Decreased Cardiac Output Nursing Diagnosis

From a layman’s point of view, the heart is considered as the wellspring for our lives due to the great role it plays to keep us alive. The primary function of the heart is to pump blood, thereby supplying different tissues and organs with oxygen and other needed nutrients. Therefore, it is the wish of everyone to have a healthy heart.

From a health perspective, one metric that can be used to measure the performance of the heart is the cardiac output. Cardiac output is the quantity of blood that is pumped by the heart every minute. At times the heart records decreased cardiac output characterized by the inadequate pumping ability of the heart. This article can guide you on how a nurse can diagnose a patient suffering from decreased cardiac output.

What Causes Decreased Cardiac Output?

You cannot diagnose a condition if you don’t understand some of the possible causes, Right? Decreased cardiac output is commonly associated with hypertension and myocardial infarction. Other heart-related conditions, such as heart failure, cardiomyopathy, and valvular heart disease, can also be a cause. Drug effects, fluid overload and electrolyte imbalance in the body could trigger this condition.

Medics have confirmed that decreased cardiac output is typical with aged people, delineating that the aging process puts people at higher risk. Aging is associated with the reduction in compliance of the ventricles exposing them to cardiac-related problems. Indeed, decreased cardiac output is not attributed to a single heart problem but rather a composite of many heart-related problems.

What are some of the defining characteristics?

Patients will complain and exhibit these signs and symptoms:

• Anxiousness and restlessness
• Changes in the level of consciousness
• Dyspnea- a condition of shortness of breath
• Increased fatigue and low activity tolerance
• Decreased level of arterial and venous oxygen saturation level
• Increased arterial and venous pressures
• Edema
• Weight gain and decreased output of urine
• The heart may produce funny and abnormal sounds

Some of the signs are observable and notable, the patient can describe them, and others may require an examination of the patient.

Diagnosis Goals and Outcomes

In the nursing diagnosis, the nurse is always guided by the goals and expected outcomes, which depend on the condition. Therefore, after the nursing diagnosis, the intent is to ensure that the patient demonstrates an adequate cardiac output level, which should be evidenced through blood pressure, pulse rate, and increased tolerance to activities.

The patient should show dry skin with the absence of pulmonary crackles. In addition, he/she should be free of the medication side effects, which means that the recovery process should be free of complications. Finally, the nursing diagnosis should enable the patient to explain the actions and precautions to take due to this condition.

Nursing Assessment and Diagnosis

The patient’s assessment is the contention of the nursing diagnosis process. In conducting this process, the nurse seeks to establish the possible problems that may have caused decreased cardiac output. This process will guide nursing care and intervention.

General Examination

At the start of the assessment, the nurse should examine the patient for the general outlook with interest in the color, temperature, and moisture. This assessment is done with the understanding that a cold, clammy, and pale skin are secondary to the decreased cardiac output and are an outcome of increasing nervous system stimulation.

At this stage, the nurse also checks the patient to determine any alterations in the level of consciousness. Changes in the level of consciousness are associated with cerebral perfusion and hypoxia that comes with difficulty in concentration by the patient. Moreover, the nurse should also check on the symptoms of chest pains. Reduced cardiac output leads to low myocardial perfusion causing chest pains.

Cardiac Parameters

The nurse may embark on several tests and examinations to determine the cardiac ability that generally measures cardiac health. The nurse should assess the respiratory rate, the rhythm, and the sounds of the breath. This is done to identify any presence of paroxysmal nocturnal dyspnea (PND). In addition, rapid rates of respiration are a clear indication of decreased cardiac output.

An assessment of the peripheral pulses is essential because weak pulses indicate a reduction in stroke volume and reduced cardiac output. Further, heart sounds for gallops are necessary as they indicate the reduced ability of ventricular ejection. In this assessment, S3 indicates left ventricular ejection failure, while s4 shows impairment of diastolic filling.

CVP and Electrocardiogram Assessment

Central venous pressure (CVP) is an assessment that indicates how the right side of the heart is filled with pressure. The evaluation of the fluid volumes on both the left and right sides of the heart suggests cardiac output.

The nurse should also conduct hemodynamic monitoring to assess the CVP, and determine the pulmonary artery diastolic pressure (PADP). Pulmonary capillary wedge pressure (PCWP) and the cardiac index can be identified, which are all measures of cardiac output.

The nurse should also monitor the electrocardiogram (ECG) to determine the rate and the rhythm of the heart, which gives a level of cardiac output. ECG is conducted targeting to identify possible cases of Tachycardia or bradycardia, which are known to compromise the cardiac output.

Urine output, Fluid balance, and BNP

Apart from the assessment of the heart condition, other assessments indicate the patient’s state of cardiac output.  In the nursing diagnosis, the nurse should assess the fluid balance of the patient, determine his /her weight, and check for any signs of pedal or sacral oedema.

The nurse must make a record of the patient’s urine output.  The level of urine counterbalances the low BP with water retention. It also indicates the patient’s level of recovery. Besides, oxygen saturation is some of the earliest signs of reduced or improved cardiac output.

Don’t Forget

A nursing diagnosis is not an end to the treatment of a patient suffering from decreased cardiac output; therefore, your intervention is guided by the goals stated earlier. Consequently, you need to ascertain the contributory factors to make specific guide treatment on the patient. Besides, a vital aspect of this is compliance by the patient on medication, level of activity, and diet. But always, have an emergency plan for the patients because decreased cardiac output is life-threatening.

References

1. Bumann, R., & Speltz, M. (1989). Decreased cardiac output: a nursing diagnosis. Dimensions of Critical Care Nursing, 8(1), 14-15.
2. Matos, L. N., Guimarães, T. C. F., Brandão, M. A. G., & Santoro, D. C. (2012). Prevalence of nursing diagnosis of decreased cardiac output and the predictive value of defining characteristics in patients under evaluation for heart transplant. Revista latino-americana de enfermagem, 20(2), 307-315
3. Martins, Q. C. S., Aliti, G., & Rabelo, E. R. (2010). Decreased cardiac output: clinical validation in patients with decompensated heart failure. International Journal of Nursing Terminologies and Classifications, 21(4), 156-165.
4. Brandão, S. M. G., Altino, D. M., Silva, R. D. C. G. E., & Lopes, J. D. L. (2011). Defining characteristics of decreased cardiac output: a literature review. International Journal of Nursing Terminologies and Classifications, 22(2), 92-102.
5. Nurse Zone. Decreased Cardiac Output. Retrieved from http://thenurseszone.com/nursing-care-plan-ncp/decreased-cardiac-output/