Risk for decreased cardiac output related to compression of cardiac structures due to swelling of the chest Risk for

decreased cardiac output is defined as the risk of inadequate blood pumping by the heart to meet the metabolic demands of the body. When there is a risk for decreased cardiac output, there is also a risk for the client to have tissue perfusion problems. Pnuemothorax is caused by trauma, tension or other predisposing ling disease that causes the lungs to be filled by air. In pnuemothorax, the air accumulated in the pleural cavity can cause pressure that may lead to lung collapse. That lung collapse may further put pressure in the pleural cavity that may lead to a condition called mediastinal shift. Mediastinal shift is the displacement of the central thoracic structures including the heart on one side that may be caused by compression or kinking of the great vessels and pressure from lung collapse. These dangerously impair the blood return to the heart. The latter cause a subsequent decrease in cardiac output and blood pressure. Mediastinal shift is a medical emergency and needs to be acted upon immediately. In relation to the patient, traumatic bilateral pnuemothorax accompanied by fractures in the 3rd-6th rib caused his chest to be swollen. Another cause of the chest swelling is the accumulation of air due to the puncture in both lungs. Due to the swelling and the pull of gravity, his major arteries can be impeded and may cause decrease cardiac output. There is also a great risk of him of having decreased cardiac output due to the possible mediastinal shift. To prevent the mediastinal shift, chest tube thoracostomy was done to the patient to decrease the pressure and remove the air that went in the pleural cavity of the client. Thoracentesis is also done to aspirate accumulated fluid in the pleural cavity that can prevent mediastinal shift that can

decrease the cardiac output of the client. In order to prevent hemodynamic instability, the researchers did the following intervention; 1) Assessed vital signs and note sudden change in BP. The rationale behind is that sudden severe hypotension may indicate mediastinal shift cause by the compression of the cardiac structure specifically the great vessels. 2) Assessed the swelling of the chest and assessed the feeling of tightness. The swelling of the chest due to the fractures of the client and the gravity compresses the cardiac structure that is why there a great need for assessment. The feeling of tightness may be an indication of mediastinal shift. 3) A liquid to soft diet is encouraged to decrease the workload of the heart. 4) Instructed the patient to limit activities and promote adequate rest. 5) Provided a calm environment. 6) Encourage verbalization of feelings, concerns and feeling of chest tightness. And lastly, the client was given health teaching regarding the possible complications of the illness and the activities to be avoided to avoid complications. As the result of the said interventions, the client has stable vital signs, no reports of exhaustion, no signs of further chest swelling, no severe hypotension, no severe chest tightness and verbalization of feelings and understanding was noted. The goal of the nursing diagnosis was fully met.