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DECREASED CARDIAC OUTPUT Nursing Care Plan

Decreased cardiac output is a state in which inadequate blood is pumped by the heart to meet the metabolic demands of the body caused by cardiac dysfunctions, blood flow obstructions, electrolyte imbalances, and more. Before coming up with a nursing care plan, a lot of assessment, tests and monitoring will be done first to find the accurate intervention to the patient. But here is an example of a nursing care plan for decreased cardiac output.

ASSESSMENT
Subjective:
"I feel that I'm having palpitations right now," as verbalized by the patient.

Objectives:
I observed from the patient that he/she has distended neck vein and facial edema. He/she also positive in prolonged capillary refill as I press his/her fingertip (prolonged capillary refill is when it takes too much time before your fingertip return to its normal color after you press it. The patient is restlessness as he can't stay still and find his/her comfort.

Vital signs are taken and noted as follows: Body temperature is 36.8 degrees Celcius, blood pressure is 110/70 mmHg, respiratory rate is 20 cycles per minute, and pulse rate is 128 beats per minute. There's slightly above normal in his/her body temperature while blood pressure and respiratory rate are in normal range. But the patient is in tachycardia as his/her pulse rate exceeds the 80-100 beats per minute normal range.

DIAGNOSIS
Decreased cardiac output related to palpitations as evidenced by altered heart rate (tachycardia) and distended neck vein. (Palpitations is a sensation when your heart has skipped a beat or added an extra beat. You may become overly aware of your heartbeat which you felt in the neck, throat, or chest and it feels like your heart is racing, pounding, or fluttering.)

PLANNING
After 4 hours of nursing intervention, the patient's cardiac output will be normalized and his/her palpitations will be gone.

INTERVENTION
Before you start any nursing interventions, determine first his/her vital signs and  hemodynamic parameters including cognitive status. The initial vital signs taken will be the baseline for comparison to follow trends and evaluate response to interventions. Note vital signs responses to activity procedures and time required to return to baseline.

You must review diagnostic and laboratory data such as cardiac makers, complete blood count and electrolytes. These will help determine the underlying 
causes of decreased in cardiac output. After these, perform periodic hemodynamic measurements as indicated such as arterial pressures and cardiac output and monitor cardiac rhythm continously to note effectiveness of medications and assistive devices such as implanted pacemaker of defibrillator.  Maintain patency of invasive intravascular monitoring and infusion lines. Tape connections to prevent air embolus and exanguination. Also assess urine periodically; weigh daily and note total fluid balance.

You may administer high-flow oxygen via mask or ventilator as indicated because this can increase oxygen available for cardiac function and tissue perfusion. In addition, depending on the client as indicated, restrict or increase fluids. You must change linens routinely and administer antipyretics as indicated, to maintain body temperature in near-normal range.

EVALUATION
After 4 hours of nursing intervention, the patient's cardiac output normalized and his/her palpitations are gone.

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