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NCLEX & CGFNS Practice Questions
Decreased Cardiac Output
  • Actual
  • Risk for (Potential)

Related To: [Check those that apply]

  • Increased or decreased ventricular filling (preload)
  • Alteration in afterload
  • Impaired contractility
  • Alteration in heart rate, rhythm, and conduction
  • Decreased oxygenation
  • Cardiac muscle disease

As evidenced by: [Check those that apply]

  • Variations in hemodynamic parameters (blood pressure [BP], heart rate, cardiovascular pressure [CVP], pulmonary artery pressures, venous oxygen saturation [S VO2], cardiac output)
  • Arrhythmias, electrocardiogram (ECG) changes
  • Rales, tachypnea, dyspnea, orthopnea, cough, abnormal arterial blood gases (ABGs), frothy sputum
  • Weight gain, edema, decreased urine output
  • Anxiety, restlessness
  • Syncope, dizziness
  • Weakness, fatigue
  • Abnormal heart sounds
  • Decreased peripheral pulses, cold clammy skin
  • Confusion, change in mental status
  • Angina
  • Ejection fraction less than 40%
  • Pulsus alternans

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Patient’s Diagnosis: –

Objective/Expected Outcome;The patient will:

  • maintains BP within normal limits; warm, dry skin; regular cardiac rhythm; clear lung sounds; and strong bilateral, equal peripheral pulses.
  • Others

Note: you need to indicate time frame/target as objective must be measurable.

Nursing Interventions Scientific Rationale
Assess mentation. Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages.
Assess heart rate and blood pressure. Sinus tachycardia and increased arterial blood pressure are seen in the early stages; BP drops as the condition deteriorates.
Assess skin color and temperature. Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
Assess peripheral pulses. Pulses are weak with reduced cardiac output.
Assess fluid balance and weight gain. Compromised regulatory mechanisms may result in fluid and sodium retention. Body weight is a more sensitive indicator of fluid or sodium retention than intake and output.
Assess heart sounds, noting gallops, S3, S4. S3 denotes reduced left ventricular ejection and is a classic sign of left ventricular failure. S4 occurs with reduced compliance of the left ventricle, which impairs diastolic filling.
Assess urine output. Determine how often the patient urinates. Oliguria can reflect decreased renal perfusion. Diuresis is expected with diuretic therapy.
Assess for chest pain. Indicates an imbalance between oxygen supply and demand.
Maintain optimal fluid balance. Administration of fluid increases extracellular fluid volume to raise cardiac output.
Maintain hemodynamic parameters at prescribed levels. For patients in the acute setting, close monitoring of these parameters guides titration of fluids and medications.
Administer stool softeners as needed. Straining for a bowel movement further impairs cardiac output.
Monitor sleep patterns; administer sedative. Rest is important for conserving energy.

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