Decreased Cardiac Output Nursing Diagnosis: Understanding Risks, Causes, and Care

Cardiac output (CO) is a vital measurement in healthcare, representing the volume of blood the heart pumps each minute, expressed in liters per minute (L/min). This crucial metric is determined by multiplying the heart rate (HR) by the stroke volume (SV)—the amount of blood ejected from the left ventricle with each heartbeat. Optimal cardiac output ensures that the body’s tissues and organs receive sufficient oxygen and nutrients to function correctly. However, various factors can compromise this delicate balance, leading to decreased cardiac output, a significant concern in nursing practice.

Decreased cardiac output occurs when the heart cannot pump enough blood to meet the body’s metabolic demands. This condition isn’t a disease itself but rather a physiological state resulting from underlying cardiovascular or systemic issues. Understanding the Risk For Decreased Cardiac Output Nursing Diagnosis is paramount for nurses to provide effective and timely patient care. This article delves into the intricacies of decreased cardiac output, exploring its causes, signs and symptoms, essential nursing assessments, targeted interventions, and comprehensive care plans.

What is Decreased Cardiac Output?

To fully grasp the implications of decreased cardiac output, it’s essential to understand the components that govern it. As mentioned, cardiac output is the product of heart rate and stroke volume. However, stroke volume itself is influenced by three key factors:

• Preload: This refers to the volume of blood in the ventricles at the end of diastole (filling phase). Think of it as the “stretch” on the heart muscle before contraction. Conditions that decrease preload, such as hypovolemia (low blood volume), can directly reduce stroke volume and consequently, cardiac output.
• Afterload: This is the resistance the heart must overcome to eject blood during systole (contraction). Increased afterload, often due to hypertension or vasoconstriction, makes it harder for the heart to pump effectively, reducing stroke volume and cardiac output.
• Contractility: This represents the force of ventricular contraction. Factors that weaken the heart muscle, like myocardial infarction (heart attack) or heart failure, diminish contractility, leading to decreased stroke volume and reduced cardiac output.

When any of these factors are compromised, the heart’s ability to pump blood efficiently is impaired, resulting in decreased cardiac output. This can have widespread effects on the body, as tissues and organs are deprived of adequate oxygen and nutrients.

Risk Factors and Causes of Decreased Cardiac Output

Numerous conditions can contribute to decreased cardiac output. These can be broadly categorized into cardiovascular and non-cardiovascular causes:

Cardiovascular Conditions

• Hypertension: Chronic high blood pressure increases afterload, forcing the heart to work harder. Over time, this can lead to heart muscle hypertrophy (enlargement) and eventual heart failure, reducing cardiac output.
• Coronary Artery Disease (CAD): CAD involves the narrowing or blockage of coronary arteries, which supply blood to the heart muscle. This can lead to myocardial ischemia (reduced blood flow) and infarction, damaging the heart muscle and impairing contractility, thus decreasing cardiac output.
• Myocardial Ischemia/Infarction: As mentioned above, ischemia and infarction directly damage the heart muscle. Ischemia reduces the oxygen supply, weakening the heart’s pumping ability, while infarction causes permanent muscle damage, both leading to decreased contractility and cardiac output.
• Congestive Heart Failure (CHF): Heart failure is a condition where the heart cannot pump enough blood to meet the body’s needs. It can result from various underlying conditions and is a primary cause of decreased cardiac output. In heart failure, the heart muscle may be weakened, stiff, or both, leading to reduced contractility and/or impaired filling.
• Genetic Cardiac Disease: Certain genetic conditions can predispose individuals to structural heart defects or cardiomyopathies (diseases of the heart muscle). These conditions can impair heart function from birth or develop over time, leading to decreased cardiac output.
• Arrhythmias: Irregular heart rhythms can significantly impact cardiac output. Tachyarrhythmias (fast heart rates) may not allow adequate time for ventricular filling, reducing stroke volume. Bradyarrhythmias (slow heart rates) reduce the number of contractions per minute, directly lowering cardiac output. Atrial fibrillation, a common arrhythmia, can lead to irregular and often rapid heart rates, impairing effective pumping.
• Cardiac Structural Abnormalities: Valvular heart disease, such as stenosis (narrowing) or regurgitation (leaking) of heart valves, can disrupt blood flow and increase the workload on the heart. Congenital heart defects, present at birth, can also interfere with normal heart function and lead to decreased cardiac output.
• Pericardial Effusions: An excessive buildup of fluid in the pericardial sac (the sac surrounding the heart) can compress the heart, restricting its ability to fill and pump effectively, leading to decreased cardiac output.
• Cardiac Tamponade: This is a severe form of pericardial effusion where the fluid accumulation is rapid and significant, causing critical compression of the heart. Cardiac tamponade is a medical emergency that drastically reduces cardiac output and can be life-threatening.

