Nursing Diagnosis Care Plan for Decreased Cardiac Output

Cardiac output (CO) is a vital hemodynamic parameter that reflects the heart’s efficiency in delivering oxygenated blood to the body’s tissues. Expressed as the volume of blood pumped per minute, it is calculated by multiplying the heart rate (HR) by the stroke volume (SV)—the amount of blood ejected with each heartbeat. Several factors influence cardiac output, including preload, afterload, and myocardial contractility. Decreased cardiac output occurs when the heart fails to pump a sufficient volume of blood to meet the metabolic and oxygen demands of the body. This condition can lead to inadequate tissue perfusion and a cascade of physiological imbalances.

In this comprehensive guide, we will explore the Nursing Diagnosis Care Plan For Decreased Cardiac Output, providing an in-depth understanding of its causes, signs and symptoms, nursing assessments, interventions, and expected outcomes.

Causes of Decreased Cardiac Output

Decreased cardiac output is not a disease itself but rather a physiological state resulting from various underlying conditions that compromise the heart’s pumping ability. These causes can be broadly categorized and include:

• Cardiovascular Conditions:

  • Hypertension: Chronic hypertension can lead to left ventricular hypertrophy, reducing the heart’s ability to relax and fill properly, ultimately decreasing stroke volume.
  • Coronary Artery Disease (CAD): CAD, characterized by the buildup of plaque in the coronary arteries, reduces blood flow to the heart muscle (myocardial ischemia). This ischemia can impair contractility and lead to decreased cardiac output.
  • Myocardial Infarction (MI): An MI, or heart attack, involves the death of myocardial tissue due to prolonged ischemia. The damaged heart muscle loses its contractile force, directly impacting stroke volume and cardiac output.
  • Congestive Heart Failure (CHF): Heart failure is a chronic condition where the heart is unable to pump enough blood to meet the body’s needs. It encompasses various underlying cardiac issues and is a primary cause of decreased cardiac output.
  • Cardiomyopathy: Diseases of the heart muscle itself, such as dilated, hypertrophic, or restrictive cardiomyopathy, can impair contractility and lead to reduced cardiac output.
  • Valvular Heart Disease: Conditions affecting the heart valves, such as stenosis (narrowing) or regurgitation (leaking), can impede blood flow and reduce the efficiency of the heart’s pumping action, resulting in decreased cardiac output.
  • Arrhythmias: Abnormal heart rhythms, whether too fast (tachycardia) or too slow (bradycardia), or irregular (atrial fibrillation), can disrupt the heart’s coordinated pumping action and decrease cardiac output. Certain arrhythmias like ventricular tachycardia can be particularly detrimental.
  • Cardiac Structural Abnormalities: Congenital heart defects or acquired structural issues can impair heart function from birth or develop over time, contributing to decreased cardiac output.
  • Pericardial Effusion and Cardiac Tamponade: Fluid buildup in the pericardial sac (pericardial effusion) can compress the heart. If this fluid accumulation is rapid and significant, it can lead to cardiac tamponade, severely restricting ventricular filling and drastically reducing cardiac output.

• Non-Cardiovascular Conditions:

  • Hypovolemia: Reduced blood volume due to dehydration, hemorrhage, or fluid shifts reduces preload, which in turn decreases stroke volume and cardiac output.
  • Sepsis and Septic Shock: Severe infection (sepsis) can lead to vasodilation and decreased systemic vascular resistance (afterload). While initially cardiac output may increase to compensate, in septic shock, myocardial dysfunction can develop, leading to decreased cardiac output.
  • Anemia: Severe anemia reduces the oxygen-carrying capacity of the blood. While the heart may compensate by increasing cardiac output initially, in severe cases or with underlying cardiac issues, the heart may be unable to maintain adequate output.
  • Pulmonary Embolism: A large pulmonary embolism can obstruct blood flow to the lungs, increasing afterload on the right ventricle and potentially affecting overall cardiac output.
  • Acidosis and Electrolyte Imbalances: Severe acidosis or significant electrolyte imbalances (e.g., hyperkalemia, hypocalcemia) can impair myocardial contractility and contribute to decreased cardiac output.
  • Medications: Certain medications, such as beta-blockers, calcium channel blockers, and some antiarrhythmics, can decrease heart rate or contractility, potentially leading to decreased cardiac output, especially in susceptible individuals.

