Lesson Objectives for Decreased Cardiac Output

• Understanding of Decreased Cardiac Output:
  • Gain a comprehensive understanding of the concept of decreased cardiac output, including its definition, contributing factors, and impact on overall cardiovascular function.
• Recognition of Signs and Symptoms:
  • Develop the ability to recognize and identify the clinical signs and symptoms associated with decreased cardiac output, enabling prompt assessment and intervention.
• Knowledge of Contributing Factors:
  • Understand the various factors that can contribute to decreased cardiac output, including cardiac conditions, fluid imbalances, and systemic factors, to facilitate targeted nursing interventions.
• Competency in Cardiovascular Assessment:
  • Acquire proficiency in conducting a thorough cardiovascular assessment, including the assessment of vital signs, heart sounds, peripheral perfusion, and other relevant parameters to evaluate cardiac output.
• Implementation of Nursing Interventions:
  • Learn and apply appropriate nursing interventions to improve and manage decreased cardiac output, with a focus on collaborative care, patient education, and monitoring outcomes.

Pathophysiology of Decreased Cardiac Output

• Impaired Myocardial Contractility:
  • Reduced ability of the myocardium to contract efficiently, often due to conditions like myocardial infarction, cardiomyopathy, or myocarditis, leading to a decrease in the amount of blood ejected from the heart.
• Increased Afterload:
  • Elevated systemic vascular resistance, commonly associated with conditions such as hypertension, makes it more challenging for the heart to pump blood into the systemic circulation, contributing to decreased cardiac output.
• Valvular Dysfunction:
  • Malfunctioning heart valves, either through stenosis (narrowing) or regurgitation (leakage), disrupt the normal flow of blood within the heart, affecting cardiac output.
• Fluid Volume Deficit:
  • Inadequate blood volume, resulting from conditions like dehydration, hemorrhage, or severe burns, leads to decreased preload, limiting the amount of blood available for the heart to pump.
• Cardiac Tamponade:
  • Accumulation of fluid or blood in the pericardial sac, as seen in pericardial effusion or cardiac tamponade, exerts pressure on the heart, impairing its ability to fill and pump effectively.

Etiology of Decreased Cardiac Output

• Myocardial Infarction:
  • Ischemic damage to the myocardium, commonly occurring during a heart attack, can impair the heart’s contractility and overall pump function.
• Heart Failure:
  • Chronic conditions like heart failure, whether systolic or diastolic, result in the heart’s inability to pump blood effectively, leading to decreased cardiac output.
• Hypertension:
  • Prolonged elevated blood pressure increases afterload, making it more difficult for the heart to eject blood into the systemic circulation, contributing to decreased cardiac output.
• Valvular Heart Disease:
  • Conditions affecting heart valves, such as stenosis or regurgitation, can disrupt the normal flow of blood within the heart, impacting cardiac output.
• Fluid Volume Deficit:
  • Conditions causing a decrease in blood volume, including dehydration, hemorrhage, or fluid loss from severe burns, reduce preload and contribute to decreased cardiac output.

Desired Outcome for Decreased Cardiac Output

• Improved Cardiac Output:
  • Achieve and maintain a cardiac output within the normal range, ensuring adequate blood circulation to meet the body’s metabolic demands.
• Resolution of Symptoms:
  • Alleviate symptoms associated with decreased cardiac output, such as fatigue, dyspnea, and peripheral edema, leading to an improved quality of life for the patient.
• Optimal Tissue Perfusion:
  • Ensure optimal perfusion to vital organs and tissues, preventing complications associated with inadequate oxygen and nutrient delivery.
• Stabilization of Hemodynamic Parameters:
  • Stabilize and maintain hemodynamic parameters, including blood pressure, heart rate, and central venous pressure, within acceptable ranges to support cardiovascular function.
• Enhanced Exercise Tolerance:
  • Improve the patient’s exercise tolerance and overall functional capacity, allowing for increased physical activity without experiencing symptoms of decreased cardiac output.

Subjective Data for Nursing Care Plan (NCP) for Decreased Cardiac Output

• Fatigue and Weakness:
  • Patient reports experiencing persistent fatigue and weakness, especially during physical activities or daily routines.
• Shortness of Breath:
  • Patient describes episodes of shortness of breath, both at rest and during exertion, indicating potential respiratory distress.
• Chest Pain or Discomfort:
  • Patient communicates sensations of chest pain or discomfort, providing details on the location, duration, and intensity of the symptoms.
• Dizziness or Lightheadedness:
  • Patient reports episodes of dizziness or lightheadedness, particularly upon standing or with sudden movements.
• Swelling (Edema):
  • Patient notes the presence of swelling, particularly in the lower extremities, which may be accompanied by feelings of tightness or discomfort.
• Changes in Urination:
  • Patient mentions changes in urinary patterns, such as increased frequency or changes in color, which may indicate fluid retention.