Non-Cardiovascular Conditions

• Shock: Various types of shock (hypovolemic, cardiogenic, septic, anaphylactic, neurogenic) share a common feature of inadequate tissue perfusion. In cardiogenic shock, the heart itself is the problem, failing to pump effectively. In other types of shock, factors like decreased blood volume (hypovolemic) or widespread vasodilation (septic, anaphylactic, neurogenic) indirectly lead to decreased cardiac output as the heart struggles to maintain adequate blood pressure and perfusion.

It’s crucial to remember that this is not an exhaustive list. Many other factors, both direct and indirect, can contribute to decreased cardiac output. Furthermore, the onset of signs and symptoms can be gradual, making early recognition challenging. Nurses play a vital role in recognizing subtle indicators and understanding how various conditions can ultimately impact a patient’s cardiac output.

Signs and Symptoms of Decreased Cardiac Output

The signs and symptoms of decreased cardiac output are diverse and can manifest both physiologically and psychologically. These clinical indicators arise from the body’s attempt to compensate for reduced blood flow and oxygen delivery.

Physiological Signs and Symptoms

• Hypotension: Low blood pressure is a hallmark sign, as the heart struggles to maintain adequate pressure due to reduced pumping capacity.
• Hypercapnia: In severe cases, decreased cardiac output can lead to impaired gas exchange in the lungs, resulting in increased carbon dioxide levels in the blood (hypercapnia).
• Cardiac Arrhythmias: The heart may attempt to compensate for decreased output by altering its rhythm. Arrhythmias can be both a cause and a consequence of decreased cardiac output.
• Chest Pain: Myocardial ischemia, resulting from reduced blood flow to the heart muscle, can cause angina (chest pain).
• Poor Tissue Perfusion: This is evident through various signs:
  • Diminished Peripheral Pulses: Pulses in the extremities (e.g., radial, pedal) may be weak or difficult to palpate due to reduced blood flow.
  • Clammy, Cool Skin: Reduced blood flow to the skin causes it to become cool and clammy to the touch, often with pallor (paleness).
• Dizziness/Lightheadedness/Syncope: Decreased blood flow to the brain can cause dizziness, lightheadedness, or even syncope (fainting).
• Fatigue and Weakness: Reduced oxygen delivery to muscles leads to generalized fatigue and weakness.
• Edema: Fluid retention can occur as the kidneys attempt to compensate for decreased cardiac output, leading to edema (swelling), particularly in the lower extremities.
• Decreased Urine Output: Reduced renal perfusion (blood flow to the kidneys) can result in oliguria (decreased urine output). In severe cases, anuria (absence of urine output) may occur.
• Altered Mental Status: Brain function is highly sensitive to oxygen deprivation. Decreased cardiac output can lead to confusion, restlessness, and in severe cases, decreased level of consciousness.

Psychological Signs and Symptoms

• Restlessness: A sense of unease and agitation can arise from the body’s physiological stress response to inadequate oxygenation.
• Anxiety: The feeling of being unwell, coupled with physiological changes, can trigger anxiety.
• Altered Mental Status/Confusion: As mentioned previously, neurological effects can manifest psychologically as confusion and disorientation.