It’s crucial to recognize that the clinical manifestations of decreased cardiac output may not be immediately apparent, especially in the early stages or when compensatory mechanisms are in place. However, as the condition progresses, or in acute situations, the signs and symptoms become more evident.

Signs and Symptoms of Decreased Cardiac Output

The signs and symptoms of decreased cardiac output are diverse and reflect the body’s response to inadequate tissue perfusion. They can be broadly categorized into physiological and psychological manifestations:

Physiological Signs and Symptoms:

• Cardiovascular:

  • Hypotension: Reduced cardiac output often leads to decreased blood pressure, as there is less blood being pumped into the arterial system.
  • Tachycardia or Bradycardia: The heart may attempt to compensate for reduced stroke volume by increasing heart rate (tachycardia). Conversely, some conditions can directly cause bradycardia, resulting in decreased cardiac output. Arrhythmias can also manifest.
  • Weak or Thready Peripheral Pulses: Reduced blood flow to the periphery results in diminished and weak peripheral pulses.
  • Chest Pain (Angina): Decreased coronary artery perfusion can lead to myocardial ischemia and chest pain, especially during exertion.
  • Heart Murmurs: New or worsening heart murmurs may indicate valvular dysfunction contributing to decreased cardiac output.
  • Jugular Vein Distention (JVD): In right-sided heart failure or fluid overload, blood backs up into the venous system, causing JVD.
  • S3 or S4 Heart Sounds: These abnormal heart sounds can indicate ventricular dysfunction and heart failure.

• Respiratory:

  • Dyspnea (Shortness of Breath): Pulmonary congestion due to back pressure from the failing heart leads to shortness of breath, especially on exertion or lying flat (orthopnea).
  • Tachypnea (Increased Respiratory Rate): The body attempts to compensate for decreased oxygen delivery by increasing respiratory rate.
  • Crackles (Rales): Fluid buildup in the lungs (pulmonary edema) results in crackles heard on auscultation.
  • Hypercapnia: In severe cases, impaired gas exchange can lead to increased carbon dioxide levels in the blood.

• Neurological:

  • Altered Mental Status: Reduced cerebral perfusion can cause confusion, restlessness, anxiety, irritability, and in severe cases, loss of consciousness or syncope (fainting).
  • Dizziness and Lightheadedness: Inadequate blood flow to the brain can cause dizziness and lightheadedness.

• Renal:

  • Decreased Urine Output (Oliguria): Reduced renal blood flow triggers the kidneys to retain fluid, leading to decreased urine output.

• Integumentary:

  • Cool, Clammy Skin: Blood is shunted away from the periphery to vital organs, resulting in cool, clammy, and pale skin.
  • Cyanosis: Bluish discoloration of the skin and mucous membranes, especially around the lips and nail beds, indicates poor oxygenation.
  • Edema: Fluid retention, particularly in the lower extremities (peripheral edema), can occur due to increased venous pressure.

• General:

  • Fatigue and Weakness: Inadequate oxygen delivery to tissues leads to generalized fatigue and weakness.

Psychological Signs and Symptoms:

• Anxiety: The sensation of breathlessness, chest discomfort, and feeling unwell can trigger anxiety.
• Restlessness: Altered mental status and physiological distress can manifest as restlessness.
• Confusion: As mentioned, reduced cerebral perfusion can lead to confusion and disorientation.

It is essential to conduct a thorough assessment to identify these signs and symptoms and correlate them with the patient’s medical history and risk factors to determine the underlying cause of decreased cardiac output.