Objective Data for Nursing Care Plan (NCP) for Decreased Cardiac Output

• Vital Signs:
  • Blood pressure measurements consistently below the patient’s baseline, indicating potential inadequate perfusion.
• Heart Rate:
  • Tachycardia or irregular heart rhythm noted during assessments, revealing disruptions in the normal cardiac cycle.
• Respiratory Rate:
  • Elevated respiratory rate, especially at rest or with minimal exertion, indicating increased effort to maintain oxygenation.
• Peripheral Edema:
  • Observable swelling in the extremities, particularly the ankles and lower legs, suggesting fluid retention and impaired venous return.
• Skin Color and Temperature:
  • Pallor or mottled skin, particularly in the extremities, along with coolness, indicating potential peripheral vasoconstriction.
• Capillary Refill Time:
  • Prolonged capillary refill time (>2 seconds) when assessing nail beds, indicating potential circulatory compromise.

Nursing Assessment for Decreased Cardiac Output

• Cardiovascular Assessment:
  • Monitor vital signs, including heart rate, blood pressure, and peripheral pulses, to assess for signs of decreased cardiac output and response to interventions.
• Fluid Balance Assessment:
  • Evaluate fluid balance by assessing input and output, monitoring for signs of dehydration or fluid overload, which can impact preload and cardiac output.
• Respiratory Assessment:
  • Assess respiratory rate, rhythm, and effort to identify signs of respiratory distress or inadequate oxygenation, which may be indicative of decreased cardiac output.
• Peripheral Perfusion Assessment:
  • Examine peripheral perfusion by assessing skin color, temperature, and capillary refill time to identify signs of poor tissue perfusion.
• Symptom Assessment:
  • Investigate and document symptoms related to decreased cardiac output, such as fatigue, dyspnea, dizziness, or syncope, to guide ongoing management.
• Heart Sounds and Murmurs:
  • Auscultate heart sounds and identify any abnormal murmurs or additional sounds that may indicate valvular dysfunction or impaired cardiac function.
• Edema Assessment:
  • Evaluate for the presence of edema, particularly in dependent areas, as it can be a manifestation of fluid imbalance and decreased cardiac output.
• Laboratory Tests:
  • Order and interpret relevant laboratory tests, including cardiac enzymes, electrolytes, and hemoglobin levels, to assess cardiac function, fluid balance, and oxygen-carrying capacity.

Interventions and Rationales for Nursing Care Plan (NCP) for Decreased Cardiac Output

• Administer Medications:
  • Rationale: Medications such as diuretics, beta-blockers, and inotropes can help optimize cardiac function, reduce fluid volume, and improve contractility.
• Monitor Electrolytes:
  • Rationale: Maintaining a balance of electrolytes is crucial for proper cardiac function. Regular monitoring helps identify and address any imbalances promptly.
• Positioning: Elevate Legs:
  • Rationale: Elevating the patient’s legs promotes venous return and reduces peripheral edema, improving overall cardiac output.
• Oxygen Therapy:
  • Rationale: Supplemental oxygen helps increase oxygenation and relieve the workload on the heart, especially in cases of decreased cardiac output.
• Fluid Restriction:
  • Rationale: Restricting fluid intake helps manage fluid overload, reducing the workload on the heart and preventing further deterioration in cardiac output.
• Continuous Cardiac Monitoring:
  • Rationale: Continuous monitoring allows early detection of arrhythmias, changes in heart rate, or other abnormalities, enabling prompt intervention.
• Assist with Activities of Daily Living (ADLs):
  • Rationale: Providing assistance with ADLs reduces the patient’s energy expenditure, conserving energy for essential physiological processes.
• Promote Adequate Nutrition:
  • Rationale: Nutritional support ensures the patient receives essential nutrients to support cardiac function and prevent malnutrition-related complications.
• Education on Medication Adherence:
  • Rationale: Patient understanding and adherence to medication regimens are crucial for managing cardiac conditions and preventing exacerbations.
• Collaborate with Multidisciplinary Team:
  • Rationale: Collaboration with physicians, cardiologists, and other healthcare professionals ensures a comprehensive approach to care, optimizing outcomes for the patient.

Evaluation for Decreased Cardiac Output

• Monitoring Hemodynamic Parameters:
  • Regularly assess and compare hemodynamic parameters, including blood pressure, heart rate, and central venous pressure, to evaluate the effectiveness of interventions and the stability of cardiovascular function.
• Symptom Resolution:
  • Evaluate the resolution of symptoms associated with decreased cardiac output, such as fatigue, dyspnea, and edema, to gauge the impact of interventions on the patient’s well-being.
• Functional Capacity:
  • Assess improvements in exercise tolerance and functional capacity, noting the patient’s ability to engage in physical activities without experiencing undue symptoms.
• Fluid Balance:
  • Monitor changes in fluid balance, including weight fluctuations and clinical signs of fluid overload or dehydration, to ensure an appropriate balance is maintained.
• Patient Compliance:
  • Evaluate the patient’s adherence to prescribed medications, dietary restrictions, and lifestyle modifications, as non-compliance can impact the effectiveness of the overall care plan.