THE NURSING PROCESS: NURSING CARE PLAN
NURSING DIAGNOSIS 2
(Problem; Etiology; Signs &
P Decreased Cardiac Output
E Atrial Fibrillation and Mechanical
S – Client on mechanical ventilation.
Albumin 1.1 – 2/4/14 – low
osmolality in blood – third spacing.
Sluggish Pupil response
Blood pressure 97/39
Heart Rate 54
Peripheral pulses diminished
Client Goal: Client will not have decreased Cardiac Output
Rationale for Nursing Interventions
(Measurable evidence that will
demonstrate that client goal was met)
(Assess; Do; Teach)
(Author and page number)
1) Client’s heart rate/rhythm will
remain in desired limits while at
Assess heart rate, rhythm and
sounds q 2h.
Without a normal rate and regular
rhythm, the heart does not perform
efficiently as a pump to circulate
oxygenated blood producing symptoms
related to the hemodynamic effect they
cause, such as decreased cardiac
output (Pellico, p. 461).
Symptoms of decreased cardiac output
may include dyspnea, orthopnea,
paroxysmal nocturnal dyspnea,
CheyneStokes respirations, fatigue,
weaknes, third and fourth heart sounds,
crackles in lunchs and positive
hepatojuglar reflex (Ackley & Ladwig,
Client may be receiving cardiac
glycosides and the potential for toxicity
is greater with hypokalemia, which is
common with imbalanced fluid volume
(Ackley & Ladwig, p. 200).
The nurse observes for the benefits and
adverse effects of medications and also
manages administration carefully, so
that a constant serum blood level of the
medication is maintained (Pellico, p.
2) Client will maintain electrolyte
and ABG values within normal
limits while at DGH.
3) Client’s family will explain each
cardiac medication prescribed once
Assess vitals including pulse ox
and all peripheral pulses q 2h.
4) Client will agree to enroll in
Cardiac Rehabilitation program by
Assess lab values daily.
Administer amiodorone and
norepinephrine as ordered with
careful monitoring to reestablish
normal sinus rhythm at all times.
Monitor I&O q 1h.
Monitor ECG q1h.
Weight client daily.
Teach client’s family of available
cardiac rehabilitation programs 2
times by discharge.
Smoking is a wellestablished risk
factor for coronary artery disease. A
study assessing right heart
hemodynamic values and respiratory
function among chronic smokers found
that cardiac output and respiratory
function worsened significantly in this
sample (Ackley & Ladwig, p. 206).
10) Teach client about all cardiac
medications prescribed including
side effects, adverse responses
and the need to take as ordered
two times by discharge.
Clinical practice guidelines states that
weighing at the same time daily is
useful to assess fluid balance. Increased
weight and severity of symptoms can
signal decreased cardiac function and
retention of fluids (Ackley & Ladwig, p.
A study that assessed 3year outcomes
of patients using rehabilitative
programs had significantly reduced
hospital readmission, length of stay and
cost per case as well as significantly
improved quality of life and functional
status (Ackley & Ladwig, p. 201).
Teach client and family the ...
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