Decreased cardiac output

NANDA Nursing Diagnose - Decreased cardiac output

  • Código del diagnóstico: 29
  • Dominio del diagnóstico: Domain 4 - Actividad/reposo
  • Clase del diagnóstico: Class 4 - Respuestas cardiovasculares/pulmonares

The NANDA-I diagnosis 'Decreased cardiac output' is a critical concept in nursing practice, underscoring the importance of understanding cardiac function in patient care. This diagnosis reflects the heart's inability to pump sufficient blood to meet the body's metabolic needs, which can lead to serious complications and requires proactive intervention. Recognizing the signs and implications of decreased cardiac output is essential for nurses, as it directly influences treatment decisions and patient outcomes, placing it at the forefront of cardiac care and management.

This post aims to explore the NANDA-I diagnosis 'Decreased cardiac output' in depth, starting with a clear definition of this pivotal diagnosis. By examining the key characteristics, risk factors, and associated problems tied to decreased cardiac output, the content will provide a comprehensive overview designed to enhance understanding and clinical application. Delving into the vital signs and symptoms, as well as the assessment strategies nurses can employ, will equip practitioners with the knowledge needed to address this condition effectively.

Definition of the NANDA-I Diagnosis

The diagnosis of 'Decreased cardiac output' refers to a clinical state in which the heart's ability to pump blood is insufficient to fulfill the metabolic requirements of the tissues and organs, leading to potential disturbances in circulatory dynamics. This condition can manifest through a variety of signs and symptoms, such as alterations in heart rate or rhythm, changes observed on electrocardiograms, fatigue, edema, and altered blood pressure. Factors may include reduced stroke volume due to impaired contractility, increased afterload, or inadequate preload. Patients may also present with specific physical signs, including jugular vein distention, abnormal skin color, decreased peripheral pulses, dyspnea, and the presence of abnormal heart sounds. The diagnosis is particularly relevant in populations at risk, such as older adults, and can arise from a range of underlying cardiac conditions, emphasizing the need for careful assessment and management to restore effective cardiac function and meet the physiological demands of the body.

Defining Characteristics of the NANDA-I Diagnosis

The NANDA-I diagnosis "Decreased cardiac output" is identified by its defining characteristics. These are explained below:

