Assessing
While assessing decreased cardiac output, it is important to gather both objective and subjective data from the patient. Subjective data includes numerous symptoms, such as fatigue, anxiety and agitation, changes in mental condition (e.g., hyperactivity or confusion), fainting, and so on (de Souza et al., 2014). Objective data includes such symptoms and signs as weight gain during a short period of time, alterations in respiratory patterns (rate, depth, and frequency), lowered blood pressure (systolic blood pressure < 90 mmHg), changes in ECG patterns, lowered peripheral pulse, clammy and cold skin, alterations in skin color (bluish discoloration), lowered urine output, S3 and S4 heart sounds, etc. (de Souza et al., 2014).
It is also essential to monitor the levels of cardiac output, for which purpose various technologies, such as pulmonary artery catheter is traditionally used (Porhomayon, Zadeii, Congello, & Nader, 2012), but non-invasive technologies, such as the non-invasive cardiac output monitor, are recommended (Lorello, Cubillos, McDonald, & Balki, 2014).
Diagnosing
According to dos Santos, de Souza, de Gutiérrez, Maria, and de Barros (2013), NANDA recognizes the condition “decreased cardiac output” as a nursing diagnosis; it is a health condition in which the heart does not pump enough blood so as to provide an adequate supply of it for the body.
PES: the problem, therefore, is decreased blood supply due to an inadequate heart function. The etiology of the condition can vary; the often occurring causes of decreased cardiac output include heart failure, myocardial infarction, serious bradycardia, chronic renal failure, hypotension, tachycardia, and others (Matos, Guimaraes, Brandao, & Santoro, 2012; de Souza et al., 2014). The symptoms and signs, as was stressed, can include various conditions, such as rapid weight gain, changes in breathing, low peripheral pulse, clammy and cold skin; an ECG and technologies for monitoring heart output can be used to diagnose the condition more precisely (Porhomayon et al., 2012; de Souza et al., 2014; Lorello et al., 2014).
Planning
Desired outcomes: the patient should have an adequate cardiac output. This should be demonstrated by adequate levels of blood pressure (within 20 mmHg of baseline) and heart rate (60-100 bpm), as well as by the normal rhythm of the heart. Peripheral pulse ought to be adequate for the heart rates of the patient. Urine output should be equal to or greater than 30 mL/hour (Gulanick & Myers, 2013). The customer also needs to be able to tolerate exercise without experiencing dyspnea or fainting.
Short-term goals: to maintain adequate heart rate, peripheral pulse, and blood pressure, as well as normal respiration.
Long-term goals: stabilize heart rate, peripheral pulse and blood pressure, and an appropriate rhythm of the heart (Gulanick & Myers, 2013; de Souza et al., 2014). The patient should also know measures for preventing further heart problems and addressing minor conditions.
Implementing
Independent measures: monitoring central venous pressure, pulmonary artery pressure, right arterial pressure, oxygen saturation; determining cardiac output; identifying heart rhythm, rate, and ectopy via an electrocardiogram; estimating chest pains; checking fatigue and lowered tolerance of physical activity; identifying causes which contribute to decreased cardiac output (Gulanick & Myers, 2013).
Collaborative and dependent measures: administering the prescribed drugs, simultaneously monitoring response and side effects; keeping hemodynamic parameters at the levels determined by the doctor; controlling fluid balance; maintaining the appropriate levels of perfusion, as well as of ventilation, by placing the client in various positions (supine, semi or high Fowler’s); controlling sleep and supplying the client with sedatives (Gulanick & Myers, 2013).
Evaluating
Evaluate the adequacy of heart rate and rhythm, as well as of peripheral pulse and blood pressure, and assess the respiration and oxygen saturation in order to assess whether the short-term goals have been reached.
Determine the cardiac output, and the urine output; assess exercise tolerance; check heart output, rate and rhythm, blood pressure, peripheral pulse, respiration, and their stability over a period of time; estimate the knowledge of the patient about preventing further complications and relapses (Gulanick & Myers, 2013; Lorello et al., 2014).
References
De Souza, V., Zeitoun, S. S., Lopes, C. T., de Oliveira, A. P. D., de Lima Lopes, J., & de Barros, A. L. B. L. (2014). Content validation of the operational definitions of the nursing diagnoses of activity intolerance, excess fluid volume, and decreased cardiac output in patients with heart failure. International Journal of Nursing Knowledge, 25(2), 85-93. Web.
Dos Santos, E. R., de Souza, M. F., de Gutiérrez, M. G. R., Maria, V. L. R., & de Barros, A. L. B. L. (2013). Validation of the concept risk for decreased cardiac output. Revista Latino-Americana de Enfermagem, 21, 97-104. Web.
Gulanick, M., & Myers, J. (2013). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). St. Louis, MO: Elsevier.
Lorello, G., Cubillos, J., McDonald, M., & Balki, M. (2014). Peripartum cardiomyopathy: Postpartum decompensation and use of non-invasive cardiac output monitoring. International Journal of Obstetric Anesthesia, 23(1), 66-70. Web.
Matos, L. N., Guimaraes, T. C. F., Brandao, 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. Web.
Porhomayon, J., Zadeii, G., Congello, S., & Nader, N. D. (2012). Applications of minimally invasive cardiac output monitors. International Journal of Emergency Medicine, 5(18), 1-9. Web.