DECREASED CARDIAC OUTPUT Date/time Cues Need Nursing Diagnosis Objectives of Care Nursing interventions 1.

Monitor vital signs especially blood pressure R: sinus tachycardia and increased arterial blood pressure are seen in early stages. 2. Monitor for clients skin color and temperature. R: cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation. 3. Auscultate lung sounds. Determine any occurrence of paroxysmal nocturnal dyspnea or othopnea. Subjective: R: crackles after accumulation of fluid secondary to impaired ventricular emptying. 4. Administer medications as ordered (Digoxin, and antihypertensives) R: Digoxin has been widely used as a positive inotrope to increase myocardial contractility. The increased force of systolic contraction cause the ventricles to empty more completely. Antihypetensives will aid the improvement of cardiac output by normalizing the blood pressure. September 8, 2012 @ 3:00 pm GOAL MET! Evaluation

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Objective: Blood pressure of mmHg ECG 12 leads reading: sinus tachycardia Electrolytes: Spinal fracture; spinal compression; autonomic dysreflexia

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After 8 hours span of care, the client did not experience further Within 8 hours span of care, the client will not 5. Place client in supine position; complications brought about by experience further semi-Folwlers position decreased complications brought R: Supine position increases venous cardiac output as about by decreased return and promote diuresis. Semi- evidenced by: cardiac output as fowlers position reduces preload evidenced by: a. Blood Decreased Cardiac and ventricular filling. pressure of output related to a. Blood pressure 6. Administer humidified oxygen ____ mmHg; decreased within normal as ordered b. Warm, dry ventricular filling range ( 90/60skin; 130/90 mmHg); R: the failing heart may not be able to c. Strong b. Warm, dry skin; respond to increased oxygen bilateral, c. Strong bilateral, equal equal peripheral demands. peripheral pulses; and 7. Maintain physical rest and pulses ; and d. Clear lung sounds. emotional rest by providing d. Clear lung quiet and relaxed environment. sounds hear upon R:to reduce oxygen demand and to auscultation. prevent increasing cardiac demans. 8. Administer stool softeners as ordered Judeah G. Salangsang, St. N R: straining for a bowel movement further impairs cardiac output. 9. Educate the family and significant others on the importance of following drug regimen, monitoring activity an following deit restrictions (low salt, low fat) R: thorough understanding of condition and what needs to be done help in ensuring that complications will not occur.

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References: Gulanick, M. & Myers, J. (2007). Nursing Care plans: nursing diagnosis and interventions. 6th edition. Mosby, Elsevier Inc. USA McKenry, et.al (2007). Mosbys Pharmacology in Nursing. 23rd edition. Mosby, Elsevier, Inc. USA