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Nursing Diagnosis: Decreased Cardiac output
Nursing Care Plans Ior Decreased Cardiac output
AAADA Definition: Inadequate blood pumped by the heart to meet metabolic demands oI the
body

Defining Characteristics: Altered heart rate/rhythm: arrhythmias (tachycardia, bradycardia);
palpitations; EKG changes; altered preload: jugular vein distention; Iatigue; edema; murmurs;
increased/decreased central venous pressure (CVP); increased/decreased pulmonary artery
wedge pressure (PAWP); weight gain; altered aIterload: cold/clammy skin; shortness oI
breath/dyspnea; oliguria; prolonged capillary reIill; decreased peripheral pulses; variations in
blood pressure readings; increased/decreased systemic vascular resistance (SVR);
increased/decreased pulmonary vascular resistance (PVR); skin color changes; altered
contractility: crackles; cough; orthopnea/paroxysmal nocturnal dyspnea; cardiac output less
than 4 L/min; cardiac index less than 2.5 L/min; decreased ejection Iraction, stroke volume index
(SVI), leIt ventricular stroke work index (LVSWI); S3 or S4 sounds; behavioral/emotional:
anxiety ; restlessness

Related Factors: Myocardial inIarction or ischemia, valvular disease, cardiomyopathy, serious
dysrhythmia, ventricular damage, altered preload or aIterload, pericarditis, sepsis, congenital
heart deIects , vagal stimulation, stress, anaphylaxis, cardiac tamponade

NOC Outcomes (Nursing Outcomes ClassiIication)
Suggested NOC Labels
Cardiac Pump EIIectiveness
Circulatory Status
Tissue PerIusion: Abdominal Organs
Tissue PerIusion: Peripheral
Vital Signs Status

Client Outcomes
O Demonstrates adequate cardiac output as evidenced by blood pressure and pulse rate and
rhythm within normal parameters Ior client; strong peripheral pulses; and an ability to
tolerate activity without symptoms oI dyspnea, syncope, or chest pain
O Remains Iree oI side eIIects Irom the medications used to achieve adequate cardiac
output
O Explains actions and precautions to take Ior cardiac disease

NIC Interventions (Nursing Interventions ClassiIication)
Suggested NIC Labels
Cardiac Care: Acute
Circulatory Care