Expected Outcomes for Decreased Cardiac Output

The primary goals of nursing care for patients with decreased cardiac output are to improve cardiac function, enhance tissue perfusion, and alleviate symptoms. Expected outcomes include:

• Hemodynamic Stability:

  • Patient will demonstrate adequate cardiac output as evidenced by blood pressure, heart rate, and rhythm within the patient’s normal limits or established baseline.
  • Patient will maintain adequate peripheral tissue perfusion, as evidenced by strong peripheral pulses, warm and dry skin, and capillary refill within normal limits.

• Improved Respiratory Function:

  • Patient will exhibit adequate oxygenation and ventilation, as evidenced by appropriate oxygen saturation levels (SpO2) and absence of adventitious breath sounds (e.g., crackles, wheezes).
  • Patient will report reduced dyspnea and orthopnea.

• Increased Activity Tolerance:

  • Patient will gradually return to their baseline activity level without experiencing excessive fatigue or shortness of breath.

• Fluid Balance:

  • Patient will maintain a balanced fluid volume, as evidenced by stable weight, balanced intake and output, and absence of edema.

• Patient Education and Self-Care:

  • Patient will verbalize understanding of their condition, treatment plan, and medications.
  • Patient will demonstrate the ability to perform self-care activities to manage their cardiac health, including medication adherence, dietary modifications, and lifestyle changes.
  • Patient will identify signs and symptoms of worsening cardiac output and understand when to seek medical attention.

These outcomes are individualized based on the patient’s specific condition, comorbidities, and overall health status. Regular evaluation and adjustment of the care plan are necessary to achieve these goals.

Nursing Assessment for Decreased Cardiac Output

A comprehensive nursing assessment is crucial for identifying and managing decreased cardiac output. The assessment includes both subjective and objective data collection.

Subjective Data:

• Patient History: Obtain a detailed medical history, including:
  • Past medical conditions, particularly cardiovascular diseases (hypertension, CAD, heart failure, arrhythmias, valvular disease).
  • Medications, including prescription, over-the-counter, and herbal supplements.
  • Allergies.
  • Surgical history.
  • Family history of heart disease.
  • Risk factors for cardiovascular disease (smoking, diabetes, hyperlipidemia, obesity, sedentary lifestyle).
• Symptom Assessment: Inquire about:
  • Chest pain (location, character, duration, precipitating and relieving factors).
  • Dyspnea (onset, severity, triggers, orthopnea, paroxysmal nocturnal dyspnea).
  • Fatigue and weakness (onset, severity, impact on daily activities).
  • Dizziness, lightheadedness, syncope.
  • Edema (location, severity, onset).
  • Palpitations or irregular heartbeats.
  • Cough (dry or productive, nocturnal cough).
  • Changes in urine output.
  • Anxiety or restlessness.

Objective Data:

• Vital Signs:

  • Heart Rate and Rhythm: Assess apical and peripheral pulses for rate, rhythm, and quality. Note any irregularities or arrhythmias. ECG monitoring is essential.
  • Blood Pressure: Measure blood pressure in both arms. Note hypotension or hypertension.
  • Respiratory Rate and Pattern: Observe respiratory rate, depth, and effort. Note tachypnea, dyspnea, or use of accessory muscles.
  • Oxygen Saturation (SpO2): Monitor oxygen saturation using pulse oximetry.
  • Temperature: Assess skin temperature (cool, clammy) and core temperature.