  • Alteration of Heart Rate/Rhythm
    • Bradycardia: Bradycardia is defined as a heart rate less than 60 beats per minute, which can lead to inadequate blood flow and oxygen delivery to tissues. In patients with decreased cardiac output, bradycardia may occur due to the heart's inability to generate sufficient force to maintain normal cardiac output, prompting a compensatory mechanism that may not effectively promote systemic perfusion.
    • Electrocardiographic Changes: Abnormalities in the heart's electrical activity can indicate underlying dysfunction, such as ischemia or previous infarctions, which can compromise contractility and overall cardiac performance, resulting in reduced output.
    • Cardiac Palpitations: The sensation of irregular or forceful heartbeats can signify increased sympathetic tone or arrhythmias as a response to decreased cardiac output. This sensation often elevates anxiety, further affecting cardiac performance.
    • Tachycardia: Elevated heart rate may be a compensatory response to decreased cardiac output, as the body attempts to maintain adequate tissue perfusion through increased heart rate, even if contractility is impaired.
  • Alteration of Preload
    • Decreased Central Venous Pressure: Low central venous pressure indicates inadequate venous return to the heart and poor filling pressures. This deficiency directly contributes to reduced stroke volume and cardiac output.
    • Decreased Pulmonary Artery Wedge Pressure: This measurement reflects left atrial pressure and can indicate underfilling of the left side of the heart, correlating with decreased cardiac output due to ineffective cardiac filling.
    • Edema: Peripheral or pulmonary edema indicates the heart's reduced capacity to manage fluid balance, leading to fluid accumulation as a consequence of decreased output.
    • Fatigue: This symptom often results from the body's insufficient perfusion and oxygenation, where the inability of the heart to pump effectively results in systemic fatigue.
    • Heart Murmur: Abnormal heart sounds during auscultation can reflect turbulent flow due to structural heart issues or changes in blood velocity, suggesting decreased effective circulation.
    • Increased Central Venous Pressure: If central venous pressure is elevated, it typically indicates congestive states where poor cardiac output leads to fluid retention and systemic congestion.
    • Increased Pulmonary Artery Wedge Pressure: This can indicate left-sided heart failure, directly corresponding with decreased cardiac output and manifesting as pulmonary congestion.
    • Jugular Venous Distension: The presence of distended neck veins suggests excess volume or fluid overload as the heart fails to maintain an adequate output, leading to backward venous congestion.
    • Weight Gain: Sudden increases in body weight can indicate fluid retention associated with heart failure and decreased cardiac output, emphasizing the heart's inability to maintain fluid homeostasis.
  • Alteration of Afterload
    • Abnormal Skin Color: Skin pallor or cyanosis can signify compromised blood circulation. These changes in skin perfusion lead to inadequate oxygen delivery, indicating decreased cardiac output.
    • Blood Pressure Alterations: Fluctuating blood pressure readings, especially hypotension, can complicate adequate organ perfusion. Decreased output often presents with lower blood pressure, hindering effective blood flow.
    • Cold and Clammy Skin: Cold extremities may suggest peripheral hypoperfusion due to inadequate cardiac output, as the body redirects blood flow towards vital organs.
    • Decreased Peripheral Pulses: Weak or absent pulses can denote insufficient arterial blood flow, directly related to low cardiac output and inadequate perfusion pressure.
    • Decreased Pulmonary Vascular Resistance: Reduced resistance in the pulmonary circulation can indicate an underlying compromise in cardiac function, impacting overall output capabilities.
    • Decreased Systemic Vascular Resistance: A drop in this resistance reflects the heart's challenge to maintain output against systemic demands, leading to fatigue in cardiac muscle.
    • Dyspnea: Difficulty in breathing often results from pulmonary congestion or inadequate oxygenation due to decreased cardiac output, particularly during exertion.
    • Increased Pulmonary Vascular Resistance: Increased resistance in the pulmonary arteries indicates potential complications from heart failure, contributing to reduced cardiac output.
    • Increased Systemic Vascular Resistance: Higher systemic resistance can impede effective blood flow, compounding the workload on a compromised heart and further reducing output.
    • Oliguria: Low urine output is a critical sign indicating decreased renal perfusion, a direct consequence of reduced cardiac output that risks acute kidney injury.
    • Prolonged Capillary Refill Time: This finding indicates poor peripheral perfusion and serves as a direct indicator of overall circulation efficiency and cardiac performance.
  • Alteration of Contractility
    • Abnormal Breath Sounds: Abnormal respiratory sounds can signify pulmonary congestion, reflecting left ventricular failure commonly associated with decreased cardiac output.
    • Cough: A cough, particularly if productive, may indicate pulmonary congestion due to heart failure and decreased cardiac output.
    • Decreased Cardiac Index: A reduction in this measurement demonstrates decreased volume of blood pumped per minute relative to body surface area, directly evidencing decreased performance of the heart.
    • Decreased Ejection Fraction: A lower than normal ejection fraction shows the heart's diminished ability to expel blood, a crucial sign of reduced cardiac function.
    • Decreased Left Ventricular Stroke Work Index: This metric illustrates reduced output from the left ventricle, highlighting inefficiencies in cardiac contractility that reflect poor perfusion.
    • Decreased Stroke Volume Index: Reduced volumes per heart beat impair overall circulation, reflecting a direct link to diminished cardiac efficiency.
    • Orthopnea: Dyspnea when lying flat often indicates congestive heart failure, where decreased output leads to pulmonary congestion and respiratory distress.
    • Paroxysmal Nocturnal Dyspnea: Episodes of sudden nighttime breathlessness reflect worsening heart function and decreased output, often requiring patient repositioning for relief.
    • Presence of S3 Heart Sound: An S3 sound may suggest congestive heart failure or volume overload, indicative of reduced cardiac output and impaired left ventricular function.
    • Presence of S4 Heart Sound: An S4 sound suggests left ventricular hypertrophy or decreased compliance, further implicating the heart's ineffectiveness at maintaining cardiac output.
  • Behavioral/Emotional Responses
    • Anxiety: Increased anxiety can stem from a patient's awareness of diminished heart function and health instability, reflecting a physiological response to compromised cardiac status.
    • Psychomotor Agitation: Restlessness can be a response to inadequate cardiovascular stability, where physical symptoms of discomfort manifest due to anxiety or hypoperfusion.

