion. For hypovolemia, supine positioning may be used to increase venous return.

Maintain adequate ventilation and perfusion through proper positioning. Upright positions reduce preload, while supine positioning increases venous return depending on the underlying cause of decreased cardiac output.

During acute events, ensure the patient remains on bed rest or maintains an activity level that does not compromise cardiac output. Activity restriction may be necessary during acute phases to reduce cardiac workload and promote recompensation. Gradually increase activity as tolerated.

Encourage the patient to engage in exercise training as indicated. Supervised exercise programs with endurance and resistance training can improve stroke volume and overall cardiac function over time.

Apply music therapy to decrease anxiety and improve cardiac function. Music therapy can promote relaxation, reduce stress hormones, and improve blood pressure, potentially enhancing cardiac function.

Instruct maneuvers that can alleviate orthostatic hypotension. Teach physical counter maneuvers like leg crossing, muscle tensing, and bending forward to improve venous return and manage orthostatic hypotension symptoms.

Ensure balloon tip deflation after PAWP measurement. After measuring pulmonary artery wedge pressure (PAWP), deflate the balloon to restore pulmonary artery blood flow and prevent complications.

Apply waist-high compression stockings or abdominal binders as indicated. Compression stockings and abdominal binders can reduce venous pooling and improve stroke volume, particularly in patients with orthostatic hypotension.

Administer oxygen therapy as prescribed. Maintain oxygen saturation above 90%. Oxygen therapy and noninvasive positive pressure ventilation (NIPPV) provide respiratory support and prevent intubation when needed.

Administer medications as prescribed, noting side effects and toxicity. Administer prescribed medications, such as digitalis, diuretics, vasodilators, antiarrhythmics, ACE inhibitors, and inotropes, and monitor for side effects and toxicity.

Regular assessment of peripheral pulses is a fundamental nursing intervention for patients with decreased cardiac output, helping to monitor tissue perfusion.

3. Management of Angina Pectoris or Chest Pain

Managing angina is crucial to reduce myocardial ischemia and improve patient comfort.

If chest pain is present, have the patient lie down, monitor cardiac rhythm, give oxygen, run an ECG, medicate for pain, and notify the healthcare provider. These actions aim to increase oxygen delivery to the myocardium and relieve chest pain promptly, preventing potential cardiac arrest scenarios where CPR might be required.

Position the patient in a semi-Fowler position during acute angina episodes. This position reduces myocardial oxygen demand during angina episodes.

Encourage smoking cessation. Smoking cessation significantly reduces adverse cardiac effects and slows atherosclerosis progression.

Promote a well-balanced diet low in saturated fat and sodium. Recommend a heart-healthy diet rich in fruits, vegetables, and unsaturated fats, while limiting saturated fats and sodium intake.

Plan the patient’s schedule for adequate rest and activities. Balance activity and rest to prevent angina and manage fatigue. Alternate activities with rest periods.

Instruct the patient to avoid extremes in temperature. Extremes in temperature, especially cold, can trigger angina. Advise patients to avoid temperature extremes during exercise.

Administer medications as prescribed.

Nitroglycerin: Administer sublingual nitroglycerin for acute angina relief and prophylactically before activities that may induce angina.
Beta-blockers: Administer beta-blockers for symptomatic angina relief and prevention of ischemic events by reducing myocardial oxygen demand and heart rate.

Administer oxygen therapy as indicated. Administer oxygen if respiratory rate increases or oxygen saturation decreases during angina episodes.

Prepare the patient for revascularization therapy as appropriate. Consider revascularization procedures like percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) for patients with severe symptoms despite maximal medical therapy.

Assist in the management of implantable cardioverter defibrillators (ICD). Manage patients with ICDs, which detect and terminate life-threatening tachyarrhythmias or fibrillation.

4. Maintaining Fluid and Nutrition Balance

Maintaining fluid and electrolyte balance is crucial for optimizing cardiac function and preventing complications.

Monitor the patient for signs and symptoms of fluid overload or dehydration. Early detection of fluid imbalances allows prompt intervention and minimizes cardiac complications.

Identify the patient’s fluid responsiveness prior to administering fluid management. Assess fluid responsiveness using passive leg raise maneuvers to guide fluid administration.

Elevate the head of the bed and assist the patient in ADLs. Head elevation reduces preload, and assistance with ADLs conserves energy and reduces cardiac workload.

Closely monitor fluid intake, including IV fluids. Maintain fluid restriction if ordered. Restrict fluids as prescribed, especially in patients with heart failure, to prevent fluid overload.

For patients with increased preload, limit fluids and sodium as ordered. Recommend a low-sodium diet (2-3 grams per day) and fluid restriction (2 liters per day) for patients with fluid overload.

Offer small, frequent meals with nutrient-dense foods. Small, frequent, nutrient-dense meals are easier to tolerate than large meals and meet nutritional needs without overtaxing the cardiovascular system.

Promote avoidance of additives and processed foods. Advise patients to avoid processed foods and food additives high in sodium.

Consider the patient’s food preferences. Incorporate patient food preferences into dietary planning and provide culturally sensitive dietary education.

Instruct the patient to check labels of commercial foods carefully. Teach patients to read food labels to identify and avoid high-sodium foods.

Caution the patient regarding ingesting large amounts of water and taking over-the-counter medications. Advise patients to be mindful of sodium content in water (especially softened water) and over-the-counter medications like antacids and laxatives.

Administer colloids or crystalloids as prescribed. Administer intravenous fluids, such as hypertonic saline or colloids, as prescribed to manage fluid balance.