• Physical Examination:

  • Cardiovascular Assessment:
    • Auscultate Heart Sounds: Listen for normal heart sounds (S1, S2) and abnormal sounds (S3, S4, murmurs, rubs).
    • Assess Peripheral Pulses: Palpate peripheral pulses (radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial) for presence, strength, and equality.
    • Observe for Jugular Vein Distention (JVD): Assess for JVD in a semi-recumbent position.
  • Respiratory Assessment:
    • Auscultate Breath Sounds: Listen for clear breath sounds or adventitious sounds (crackles, wheezes, rhonchi).
    • Observe for Signs of Respiratory Distress: Note signs like nasal flaring, retractions, and cyanosis.
  • Neurological Assessment:
    • Assess Level of Consciousness (LOC): Evaluate alertness, orientation to time, place, and person, and responsiveness to stimuli. Use a standardized scale like the Glasgow Coma Scale if indicated.
    • Assess Mental Status: Observe for confusion, restlessness, anxiety, and cognitive impairment.
  • Renal Assessment:
    • Monitor Urine Output: Measure and record urine output. Note oliguria or anuria.
    • Assess for Edema: Examine for peripheral edema (legs, ankles, feet, sacrum), ascites, and pulmonary edema.
  • Integumentary Assessment:
    • Inspect Skin Color and Temperature: Note pallor, cyanosis, coolness, clamminess, and diaphoresis.
    • Assess Capillary Refill: Check capillary refill time in nail beds.

• Diagnostic and Laboratory Data:

  • Electrocardiogram (ECG): Obtain and interpret ECG findings to identify arrhythmias, ischemia, or conduction abnormalities (e.g., bundle branch block).
  • Echocardiogram: Review echocardiogram results to assess cardiac structure, function, ejection fraction, and valve function.
  • Cardiac Enzymes (Troponin, CK-MB): Monitor cardiac enzyme levels to detect myocardial injury.
  • Brain Natriuretic Peptide (BNP) or N-terminal pro-BNP (NT-proBNP): Review BNP levels, which are elevated in heart failure.
  • Electrolytes, Renal Function Tests (BUN, Creatinine), Liver Function Tests: Assess electrolyte balance, renal function, and liver function, as these can be affected by and contribute to decreased cardiac output.
  • Complete Blood Count (CBC): Evaluate hemoglobin and hematocrit levels to assess for anemia.
  • Arterial Blood Gases (ABGs): Monitor ABGs to assess oxygenation and acid-base balance, especially in patients with respiratory distress.
  • Chest X-ray: Review chest X-ray findings for cardiomegaly, pulmonary congestion, or pleural effusions.

Continuously monitor these assessment parameters to detect changes in the patient’s condition and guide nursing interventions.

Nursing Interventions for Decreased Cardiac Output

Nursing interventions for decreased cardiac output are aimed at improving cardiac function, optimizing oxygenation, reducing cardiac workload, and promoting patient comfort and education.

1. Optimize Oxygenation:

• Administer Supplemental Oxygen: Provide supplemental oxygen as prescribed to maintain adequate SpO2 levels. Oxygen therapy improves oxygen delivery to the myocardium and peripheral tissues.
• Elevate Head of Bed: Position the patient in a semi-Fowler’s or high-Fowler’s position to promote lung expansion and improve ventilation.
• Monitor Respiratory Status: Continuously assess respiratory rate, rhythm, depth, and breath sounds. Report any signs of respiratory distress.

2. Enhance Cardiac Function:

• Administer Prescribed Medications: Administer medications as ordered, which may include:
  • Inotropes (e.g., Digoxin, Dobutamine, Milrinone): To increase myocardial contractility and improve stroke volume.
  • Diuretics (e.g., Furosemide, Spironolactone): To reduce fluid overload, decrease preload, and alleviate pulmonary congestion.
  • Vasodilators (e.g., Nitroglycerin, Nitroprusside): To reduce afterload and improve cardiac output.
  • ACE Inhibitors or Angiotensin Receptor Blockers (ARBs): To reduce afterload and promote vasodilation.
  • Beta-Blockers (in stable heart failure): To reduce heart rate, decrease myocardial oxygen demand, and improve diastolic filling.
  • Antiarrhythmics (e.g., Amiodarone, Metoprolol): To control arrhythmias and maintain a regular heart rhythm.
• Monitor Hemodynamic Parameters: Closely monitor heart rate, blood pressure, ECG, and potentially invasive hemodynamic parameters (e.g., central venous pressure, pulmonary artery wedge pressure) as indicated.
• Fluid Management:
  • Fluid Restriction: Implement fluid restriction as prescribed to manage fluid overload and reduce preload.
  • Monitor Intake and Output: Accurately measure and record fluid intake and output to assess fluid balance.
  • Sodium Restriction: Educate the patient about sodium restriction to minimize fluid retention.

3. Reduce Cardiac Workload:

• Promote Rest and Energy Conservation: Encourage rest periods and cluster nursing activities to minimize patient exertion and reduce myocardial oxygen demand.
• Bedrest During Acute Phase: During acute episodes, bedrest may be necessary to reduce cardiac workload. Gradually increase activity as the patient’s condition stabilizes.
• Manage Pain and Anxiety: Address chest pain and anxiety promptly, as these can increase sympathetic nervous system activity and cardiac workload. Provide pain relief measures and anxiety-reducing interventions.
• Avoid Valsalva Maneuvers: Educate patients to avoid Valsalva maneuvers (e.g., straining during bowel movements) as they can increase cardiac workload.

4. Promote Patient Education and Self-Care:

• Educate Patient and Family: Provide comprehensive education about decreased cardiac output, its causes, symptoms, treatment plan, medications, lifestyle modifications, and self-care measures.
• Medication Education: Educate patients about their medications, including purpose, dosage, administration, side effects, and importance of adherence.
• Lifestyle Modifications: Counsel patients on lifestyle modifications to improve cardiac health, such as:
  • Dietary Changes: Low-sodium diet, heart-healthy diet (DASH diet, Mediterranean diet).
  • Smoking Cessation: Provide resources and support for smoking cessation.
  • Alcohol and Caffeine Limitation: Advise patients to limit or avoid alcohol and caffeine intake.
  • Regular Exercise (Cardiac Rehabilitation): Encourage participation in cardiac rehabilitation programs and gradual exercise progression as tolerated.
  • Stress Management Techniques: Teach stress reduction techniques (relaxation exercises, deep breathing, meditation).
• Home Self-Care Education: Instruct patients on home self-monitoring (weight, blood pressure, pulse), recognizing signs and symptoms of worsening condition, and when to seek medical attention.
• Refer to Cardiac Rehabilitation: Refer patients to cardiac rehabilitation programs for structured exercise, education, and support.

5. Monitor for Complications and Deterioration:

• Continuous Cardiac Monitoring: Place the patient on a cardiac monitor to detect arrhythmias and changes in heart rate and rhythm.
• Monitor Vital Signs and Clinical Status Closely: Frequently assess vital signs, LOC, respiratory status, and other relevant parameters to detect early signs of deterioration.
• Anticipate Potential Deterioration: Be vigilant for signs of worsening cardiac output, such as declining vital signs, altered mental status, increasing dyspnea, or chest pain. Be prepared to alert the medical team and initiate emergency measures if needed.

These nursing interventions are tailored to the individual patient’s needs and are implemented collaboratively with the healthcare team. Continuous evaluation and adjustment of the care plan are essential to optimize patient outcomes.

Nursing Care Plans Examples for Decreased Cardiac Output

Here are three examples of nursing care plans for decreased cardiac output, illustrating different underlying causes and focuses of care:

Care Plan #1: Decreased Cardiac Output related to Bradycardia

Diagnostic Statement: Decreased cardiac output related to excessively slow heart rate secondary to bradycardia as evidenced by heart rate of 50 bpm, dizziness, and fatigue.

Expected Outcomes:

• Patient will maintain a heart rate within the acceptable range (60-100 bpm).
• Patient will report resolution of dizziness and fatigue.
• Patient will demonstrate improved activity tolerance.