Related Factors (Etiology) of the NANDA-I Diagnosis

The etiology of "Decreased cardiac output" is explored through its related factors. These are explained below:

  • Cardiac Muscle Dysfunction
    The heart muscle can be compromised due to various conditions such as ischemic heart disease, cardiomyopathy, or myocardial infarction. This dysfunction leads to impaired contractility, reducing the volume of blood ejected with each heartbeat (stroke volume). As a consequence, the heart struggles to maintain adequate circulation during increased demands, leading to decreased cardiac output. Clinically, this may manifest as fatigue, dyspnea, and signs of poor perfusion. Monitoring cardiac function through echocardiography and frequent assessment of vital signs can guide treatment, which may include medications like inotropes to improve contractility.
  • Hypovolemia
    A significant decrease in circulating blood volume, whether due to hemorrhage, dehydration, or excessive fluid loss (as seen in severe burns or prolonged vomiting), leads to reduced venous return. The heart receives less blood to pump, creating a direct impact on cardiac output. Clinically, hypovolemia can result in hypotension, tachycardia, and altered mental status due to inadequate perfusion. Rehydration and fluid resuscitation are crucial interventions, requiring careful monitoring of fluid balance and vital signs to restore adequate perfusion without causing fluid overload.
  • Increased Systemic Vascular Resistance (SVR)
    Conditions such as hypertension or systemic inflammatory responses may lead to increased SVR, which makes it more difficult for the heart to pump blood effectively. When resistance is elevated, the heart must work harder to overcome this pressure, leading to potential heart failure over time as the cardiac output decreases. Clinically, patients may present with symptoms of congestion, including peripheral edema and shortness of breath. Management strategies often include medications to decrease blood pressure and improve vascular dilation, thus supporting better cardiac output.
  • Arrhythmias
    Dysrhythmias can result in inefficient or ineffective contractions of the heart, leading to inconsistencies in the heart rate and compromised stroke volume. This unpredictability can severely reduce cardiac output. Atrial fibrillation and ventricular tachycardia are examples where the heart beats too fast or irregularly, drastically impacting the heart's ability to fill and empty properly. Clinically, patients may experience syncope, palpitations, or signs of decreased perfusion. Treatment often includes antiarrhythmic medications, cardioversion, or even pacemaker insertion, depending on the severity and type of arrhythmia.
  • Severe Anemia
    A reduction in oxygen-carrying capacity of the blood can lead to compensatory mechanisms that may impair cardiac output. The body may respond by increasing heart rate to maintain tissue oxygenation, but this compensatory increase can sometimes fail, leading to diminished cardiac efficiency. In severe cases, patients may present with fatigue, pallor, and tachycardia. Management includes addressing the underlying cause of anemia, whether through iron supplementation for iron deficiency or transfusions for critical cases, thus ensuring an adequate oxygen supply and supporting improved cardiac function.