It’s important to note that the presentation of decreased cardiac output can vary significantly between individuals and depends on the underlying cause and severity. A comprehensive assessment is crucial for accurate diagnosis and timely intervention.

Nursing Assessment for Decreased Cardiac Output

A thorough nursing assessment is the cornerstone of identifying and managing decreased cardiac output. It involves gathering both subjective and objective data to understand the patient’s condition comprehensively.

1. Monitor Heart Rate and Blood Pressure:

   • Rationale: The sympathetic nervous system is activated in response to low cardiac output to compensate. Initially, this may cause an increased heart rate (tachycardia) and potentially elevated blood pressure as the body tries to maintain perfusion. However, as the condition worsens, blood pressure often drops (hypotension) as the heart’s compensatory mechanisms fail.
   • Action: Regularly monitor heart rate and blood pressure. Note any trends, including tachycardia, bradycardia, hypertension (initially), and hypotension.

2. Monitor Breath Sounds, Respiratory Rate and Pattern, and Oxygen Saturation:

   • Rationale: Decreased cardiac output can lead to pulmonary congestion as blood backs up into the lungs. This can manifest as shortness of breath (dyspnea), increased respiratory rate, and abnormal breath sounds like crackles (rales). Oxygen saturation (SpO2) provides objective data on the patient’s oxygenation status.
   • Action: Assess respiratory rate, pattern (depth and effort), and breath sounds. Auscultate for adventitious sounds, particularly crackles. Continuously or intermittently monitor oxygen saturation using pulse oximetry.

3. Monitor Heart Rhythm:

   • Rationale: Decreased cardiac output can both cause and be caused by cardiac arrhythmias. Atrial fibrillation is a common arrhythmia associated with this condition. Ventricular tachycardia and ventricular fibrillation are life-threatening arrhythmias that can severely compromise cardiac output and require immediate intervention.
   • Action: Continuously monitor heart rhythm using ECG (electrocardiogram) monitoring, especially in acute settings. Identify and document any arrhythmias.

4. Monitor Heart Sounds:

   • Rationale: Normal heart sounds (S1 and S2) may be diminished with poor heart function. Abnormal heart sounds, such as S3 and S4, can indicate heart failure and decreased cardiac output.
   • Action: Auscultate heart sounds at all auscultatory areas. Note the intensity of S1 and S2. Listen for the presence of S3 or S4, which are abnormal diastolic sounds.

5. Assess Peripheral Pulses:

   • Rationale: Decreased cardiac output reduces blood flow to the periphery, leading to weak or diminished peripheral pulses.
   • Action: Palpate peripheral pulses (radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial) bilaterally. Assess pulse strength (bounding, strong, weak, thready, absent) and regularity.

6. Assess Skin Color and Temperature:

   • Rationale: Poor tissue perfusion due to decreased cardiac output results in reduced oxygen delivery to the skin. This can manifest as pale, cool, and clammy skin. Cyanosis (bluish discoloration) may also be present in severe cases, indicating severe hypoxemia.
   • Action: Observe skin color (pallor, cyanosis). Palpate skin temperature (cool, warm, clammy). Assess capillary refill time, which may be prolonged with poor perfusion.

7. Assess the Patient’s Mental Status:

   • Rationale: The brain is highly sensitive to oxygen deprivation. Decreased cardiac output and reduced cerebral blood flow can lead to altered mental status, ranging from mild confusion to lethargy and unresponsiveness.
   • Action: Assess level of consciousness using scales like the Glasgow Coma Scale (GCS) if indicated. Evaluate orientation to time, place, and person. Observe for restlessness, confusion, or lethargy.