Nursing Interventions and Rationales
O Monitor Ior symptoms oI heart Iailure and decreased cardiac output, including
diminished quality oI peripheral pulses, cool skin and extremities, increased respiratory
rate, presence oI paroxysmal nocturnal dyspnea or orthopnea, increased heart rate, neck
vein distention, decreased level oI consciousness, and presence oI edema. As these
symptoms oI heart Iailure progress, cardiac output declines.
O Listen to heart sounds; note rate, rhythm, presence oI S3, S4, and lung sounds. The new
onset oI a gallop rhythm, tachycardia, and Iine crackles in lung bases can indicate onset
oI heart Iailure. II client develops pulmonary edema, there will be coarse crackles on
inspiration and severe dyspnea.
O Observe Ior conIusion , restlessness, agitation, dizziness. Central nervous system
disturbances may be noted with decreased cardiac output.
O Observe Ior chest pain or discomIort; note location, radiation, severity, quality, duration,
associated maniIestations such as nausea, and precipitating and relieving Iactors. Chest
pain/discomIort is generally indicative oI an inadequate blood supply to the heart, which
can compromise cardiac output. Clients with heart Iailure can continue to have chest pain
with angina or can reinIarct.
O II chest pain is present, have client lie down, monitor cardiac rhythm, give oxygen, run a
strip, medicate Ior pain, and notiIy the physician. These actions can increase oxygen
delivery to the coronary arteries and improve client prognosis.
O Place on cardiac monitor; monitor Ior dysrhythmias, especially atrial Iibrillation. Atrial
Iibrillation is common in heart Iailure.
O Monitor hemodynamic parameters Ior an increase in pulmonary wedge pressure, an
increase in systemic vascular resistance, or a decrease in cardiac output and index.
Hemodynamic parameters give a good indication oI cardiac Iunction.
O Titrate inotropic and vasoactive medications within deIined parameters to maintain
contractility, preload, and aIterload per physician's order. By Iollowing parameters, the
nurse ensures maintenance oI a delicate balance oI medications that stimulate the heart to
increase contractility, maintaining adequate perIusion oI the body.
O Monitor intake and output. II client is acutely ill, measure hourly urine output and note
decreases in output. Decreased cardiac output results in decreased perIusion oI the
kidneys, with a resulting decrease in urine output.
O Note results oI EKG and chest Xray. EKG can reveal previous MI,or evidence oI leIt
ventricular hypertrophy, indicating aortic stenosis or chronic systemic hypertension .
Xray may provide inIormation on pulmonary edema, pleural eIIusions, or enlarged
cardiac silhouette Iound in dilated cardiomyopathy or large pericardial eIIusion.
O Results oI diagnostic imaging studies such as echocardiogram, radionuclide imaging or
dobutamine stress echocardiography. The echocardiogram is the most important imaging
tool Ior evaluation patients with symptoms oI heart Iailure because overall systolic
Iunction and chamber size can be evaluated quickly. In addition, global versus regional
leIt ventricular Iunction, valvular abnormalities, and diastolic Iunction can be deIined,
assisting in diIIerential diagnosis. An ejection Iraction in a healthy heart is approximately
50. Most patients experiencing heart Iailure have an ejection Iraction oI less than 40.
O Watch laboratory data closely, especially arterial blood gases and electrolytes, including
potassium. Client may be receiving cardiac glycosides and the potential Ior toxicity is
greater with hypokalemia; hypokalemia is common in heart clients because oI diuretic
use.
O Monitor lab work such as complete blood count, sodium level, and serum creatinine.
Routine blood work can provide insight into the etiology oI heart Iailure and extent oI
decompensation. A low serum sodium level oIten is observed with advanced heart Iailure
and can bea poor prognostic sign. Serum creatinine levels will elevate in clients with
severe heart Iailure because oI decreased perIusion to the kidneys.Creatinine may also
elevate because oI ACE inhibitors.
O Administer oxygen as needed per physician's order.
O Place client in semi-Fowler's position or position oI comIort. Elevating the head oI the
bed may decrease the work oI breathing, and also decrease venous return and preload.
O Check blood pressure, pulse, and condition beIore administering cardiac medications
such as angiotensin converting enzyme (ACE) inhibitors, digoxin, and beta-blockers such
as carvedilol. NotiIy physician iI heart rate or blood pressure is low beIore holding
medications. It is important that the nurse evaluate how well the client is tolerating
current medications beIore administering cardiac medications; do not hold medications
without physician input. The physician may decide to have medications administered
even though the blood pressure or pulse rate has lowered.
O During acute events, ensure client remains on bed rest or maintains activity level that
does not compromise cardiac output. In severe heart Iailure, restriction oI activity oIten
Iacilitates temporary recompensation.
O Gradually increase activity when client's condition is stabilized by encouraging slower
paced activities or shorter periods oI activity with Irequent rest periods Iollowing exercise
prescription; observe Ior symptoms oI intolerance. Take blood pressure and pulse beIore
and aIter activity and note changes. Activity oI the cardiac client should be closely
monitored. See Activity intolerance .
O Serve small sodium-restricted, low-cholesterol meals. Give only small amounts oI
caIIeine-containing beverages, iI no resulting dysrhythmia. Sodium-restricted diets help
decrease Iluid volume excess. Low-cholesterol diets help decrease atherosclerosis, which
causes coronary artery disease. Clients with cardiac disease tolerate smaller meals better
because they require less cardiac output to digest. One cup oI caIIeinated coIIee has
generally not been Iound to have any signiIicant eIIect (Schneider, 1987; Powell, 1993).
O Monitor bowel Iunction. Provide stool soIteners as ordered. Caution client not to strain
when deIecating. Decreased activity can cause constipation. Straining when deIecating
that results in the Valsalva maneuver can lead to dysrhythmia, decreased cardiac
Iunction, and sometimes death.
O Have clients use a commode or urinal Ior toileting and avoid use oI a bedpan. Getting out
oI bed to use a commode or urinal does not stress the heart any more than staying in bed
to toilet. In addition, getting the client out oI bed minimizes complications oI immobility
and is oIten preIerred by the client.
O Provide a restIul environment by minimizing controllable stressors and unnecessary
disturbances. Schedule rest periods aIter meals and activities. Rest periods decrease
oxygen consumption.
O Weigh client at same time daily. An accurate daily weight is a good indicator oI Iluid
balance. Increased weight and severity oI symptoms can signal decreased cardiac
Iunction with retention oI Iluids.
O Assess Ior presence oI anxiety; see interventions Ior Anxiety to Iacilitate reduction oI
anxiety in clients and Iamily.
O Consider using music to decrease anxiety and improve cardiac Iunction. Music has been
shown to reduce heart rate, blood pressure, anxiety, and cardiac complications.
O Closely monitor Iluid intake including IV lines. Maintain Iluid restriction iI ordered. In
clients with decreased cardiac output, poorly Iunctioning ventricles may not tolerate
increased Iluid volumes.
O ReIer to heart Iailure program or cardiac rehabilitation program Ior education, evaluation,
and guided support to increase activity and rebuild liIe. Exercise can help many patients
with heart Iailure. Whereas rest was commonly recommended a Iew years ago, it has
become clear that inactivity can worsen the skeletal muscle myopathy in these patients.A
careIully monitored exercise program can improve both Iunctional capacity, and leIt
ventricular Iunction. Exercise based cardiac rehabilitation programs apppear to be
eIIective in reducing cardiac deaths, but the evidence base is weakened by poor quality
trials.