Problems Associated with the NANDA-I Diagnosis

The diagnosis "Decreased cardiac output" can interrelate with other problems. These are explained below:

  • Alteration of Preload
    The preload refers to the volume of blood in the ventricles at the end of diastole, prior to contraction. A decreased cardiac output can lead to reduced preload due to inadequate venous return or fluid depletion, compromising cardiac filling. This alteration is significant because insufficient preload impairs the heart's ability to generate an effective stroke volume, resulting in diminished overall circulation and increased risk of tissue hypoxia. Understanding and managing preload is crucial in clinical settings, as interventions may include fluid management or the use of medications to optimize filling pressures and enhance overall cardiac output.
  • Alteration of Afterload
    Afterload represents the resistance the left ventricle must overcome to circulate blood. In states of decreased cardiac output, it may be exacerbated by conditions such as hypertension or aortic stenosis, where increased vascular resistance makes it harder for the heart to eject blood. This can lead to further decline in cardiac performance. Careful monitoring and strategies to reduce afterload, such as vasodilatory agents, are vital for improving cardiac efficiency and restoring adequate output, thereby preventing potential complications like cardiac ischemia or heart failure exacerbation.
  • Alteration of Contractility
    Contractility refers to the inherent ability of cardiac muscle to contract. Decreased cardiac output can be a result of diminished contractility, which can arise from myocardial infarction, cardiomyopathy, or negative inotropic effects of certain medications. Understanding the relationship between decreased output and contractility is essential, as it directly influences treatment strategies involving inotropes or other pharmacologic interventions aimed at enhancing myocardial contractile function. Failure to address this aspect can lead to further progression of heart failure and its associated complications.
  • Alteration of Heart Rate
    Changes in heart rate, whether bradycardia or tachycardia, can occur in response to decreased cardiac output. Bradycardia may signify inadequate cardiac stimulus, while tachycardia often attempts to compensate for low stroke volume. Assessing and managing heart rate is critical because it impacts cardiac output significantly; persistent abnormalities signal underlying pathologies that require intervention, such as pacemaker insertion in bradycardia or antiarrhythmic therapy for tachyarrhythmias. Optimal heart rate control is vital for achieving adequate tissue perfusion and preventing subsequent organ dysfunction.
  • Alteration of Cardiac Rhythm
    Irregularities in cardiac rhythm, such as atrial fibrillation or ventricular tachycardia, can coexist with decreased cardiac output, leading to compromised hemodynamics. These arrhythmias can cause ineffective contraction patterns, further impairing the heart's ability to maintain adequate circulation. Effective management often requires rhythm control strategies, whether through pharmacologic means or procedural interventions like cardioversion, highlighting the importance of early cardiac rhythm assessment to prevent exacerbation of heart failure symptoms and potential thromboembolic events.
  • Alteration of Stroke Volume
    Stroke volume is defined as the volume of blood ejected from the heart during each contraction. When cardiac output decreases, it is often accompanied by a reduction in stroke volume, which can stem from volume overload, reduced contractility, or increased afterload. Understanding this relationship is critical for clinicians, as optimizing stroke volume through fluid resuscitation or medications like dobutamine can effectively improve overall cardiac output. Continuous assessment and targeted interventions are necessary to address the implications of stroke volume alterations in the context of heart failure or shock states, ensuring patient stability and recovery.

NOC Objectives / Expected Outcomes

For the NANDA-I diagnosis "Decreased cardiac output", the following expected outcomes (NOC) are proposed to guide the evaluation of the effectiveness of nursing interventions. These objectives focus on improving the patient's status in relation to the manifestations and etiological factors of the diagnosis:

