Actual Nursing Care Plan example from Nursing for Life Organization

1. Nursing Care Plan
"Decreased cardiac output"
Patient
Problem
Actual ( )
Nursing diagnosis Decreased cardiac output related to (contributing factor
according to the patient’s condition)
Subjective
Data
 According to the nurse’s observation.
Objective
Data
 According to the patient description.
Objectives
Short
term
In 2 days, the patient will…
 Explain actions and precautions to take for cardiac disease.
Long
term
In 2 weeks, the patient will…
 remain free of side effects from the medications used to achieve adequate
cardiac output.
 demonstrate adequate cardiac output as evidenced by blood pressure and
pulse rate and rhythm within normal parameters for patient; strong
peripheral pulses; and an ability to tolerate activity without symptoms of
dyspnea, syncope, or chest pain.
Nursing
intervention
Assessment
 Assess skin color, temperature, and moisture.
- Rationale: Cold, clammy, and pale skin is secondary to compensatory
increase in sympathetic nervous system stimulation and low cardiac
output and oxygen desaturation.
 Assess level of consciousness.
- Rationale: Decreased cerebral perfusion and hypoxia are reflected in
irritability, restlessness, and difficulty concentrating. Aged patients are
particularly susceptible to reduced perfusion.
 Assess heart rate and blood pressure.
- Rationale: Most patients have compensatory tachycardia and
significantly low blood pressure in response to reduced cardiac output.

2.  Assess peripheral pulses, including capillary refill.
- Rationale: Weak pulses are present in reduced stroke volume and cardiac
output. Capillary refill is sometimes slow or absent.
 Assess fluid balance and weight gain. Weigh patient regularly prior to
breakfast. Check for pedal and sacral edema.
- Rationale: Compromised regulatory mechanisms may result in fluid and
sodium retention. Body weight is a more sensitive indicator of fluid or
sodium retention than intake and output.
 Assess heart sounds for gallops (S3, S4).
- Rationale: S3 indicates reduced left ventricular ejection and is a class sign
of left ventricular failure. S4 occurs with reduced compliance of the left
ventricle, which impairs diastolic filling.
 Assess respiratory rate, rhythm, and breath sounds. Identify any presence
of paroxysmal nocturnal dyspnea (PND) or orthopnea.
- Rationale: Shallow, rapid respirations are characteristics of decreased
cardiac output. Crackles indicate fluid buildup secondary to impaired left
ventricular emptying.
 Assess symptoms for chest pain.
- Rationale: Low cardiac output can further decrease myocardial perfusion,
resulting in chest pain.
 Assess for reports of fatigue and reduced activity tolerance.
- Rationale: Fatigue and exertional dyspnea are common problems with
low cardiac output states. Close monitoring of the patient’s response
serves as a guide for optimal progression of activity.
 Assess electrocardiogram (ECG) for rate, rhythm, and ectopy.
- Rationale: Cardiac dysrhythmias may occur from low perfusion, acidosis,
or hypoxia. Tachycardia, bradycardia, and ectopic beats can further
compromise cardiac output. Older patients are especially sensitive to the
loss of atrial kick in atrial fibrillation.

3. interventions
 Record intake and output. If patient is acutely ill, measure hourly urine
output and note decreases in output.
- Rationale: Reduced cardiac output results in reduced perfusion of the
kidneys, with a resulting decrease in urine output.
 For patients with increased preload, limit fluids and sodium as ordered.
- Rationale: Fluid restriction decreases extracellular fluid volume and
reduces demands on the heart.
 Closely monitor fluid intake including IV lines. Maintain fluid restriction if
ordered.
- Rationale: In patients with decreased cardiac output, poorly functioning
ventricles may not tolerate increased fluid volumes.
 Auscultate heart sounds; note rate, rhythm, presence of S3, S4, and lung
sounds.
- Rationale: The new onset of a gallop rhythm, tachycardia, and fine
crackles in lung bases can indicate onset of heart failure. If patient
develops pulmonary edema, there will be coarse crackles on inspiration
and severe dyspnea.
 Closely monitor for symptoms of heart failure and decreased cardiac
output, including diminished quality of peripheral pulses, cold and
clammy skin and extremities, increased respiratory rate, presence of
paroxysmal nocturnal dyspnea or orthopnea, increased heart rate, neck
vein distention, decreased level of consciousness, and presence of edema.
- Rationale: As these symptoms of heart failure progress, cardiac output
declines.
 Note chest pain. Identify location, radiation, severity, quality, duration,
associated manifestations such as nausea, and precipitating and relieving
factors.
- Rationale: Chest pain/discomfort is generally suggestive of an inadequate
blood supply to the heart, which can compromise cardiac output. Patients
with heart failure can continue to have chest pain with angina or can re-
infect.
 If chest pain is present, have patient lie down, monitor cardiac rhythm,
give oxygen, run a strip, medicate for pain, and notify the physician.
- Rationale: These actions can increase oxygen delivery to the coronary
arteries and improve patient prognosis.

4.  Monitor laboratory tests such as complete blood count, sodium level, and
serum creatinine.
- Rationale: Routine blood work can provide insight into the etiology of
heart failure and extent of decompensation. A low serum sodium level
often is observed with advanced heart failure and can be a poor prognostic
sign. Serum creatinine levels will elevate in patients with severe heart
failure because of decreased perfusion to the kidneys. Creatinine may also
elevate because of ACE inhibitors.
 Administer medications as prescribed, noting side effects and toxicity.
- Rationale: Depending on etiological factors, common medications
include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmic,
angiotensin-converting enzyme inhibitors, and inotropic agents.
 Position patient in semi-Fowler’s to high-Fowler’s
- Rationale: Upright position is recommended to reduce preload and
ventricular filling when fluid overload is the cause.
 Place the patient in a supine position
- Rationale: For hypovolemia, supine positioning increases venous return
and promotes diuresis.
 Administer oxygen therapy as prescribed.
- Rationale: The failing heart may not be able to respond to increased
oxygen demands. Oxygen saturation need to be greater than 90%.
Health
Teaching
 Advise patient to use a commode or urinal for toileting and avoid use of a
bedpan.
- Rationale: Getting out of bed to use a commode or urinal does not stress
the heart any more than staying in bed to toilet. In addition, getting the
patient out of bed minimizes complications of immobility and is often
preferred by the patient.
 Educate family and patient about the disease process, complications of
disease process, information on medications, need for weighing daily, and
when it is appropriate to call doctor.
- Rationale: Early recognition of symptoms facilitates early problem
solving and prompt treatment.
 Explain importance of smoking cessation and avoidance of alcohol intake.
- Rationale: Smoking cessation advice and counsel given by nurses can be
effective, and should be available to patients to help stop smoking.
-

5.  Aid family adapt daily living patterns to establish life changes that will
maintain improved cardiac functioning in the patient.
- Rationale: Transition to the home setting can cause risk factors such as
inappropriate diet to reemerge.
 Educate patient the need for and how to incorporate lifestyle changes.
- Rationale: Psychoeducational programs including information on stress
management and health education have been shown to reduce long term
mortality and recurrence of myocardial infarction in heart patients.
Evaluation
Achieved ( ) Partially achieved ( ) Not achieved ( )
Evidence by:
Important Note
"We just recommend examples of nursing care plans. There are many references and
interventions may change according to patient condition. You should consider this, search,
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