Nursing Interventions:

1. Monitor Heart Rate and Rhythm: Continuously monitor heart rate and rhythm via ECG. Assess apical and peripheral pulses regularly.
2. Identify Underlying Cause of Bradycardia: Review medication history, electrolyte levels, and potential underlying medical conditions contributing to bradycardia.
3. Administer Medications as Prescribed: Administer medications to increase heart rate as ordered (e.g., atropine).
4. Prepare for Potential Pacing: If bradycardia is severe or symptomatic and unresponsive to medications, prepare for temporary or permanent pacing as indicated.
5. Assess for Signs and Symptoms of Decreased Cardiac Output: Monitor for hypotension, dizziness, fatigue, altered mental status, and decreased urine output.
6. Promote Rest and Energy Conservation: Encourage rest periods and assist with activities of daily living to reduce fatigue.
7. Educate Patient about Bradycardia and Treatment: Explain the cause of bradycardia, treatment plan, medications, and follow-up care.

Care Plan #2: Decreased Cardiac Output related to Fluid Overload

Diagnostic Statement: Decreased cardiac output related to increased preload secondary to fluid volume overload as evidenced by peripheral edema, crackles in lungs, and shortness of breath.

Expected Outcomes:

• Patient will demonstrate improved cardiac output as evidenced by reduced edema, clear breath sounds, and improved breathing.
• Patient will achieve fluid balance as evidenced by stable weight and balanced intake and output.
• Patient will adhere to fluid and sodium restrictions.

Nursing Interventions:

1. Assess Fluid Status: Monitor weight daily, assess for peripheral edema, auscultate lung sounds for crackles, and monitor intake and output.
2. Administer Diuretics as Prescribed: Administer diuretics as ordered to promote fluid excretion and reduce preload.
3. Fluid Restriction: Implement and maintain prescribed fluid restrictions.
4. Sodium Restriction Education: Educate the patient about sodium restriction and provide guidance on low-sodium diet choices.
5. Elevate Legs: Elevate the patient’s legs when sitting or lying down to promote venous return and reduce edema.
6. Monitor Electrolyte Levels: Monitor electrolyte levels, especially potassium, during diuretic therapy.
7. Educate Patient about Heart Failure Management: Provide comprehensive education about heart failure, fluid management, medications, diet, and lifestyle modifications.

Care Plan #3: Decreased Cardiac Output related to Myocardial Infarction

Diagnostic Statement: Decreased cardiac output related to reduced contractility secondary to myocardial infarction as evidenced by chest pain, ECG changes, and hypotension.

Expected Outcomes:

• Patient will have pain effectively managed.
• Patient will demonstrate hemodynamic stability as evidenced by stable blood pressure and heart rate.
• Patient will receive timely and appropriate treatment for myocardial infarction.

Nursing Interventions:

1. Pain Assessment and Management: Assess chest pain using a pain scale and administer analgesics as prescribed (e.g., morphine, nitroglycerin).
2. Cardiac Monitoring: Continuously monitor ECG for arrhythmias and ST-segment changes.
3. Oxygen Therapy: Administer supplemental oxygen to maintain adequate SpO2.
4. Administer Medications as Ordered: Administer medications as prescribed, such as:
   • Antiplatelets (e.g., Aspirin, Clopidogrel): To prevent further clot formation.
   • Anticoagulants (e.g., Heparin): To prevent thrombus extension.
   • Nitrates (e.g., Nitroglycerin): To relieve chest pain and improve coronary blood flow.
   • Beta-Blockers: To reduce myocardial oxygen demand and prevent arrhythmias.
   • ACE Inhibitors: To reduce afterload and improve long-term outcomes.
5. Monitor Hemodynamic Status: Closely monitor blood pressure, heart rate, and rhythm. Be prepared to manage hypotension or arrhythmias.
6. Promote Rest and Reduce Anxiety: Provide a calm and restful environment. Address patient anxiety and provide emotional support.
7. Educate Patient about Post-MI Care: Educate the patient about medications, cardiac rehabilitation, lifestyle modifications, and follow-up care after myocardial infarction.

These care plan examples provide a framework for nursing care. Individualized care plans should be developed based on a thorough assessment of each patient’s unique needs and clinical presentation.

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