Geriatric Care Plans
O Observe Ior atypical pain; the elderly oIten have jaw pain instead oI chest pain or may
have silent myocardial inIarctions with symptoms oI dyspnea or Iatigue. The elderly have
altered pain pathways and oIten do not experience the usual chest pain oI cardiac
patients.
O Observe Ior syncope, dizziness, palpitations, or Ieelings oI weakness associated with a
irregular heart rhythm. Dysrhythmias are common in the elderly.
O Observe Ior side eIIects Irom cardiac medications. The elderly have diIIiculty with
metabolism and excretion oI medications due to decreased Iunction oI the liver and
kidneys; thereIore toxic side eIIects are more common.

Home Care Interventions 14r Decreased Cardiac 4:95:9
O Begin discharge planning as soon as possible with case manager or social worker to
assess home support systems and the need Ior community or home health services. These
may be to assist with home care, assistance with meal perparations, housekeeping,
personal care, transportation to doctor visits, or emotional support. Clients oIten need
help upon discharge. The existing social support network needs to be assessed and
assistance provided as needed to meet client needs and to keep the support persons Irom
being overwhelmed. Being discharged to home without adequate support has been shown
to be related to readmission oI elderly patients.
O Assess or reIer to case manager or social worker to evaluate client ability to pay Ior
prescriptions. The cost oI drugs may be a Iactor to Iill prescriptions and adhere to a
treatment plan.
O Continue to monitor client Ior exacerbation oI heart Iailure when discharged home.
Transition to home can create increased stress and physiological instability related to
diagnosis.
O Assess client Ior understanding and compliance with medical regimen, including
medications, activity level, and diet.
O Instruct Iamily and client about the disease process, complications oI disease process,
inIormation on medications, need Ior weighing daily, and when it is appropriate to call
doctor. Early recognition oI symptoms Iacilitates early problem solving and prompt
treatment. Clients with heart Iailure need intensive guideline gased education about these
topics to help prevent readmission to the hospital.
O IdentiIy emergency plan, including use oI CPR. Decreased cardiac output can be liIe
threatening.
O Help Iamily adapt daily living patterns to establish liIe changes that will maintain
improved cardiac Iunctioning in the client. Transition to the home setting can cause risk
Iactors such as inappropriate diet to reemerge.
O ReIer to physical therapy Ior strengthening exercises iI client is not involved in cardiac
rehabilitation.
O ReIer to medical social services as necessary Ior counseling about the impact oI severe or
chronic cardiac disease. Social workers can assist the client and Iamily with acceptance
oI liIe changes.

Client/Family Teaching
O Teach symptoms oI heart Iailure and appropriate actions to take iI client becomes
symptomatic.
O Teach importance oI smoking cessation and avoidance oI alcohol intake. Clients who
continue to smoke increase their chance oI dying by at least 50, and alcohol depresses
heart contractility. Smoking cessation advice and counsel given by nurses can be
eIIective, and should be available to clients to help stop smoking.
O Teach stress reduction (e.g., imagery, controlled breathing, muscle relaxation
techniques).
O Explain necessary restrictions, including consumption oI a sodium-restricted diet,
guidelines on Iluid intake, and the avoidance oI Valsalva's maneuver. Teach the
importance oI pacing activities, work simpliIication techniques, and the need to rest
between activities to prevent becoming overly Iatigued. Sodium retentiion leading to
Iluid overload is a common cause oI hospital readmission.
O Assist client in understanding the need Ior and how to incorporate liIestyle changes.
ReIer to cardiac rehabilitation Ior assistance with coping and adjustment.
Psychoeducational programs including inIormation on stress management and health
education have been shown to reduce long term mortality and recurrence oI myocardial
inIarction in heart patients.
O Teach client actions, side eIIects, and importance oI consistently taking cardiovascular
medications. Medications can prolong the lives oI heart Iailure clients but oIten are not
taken, resulting in hospital readmissions.
O Provide client/Iamily with advance directive inIormation to consider. Allow client to give
advance directions about medical care or designates who should make medical decisions
iI he or she should lose decision-making capacity.
O Instruct client on importance oI getting a pneumonia shot and yearly Ilu shots as
prescribed by physician. Clients with decreased cardiac output are considered higher risk
Ior complications or death iI they do not get immunization injections.
O Instruct client/Iamily on the need to weigh daily and keep a weight log. Ask iI client has a
scale at home; iI not, assist in getting one. Instruct on establishing baseline weight on
own scale when gets home. Weighing daily is an essential aspect oI selI-management. A
scale is necessary. Scales vary and the client needs to establish a baseline weight on their
home scale.
O Provide speciIic written materials and selI care plan Ior client/caregivers to use Ior
reIerence. Consult dietitian or assist client in understanding the need Ior a sodium-
restricted diet. Provide alternatives Ior salt such as spices, herbs, lemon juice, or vinegar.
Although the initial elimination oI salt Irom the diet is very diIIicult Ior a person use to
its taste, the taste oI salt can be unlearned. The above can enhance the taste appeal oI
Iood while the preIerence Ior salt is changing.
O Instruct Iamily regarding cardiopulmonary resuscitation.