Administer vasopressors as indicated. Administer vasopressors, such as norepinephrine or vasopressin, as prescribed to maintain systemic arterial pressure in acute ventricular failure.

5. Provide Education on Emergency Cardiac Support and CPR

Preparing patients and caregivers for cardiac emergencies, including CPR, is vital to improve outcomes in life-threatening situations.

Assess the patient for responsiveness and breathing to recognize cardiac arrest. Educate caregivers on recognizing cardiac arrest based on unresponsiveness and absent or abnormal breathing. For healthcare professionals, pulse checks are also included in cardiac arrest recognition.

Activate the Emergency Response System (ERS) in case of cardiac arrest. Instruct caregivers to activate EMS (911) immediately in case of cardiac arrest at home. In hospital settings, activate the Code Blue team.

Initiate CPR after recognizing cardiac arrest. Educate caregivers and healthcare professionals on initiating CPR promptly upon recognizing cardiac arrest. Teach chest compression-only CPR for lay rescuers and conventional CPR (compressions and ventilation) for healthcare professionals.

Emphasize proper hand placement, compression depth (at least 2 inches), compression rate (100-120/minute), and complete chest recoil.
Train on minimizing CPR interruptions and switching providers every two minutes to maintain effective compressions.

Administer rescue breaths as appropriate (for healthcare providers). Train healthcare providers on delivering rescue breaths using a head-tilt/chin-lift maneuver and bag-valve mask or mouth-to-mask device.

Perform defibrillation as soon as an automated external defibrillator (AED) is available. Educate on AED use and emphasize the importance of rapid defibrillation for improving survival in ventricular fibrillation or pulseless ventricular tachycardia.

Assist in the insertion of an artificial airway as appropriate (for healthcare professionals). Prepare for and assist with advanced airway placement (e.g., endotracheal intubation) to ensure a patent airway and adequate ventilation in advanced resuscitation efforts.

Provide strict follow-up monitoring and care post-resuscitation. After resuscitation and transfer to the ICU, ensure continuous ECG monitoring and frequent blood pressure assessments until hemodynamic stability is achieved. Address the underlying cause of cardiac arrest and provide ongoing supportive care.

This comprehensive approach to CPR education ensures that both healthcare professionals and laypersons are equipped to respond effectively in cardiac emergencies, improving patient outcomes and survival rates in situations of decreased cardiac output progressing to cardiac arrest.

6. Client and Caregiver Education

Comprehensive education empowers patients and families to actively participate in managing their condition and recognizing when to seek help, including understanding the role of CPR in emergencies.

Identify an emergency plan, including CPR. Develop and communicate a clear emergency plan that includes CPR training for caregivers, recognizing the critical role of CPR in managing cardiac arrest secondary to decreased cardiac output.

Assess the client’s and family members’ ability to recognize cardiac symptoms. Educate patients and families on recognizing cardiac symptoms and appropriate responses, including when to activate EMS and initiate CPR.

Assess the client’s and caregiver’s understanding of the disease process and therapeutic regimen. Provide clear, simple explanations of the disease process, treatment plan, and medications. Clarify any misinformation and address concerns.

Advise the client to use a commode or urinal for toileting and avoid using a bedpan. Encourage commode or urinal use to minimize cardiac strain and promote mobility.

Encourage the client to adopt a healthy lifestyle. Emphasize smoking cessation, limiting alcohol intake, and adopting a heart-healthy lifestyle.

Educate the client and significant others about the disease process, complications, medications, daily weight monitoring, and when to contact the healthcare provider. Provide detailed education on self-management, symptom recognition, medication management, and when to seek medical attention.

Aid the family to adapt daily living patterns to support life changes that maintain improved cardiac functioning. Support families in adapting daily routines to accommodate lifestyle changes needed for improved cardiac health.

Educate clients on the need for and how to incorporate lifestyle changes. Provide psychoeducational programs on stress management and health education to promote long-term adherence to lifestyle modifications and reduce recurrence of cardiac events. Encourage family CPR training.

Provide emotional support. Offer emotional support, listen to concerns, answer questions, and connect patients with support groups or counseling services.

6.1. Provide education on the proper care of an implantable cardiac device (ICD).

Instruct the client on how to avoid infection at the insertion site. Educate on infection prevention measures at the ICD insertion site, including regular site inspection and reporting signs of infection.

Educate on checking the pulse regularly. Teach patients to monitor their pulse daily and report any sudden changes in heart rate, which may indicate ICD malfunction.

Explain the importance of avoiding electromagnetic interference. Advise patients to avoid strong magnetic fields that can interfere with ICD function.

Instruct the client to adhere to activity limitations. Provide guidelines on activity restrictions, especially arm movements, in the initial post-implantation period.

Provide precautions and safety measures. Instruct patients to keep a log of ICD discharges and wear a medical alert bracelet.

Explain to caregivers and family members the effects of the ICD on them. Inform family members that they may feel a shock if they touch the patient during ICD discharge, but it is not harmful.

Additional interventions: Refer to comprehensive heart failure nursing care plans for further interventions related to decreased cardiac output.

Related Nursing Care Plans

Conditions and diseases related to decreased cardiac output include:

Heart Failure Nursing Care Plan
Myocardial Infarction Nursing Care Plan
Cardiogenic Shock Nursing Care Plan
Hypertension Nursing Care Plan
Arrhythmias Nursing Care Plan
Fluid Volume Excess Nursing Care Plan
Fluid Volume Deficit Nursing Care Plan

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources:

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

Utilizing resources like the Nursing Diagnosis Handbook is essential for nurses to enhance their diagnostic skills and care planning for conditions like decreased cardiac output.

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