8. Assess Lab Values and Results of Imaging Studies:

   • Rationale: Laboratory tests and imaging studies can help identify underlying causes and assess the severity of decreased cardiac output. For example, cardiac enzymes can indicate myocardial damage, electrolytes imbalances can contribute to arrhythmias, and echocardiography can assess heart function and structure.
   • Action: Review relevant lab values (e.g., electrolytes, cardiac enzymes, BNP, renal function tests). Examine results of imaging studies like ECG, chest X-ray, echocardiogram, and cardiac catheterization, if performed.

9. Monitor Weight Closely:

   • Rationale: Fluid retention is a common compensatory mechanism in decreased cardiac output and heart failure. Rapid weight gain can indicate fluid accumulation.
   • Action: Weigh the patient daily, ideally at the same time each day, using the same scale. Monitor for sudden weight gain.

10. Monitor Intake and Output Closely:

    • Rationale: Monitoring fluid intake and output provides crucial information about fluid balance. Decreased urine output can be an early indicator of reduced renal perfusion secondary to decreased cardiac output.
    • Action: Accurately measure and record all fluid intake (oral, intravenous) and output (urine, drainage, emesis). Calculate fluid balance over 24-hour periods.

11. Monitor Patient’s Activity Level:

    • Rationale: Patients with decreased cardiac output often experience fatigue and reduced exercise tolerance due to insufficient oxygen delivery to muscles.
    • Action: Assess the patient’s ability to perform activities of daily living (ADLs). Note reports of fatigue, weakness, or shortness of breath with exertion.

Nursing Interventions for Decreased Cardiac Output

Nursing interventions are aimed at improving cardiac output, reducing symptoms, and addressing the underlying causes. These interventions are tailored to the individual patient’s needs and clinical presentation.

1. Administer Supplemental Oxygen as Needed:

   • Rationale: Hypoxemia (low blood oxygen levels) is common in decreased cardiac output. Supplemental oxygen increases oxygen availability to tissues, improving overall oxygenation and reducing cardiac workload.
   • Action: Administer oxygen via nasal cannula, face mask, or other appropriate delivery system as prescribed by the physician. Monitor oxygen saturation and adjust oxygen flow rate as needed to maintain target SpO2 levels.

2. Administer Prescribed Medications as Ordered:

   • Rationale: Various medications are used to manage decreased cardiac output, depending on the underlying cause. These may include:
     • ACE inhibitors and ARBs: Reduce afterload and blood pressure, improve heart function.
     • Beta-blockers: Slow heart rate, reduce myocardial oxygen demand, improve diastolic filling.
     • Diuretics: Reduce fluid volume overload, decrease preload and pulmonary congestion.
     • Inotropes (e.g., Digoxin, Dobutamine): Increase contractility, improve cardiac output (often used in acute decompensation).
     • Vasodilators (e.g., Nitroglycerin, Nitroprusside): Reduce afterload and preload, improve blood flow.
     • Antiarrhythmics: Manage arrhythmias that contribute to or result from decreased cardiac output.
   • Action: Administer medications as prescribed, ensuring correct dose, route, and timing. Monitor for therapeutic effects and potential side effects. Educate the patient and family about medications, including purpose, dosage, and potential side effects.

3. Elevate the Head of the Bed:

   • Rationale: Elevating the head of the bed (semi-Fowler’s or Fowler’s position) promotes lung expansion, reduces venous return to the heart (decreasing preload), and can ease breathing.
   • Action: Position the patient with the head of the bed elevated to 30-45 degrees or higher as tolerated, unless contraindicated.

4. Maintain Fluid Restriction and/or Sodium Restriction:

   • Rationale: Fluid and sodium retention exacerbate fluid overload in decreased cardiac output. Restrictions help minimize fluid accumulation and reduce preload.
   • Action: Implement fluid restriction and/or sodium restriction as prescribed. Educate the patient and family about dietary restrictions and strategies for managing thirst. Monitor intake and output closely.