  • Cardiac Output
    This outcome directly measures the volume of blood the heart pumps in a minute. Monitoring cardiac output is essential in assessing the effectiveness of interventions aimed at enhancing cardiovascular function. An improvement in this outcome indicates that the interventions are effective in increasing cardiac efficiency and managing the symptoms associated with decreased cardiac output.
  • Tissue Perfusion: Peripheral
    Monitoring peripheral tissue perfusion is vital for understanding how well blood is being delivered to extremities and tissues. In cases of decreased cardiac output, there may be inadequate perfusion leading to tissue ischemia. Improvement in this outcome indicates enhanced blood flow to tissues, which is crucial for preventing organ dysfunction and promoting healing.
  • Vital Signs
    Ongoing assessment of vital signs, including heart rate, blood pressure, and respiratory rate, is critical in the management of decreased cardiac output. They provide immediate indicators of the patient’s hemodynamic status. Improvements in vital signs can reflect effective management of cardiac output and overall cardiovascular stability.
  • Endurance
    This outcome evaluates the patient's ability to perform activities of daily living without undue fatigue. A decrease in cardiac output can impair physical capacity, and monitoring endurance helps to assess the impact of nursing interventions on the patient's functional status. Improvement signifies that the patient can engage more fully in life with limited symptoms.

NIC Interventions / Nursing Care Plan

To address the NANDA-I diagnosis "Decreased cardiac output" and achieve the proposed NOC objectives, the following nursing interventions (NIC) are suggested. These interventions are designed to treat the etiological factors and manifestations of the diagnosis:

  • Cardiac Monitoring
    This intervention involves continuous or intermittent monitoring of the patient's heart rate, rhythm, and other vital signs. Regular assessment of cardiac function helps detect any changes in cardiac output early and enables prompt interventions, enhancing patient safety and stabilizing hemodynamic status.
  • Fluid Management
    This intervention includes the careful administration of fluids to maintain optimal intravascular volume. By ensuring adequate hydration and preventing fluid overload, this intervention supports cardiac filling pressures and improves cardiac output, especially in patients with volume depletion.
  • Positioning
    This intervention involves adjusting the patient's position to optimize blood flow and improve hemodynamics. Positions such as sitting up or using a semi-Fowler's position can reduce preload on the heart and enhance comfort, potentially improving cardiac output through better perfusion dynamics.
  • Medication Management
    This entails the administration and monitoring of medications prescribed to enhance cardiac performance, such as inotropes and diuretics. Proper management and dosage can improve myocardial contractility and reduce preload, therefore, increasing cardiac output effectively.
  • Patient Education
    This intervention focuses on providing information regarding lifestyle changes, dietary modifications, and medication adherence. Educating the patient empowers them to participate in their care, reducing the risk of exacerbation of cardiac conditions and promoting overall cardiovascular health.

Detailed Nursing Activities

The NIC interventions for the NANDA-I diagnosis "Decreased cardiac output" are composed of specific activities that nursing staff carry out to provide effective care. Below, examples of activities for the key identified interventions are detailed:

For the NIC Intervention: Cardiac Monitoring

  • Continuously monitor the patient's heart rate and rhythm using telemetry to quickly identify any arrhythmias that could affect cardiac output.
  • Regularly assess blood pressure and respiratory status to evaluate the patient's hemodynamic stability and guide necessary interventions.
  • Document any changes in vital signs and report significant findings to the healthcare team for timely management and intervention.

For the NIC Intervention: Fluid Management

  • Administer IV fluids as prescribed, closely monitoring the rate and total volume to maintain optimal hydration without causing fluid overload.
  • Assess daily weights and evaluate edema to determine fluid status and effectiveness of fluid management strategies.
  • Monitor laboratory values, such as electrolytes and hematocrit, to guide fluid replacement needs and avoid complications.

For the NIC Intervention: Medication Management

  • Administer inotropic medications as prescribed, and monitor their effects on cardiac output and patient stability.
  • Educate the patient about the purpose and potential side effects of medications to ensure adherence and prompt reporting of adverse effects.
  • Evaluate the effectiveness of diuretics by monitoring urine output and serum electrolyte levels to prevent complications associated with fluid imbalance.

Practical Tips and Advice

To more effectively manage the NANDA-I diagnosis "Decreased cardiac output" and improve well-being, the following suggestions and tips are offered for patients and their families:

  • