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Meg/Surg Nursing Diagnosis: Decreased Cardiac Output r/t chronic arrhythmias and an increase in preload and in afterload aeb

a BNP of 1,270, ejection


fraction 40%, and LS with rales in upper lobes and diminished breath sounds in lower lobes.
Long Term Goal: Pt will have adequate cardiac output.

Outcome Criteria

Interventions

Rationale

Evaluation

One outcome criteria for each


intervention. Number each one.

Label each intervention as:


Assess/Monitor/Independent/
Dependent/Teaching/Collaboration

Answers why, how, what your interventions will help solve, prevent or
lessen the stated problem specific to this patient.

Evaluate the patient


outcome NOT the
intervention

1.

Pt's BP will be within


normal limits of
120/80 +/- 10 q 4 hrs.

1. Assess: Assess pt's BP


q 4 hrs.

1. Pt is in acute on chronic heart failure so checking his blood pressure is extremely


important to show how well the blood is flowing through his body. Blood pressure
increases because of excess blood volume or excess fluid volume. By checking his blood
pressure it gives a good indication of how well his heart is working. Pt's BP was low
(98/56mmHg) related to medications that he was taking. For example he was taking
lisinopril which is a beta blocker and taken to reduce blood pressure and heart rate which
his was 80 regular beats per minute. Also he is taking digoxin which helps the contractility
of the heart and slows down atrial fibrillation which if not controlled can increase heart
failure. If his blood pressure stays this low (98/56mmHg) it can really effect his cardiac
output. Basically if blood pressure stays low all of his organs will be effected by not being
perfused adequately. For example his brain and kidneys are just two examples of organs
that need adequate perfusion. If not brain is not perfused adequately his LOC would
deteriorate. If his kidneys are not perfused properly his urine output would decrease and
his heart failure would increase due to the increase in fluid overload.

1. U = Pt's outcome
was unmet with the BP
of 98/56.

2.

Pt will have clear


lungs sounds q 4 hrs.

2. Assess: Assess pt's LS


q 4 hrs.

2. The most common heart failure is related to the left side, which causes a back up of
fluid in the lungs. Left-sided HF results from left ventricular dysfunction. This prevents
normal, forward blood flow and causes blood to back up into the left atrium and
pulmonary veins. The increased pulmonary pressure causes fluid leakage from the
pulmonary capillary bed into the interstitium and then the alveoli. This manifests as
pulmonary congestion and edema. This can be evident by hearing crackles in the lungs, a
change in respiratory pattern, shortness of breath or orthopnea then that is an indication of
respiratory changes that are signs of fluid accumulation in the lungs. This pt had crackles
in his lungs heard while listening to his lungs and that indicates he needs to have fluid
removed from his body and/or a medication to help his heart pump more efficiently.

2. U = Pt's outcome
was unmet because pt
still had rales on d/c.

3.

Pt's BNP results will


decrease by
10 ng/L q day.

3. Dependent: Obtain pt's


series of BNP results q
day.

3. An echocardiogram shows the ejection fraction which provides information about the
function of the left ventricle during systole. A E.F. Of 40% is low and shows that the
patients heart is not pumping effectively. This measurement can indicate that the patient
needs other medications to reduce fluid or a stricter fluid intake. Pt's ECHO showed
diastolic hear failure and severely dilated right ventricle. These results directly relate to
this pt's decreased cardiac output because diastolic heart failure is when the left ventricle
can't relax and fill during diastole. The stroke volume falls which directly effects the
cardiac output by decreasing it also. Now that it shows a dilated right ventricle in the pt's
heart, his heart is going to become even more ineffective at perfusing his body. His
ventricle is enlarged and weakened. In some cases, it prevents the heart from relaxing and
filling with blood as it should. Over time, it becomes an effective pump and cardiac output
will decrease.

3. M = Pt did this met


outcome criteria
because his BNP went
from 1408 ng/l to
1,279 ng/l in 11days
(decrease of 129 ng/L).