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Ms. Sandler, 27 years old, a certified public accountant. She has irregular menstruation flow. One day she experienced 2 weeks menstrual bleeding which she thought it was a bad sign so she decided to go to see a doctor. She never experience bleeding a lot that she could soak 6 pads every day and she said to her doctor that she felt having palpitations. Below is a sample of decreased cardiac output nursing care plan of Ms. Sandler.



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


I observed from the patient that she has distended neck vein and facial edema. 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 she can't stay still and find his/her comfort.


Vital signs are taken and noted as follows: Body temperature is 36.8 degrees Celsius, 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 her body temperature while blood pressure and respiratory rate are in normal range. But the patient is in tachycardia as her pulse rate exceeds the 80-100 beats per minute normal range.



Decreased cardiac output related to palpitations as evidenced by altered heart rate (tachycardia) and distended neck vein.



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



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


- You must review her 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 to Ms. Sandler the periodic hemodynamic measurements as indicated such as arterial pressures and cardiac output and monitor cardiac rhythm continuously to note effectiveness of medications and assistive devices such as implanted pacemaker of defibrillator.  Maintain patency of invasive intravascular monitoring and infusion lines. Tape the connections to prevent air embolus and exsanguination. Also assess the patient's urine periodically; weigh daily and note her total fluid balance.


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



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

For more samples of nursing care plan you are free to check it out in our NCP LIST page.

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