5. Initially Allow for Bedrest During Acute Phase; Gradually Increase Activity:

   • Rationale: During acute episodes of decreased cardiac output, bedrest reduces cardiac workload and oxygen demand. As the patient stabilizes, gradual activity increases tolerance and prevents deconditioning.
   • Action: Encourage bedrest during acute phases. Once stable, gradually increase activity level as tolerated, starting with passive range of motion exercises and progressing to ambulation. Monitor patient response to activity and adjust accordingly.

6. Educate the Patient on Home Self-Care:

   • Rationale: Patient education empowers individuals to manage their condition effectively at home, improve adherence to treatment, and prevent complications.
   • Action: Provide comprehensive education on:
     • Medication management (purpose, dosage, side effects, adherence).
     • Dietary modifications (sodium restriction, fluid management).
     • Activity guidelines and exercise recommendations.
     • Recognizing signs and symptoms of worsening condition and when to seek medical attention.
     • Importance of regular follow-up appointments.

7. Place the Patient on a Cardiac Monitor:

   • Rationale: Continuous cardiac monitoring allows for early detection and management of arrhythmias, which are common and potentially life-threatening in decreased cardiac output.
   • Action: Apply cardiac monitor leads and ensure proper functioning. Continuously monitor heart rate and rhythm. Respond promptly to any arrhythmias or alarms.

8. Educate Patient to Avoid Valsalva Maneuvers:

   • Rationale: Valsalva maneuvers (straining during bowel movements, holding breath during exertion) increase intrathoracic pressure, which can transiently decrease venous return and cardiac output.
   • Action: Educate the patient about Valsalva maneuvers and how to avoid them. Encourage strategies to prevent constipation (adequate fluid and fiber intake, stool softeners if needed).

9. Implement a Rehabilitation Plan for Activity (PT and/or Cardiac Rehab):

   • Rationale: Cardiac rehabilitation programs improve functional capacity, quality of life, and reduce mortality in patients with cardiac conditions, including decreased cardiac output. Physical therapy helps improve strength and mobility.
   • Action: Refer eligible patients to cardiac rehabilitation programs and/or physical therapy as appropriate.

10. Anticipate Potential for Deterioration:

    • Rationale: Patients with decreased cardiac output are at risk for cardiac arrest and other life-threatening complications. Early recognition of deterioration allows for timely intervention and potentially prevents adverse outcomes.
    • Action: Continuously monitor vital signs, level of consciousness, and overall clinical status. Be vigilant for signs of deterioration (worsening vital signs, increased anxiety, changes in mental status). Be prepared to alert the medical team and initiate emergency measures, including resuscitation, if necessary.

Nursing Care Plans Examples

Nursing care plans provide a structured framework for prioritizing assessments and interventions, guiding both short-term and long-term care goals. Here are examples of nursing care plans for decreased cardiac output, focusing on different related factors:

Care Plan #1

Diagnostic statement:

Decreased cardiac output related to altered heart rate secondary to bundle branch block as evidenced by ECG changes and chest pain.

Expected outcomes:

• Patient will demonstrate adequate cardiac output as evidenced by:
  • Heart rate 60-100 beats per minute
  • Blood pressure 90-130/60-90 mmHg
  • Regular sinus rhythm
  • Absence of chest pain
  • Absence of dyspnea
• Patient will not manifest a decrease in the level of consciousness.

Assessment:

1. Monitor chest pain.
   • Note precipitating and relieving factors, quality, radiation, severity, time (onset and duration), location, and associated symptoms such as excessive sweating, nausea, and indigestion. Chest pain may indicate myocardial ischemia leading to decreased cardiac output. If decreased cardiac output is not adequately addressed, it will lead to end organ damage.
2. Monitor ECG findings.
   • Bundle Branch Block is an incidental ECG finding and may be asymptomatic. However, the lack of signs and symptoms does not exclude diagnosing a heart condition. A bundle branch block indicates progressive myocardial degeneration. Hence, BBB associated with cardiac symptoms may already imply a worsening underlying myocardial dysfunction.

Interventions:

1. Instruct the patient to relax during the chest pain episodes.
   • Relaxing helps decrease myocardial oxygen demand and restore supply and demand balance.
2. Administer sublingual nitroglycerin every 5 minutes for a maximum of three doses until chest pain is relieved.
   • Chest pain is indicative of myocardial ischemia requiring urgent therapy. Nitroglycerin, taken sublingually, relieves acute chest pain by dilating cardiac arteries and veins, thereby improving cardiac tissue perfusion.
3. Administer oxygen as indicated.
   • Increasing arterial oxygen saturation increases oxygen delivered to the heart.
4. Educate the patient on avoiding angina-provoking factors such as heavy meals, excessive physical exertion, extreme temperatures, emotional stress, and stimulants.
   • It is in the patient’s control not to engage in these circumstances. Knowing these factors will help in increasing compliance.
5. Refer to a cardiac rehabilitation program for education and monitored exercise.
   • Exercise training is recommended for patients experiencing decreased cardiac output. Cardiac rehabilitation can improve quality of life and functional capacity and reduce mortality.

Care Plan #2

Diagnostic statement:

Decreased cardiac output related to altered rhythm secondary to atrial fibrillation as evidenced by irregular pulse and dizziness.

Expected outcomes:

• Patient will demonstrate adequate cardiac output as evidenced by:
  • Regular sinus rhythm
  • Strong regular peripheral pulses
  • Heart rate 60-100 beats per minute
  • Blood pressure 90-130/60-90 mmHg
• Patient will not experience falls or injuries from dizziness.

Assessment:

1. Hook to ECG monitor.
   • Patients experiencing atrial fibrillation are at increased risk for thromboembolism, stroke, and premature death. Prompt management is necessary. Use continuous cardiac monitoring to assess rate and rhythm of the heart.
2. Monitor hemodynamic parameters (i.e., pulmonary wedge pressure, systemic vascular resistance, stroke volume, and cardiac output).
   • If the patient is hemodynamically unstable, central monitoring may be necessary. Cardiogenic shock may occur as a devastating complication of atrial fibrillation. Increased pulmonary wedge pressure, elevated systemic vascular resistance, or decreased stroke volume, cardiac output, and cardiac index may be present in patients with shock.
3. Identify the underlying cause of atrial fibrillation.
   • If the patient is not currently hemodynamically unstable, the nurse should focus their assessment on identifying the underlying cause of the atrial fibrillation. The nurse should ask about the timing and frequency of the episodes, previous episodes, history of cardiovascular disease and current medication usage.

Interventions:

1. Place the patient in a semi-Fowler’s to high-Fowler’s position and administer oxygen therapy as prescribed.
   • These measures help to maintain adequate ventilation and perfusion.
2. If the patient is hemodynamically unstable, anticipate immediate cardioversion.
   • Cardioversion can be completed either using a bolus of IV medication or by using electricity. In either case, the goal is to “reset” the sinoatrial node with the goal that the heart starts beating in a normal sinus pattern.
3. Administer medications as ordered.
   • Calcium channel blockers or beta blockers are usually given to reduce or prevent rapid ventricular response by controlling cardiac rate and rhythm. Depending on the patient’s risk level, they may also be prescribed a long term anticoagulant.
4. Educate the patient about lifestyle modification activities.
   • Medications: Patients should be educated on the importance of medication adherence including risks of bleeding related to anticoagulation if prescribed.
   • Diet: If the patient is on warfarin, note that foods high in Vitamin K such as kale, spinach, broccoli, animal liver products, and lettuce can affect clotting factors and make warfarin less effective.
   • Avoid alcohol and caffeine as these substances can trigger atrial fibrillation.
   • Smoking cessation: Nicotine is a cardiac stimulant that can aggravate the dysrhythmia
   • Be wary of OTC medications (e.g. cold remedies and nasal spray) that contain cardiac stimulants and worsen atrial fibrillation
   • Stress triggers atrial fibrillation. Doing relaxing techniques may help to prevent dysrhythmia.
5. Refer the patient to a community resources program for education, evaluation, and guided support to increase activity and rebuild the quality of life.
   • Depending on the aetiology and severity of the atrial fibrillation, it can be a complex disease to manage. Patients should be referred to outpatient clinics for follow up and education about disease management and lifestyle modifications. Multidisciplinary care systems designed to support clients with atrial fibrillation can improve outcomes.

Care Plan #3

Diagnostic statement:

Decreased cardiac output related to altered preload as evidenced by anxiety and altered blood pressure.

Expected outcomes:

• Patient will demonstrate adequate cardiac output as evidenced by:
  • Stable blood pressure, pulse rate, and rhythm
  • Strong peripheral pulses
  • No deterioration in the level of mentation
  • No chest pain and dyspnea
  • Adequate urinary output
• Patient will explain actions and precautions to prevent primary or secondary cardiac disease.

Assessment:

1. Monitor and report the presence and degree of symptoms.
   • Dyspnea at rest or with reduced exercise capacity, orthopnea, paroxysmal nocturnal dyspnea, nocturnal cough, distended abdomen, fatigue, or weakness are consistent with heart failure and decreased cardiac output.
2. Monitor vital signs and level of consciousness closely.
   • Patients that are experiencing current changes in blood pressure and anxiety may be experiencing an acute cardiac event. The nurse should perform frequent assessments, escalating care if the patient is decompensating.
3. Monitor intake and output (I&O). For patients with acute conditions, perform hourly monitoring of urine output and note oliguria or anuria.
   • Decreased cardiac output results in decreased renal perfusion, leading to oliguria. Monitoring I&Os is useful for monitoring treatment response.

Interventions:

1. Place the patient in a semi-Fowler’s or high Fowler’s position with legs down or in a position of comfort.
   • Elevating the head of the bed and legs in a down position may decrease the work of breathing and decrease venous return and preload.
2. Obtain an ECG and stat blood work if an acute cardiac event is suspected.
   • If the nurse suspects an acute event of decompensation is underway, the nurse should call the care team or call or code blue if they suspect the patient’s condition is deteriorating rapidly.
3. Provide a restful environment by minimizing controllable stressors and unnecessary disturbances.
   • Reducing stressors decreases cardiac workload and oxygen demand.
4. Teach the types and progression patterns of worsening heart failure symptoms.
   • This information will help the family identify an emergency, when to call a healthcare provider for help, and when to go to the hospital for urgent care.

Expected Outcomes

Across all nursing care plans for decreased cardiac output, common expected outcomes include:

• Hemodynamic Stability: Patient will achieve and maintain stable vital signs, including blood pressure, heart rate, and rhythm within normal limits for their individual baseline.
• Adequate Tissue Perfusion: Patient will demonstrate improved tissue perfusion, evidenced by strong peripheral pulses, warm and dry skin, appropriate capillary refill, and adequate urine output.
• Improved Respiratory Status: Patient will exhibit improved breathing, as indicated by appropriate oxygen saturation levels and the absence of adventitious breath sounds.
• Increased Activity Tolerance: Patient will gradually return to their baseline activity level or achieve the highest possible level of function.
• Self-Care Knowledge: Patient will verbalize understanding of self-care strategies to manage their cardiac health and prevent future episodes of decreased cardiac output.
• Absence of Complications: Patient will remain free from complications related to decreased cardiac output, such as falls, injuries, and further cardiac decompensation.

Conclusion

The risk for decreased cardiac output nursing diagnosis is a critical consideration in the care of patients with various cardiovascular and systemic conditions. Nurses play a central role in the early identification, comprehensive assessment, and effective management of this complex physiological state. By understanding the causes, recognizing the signs and symptoms, implementing targeted nursing interventions, and developing individualized care plans, nurses can significantly improve patient outcomes and enhance the quality of life for individuals at risk for or experiencing decreased cardiac output. Continuous monitoring, patient education, and a collaborative approach are essential to ensure optimal cardiac function and overall well-being.

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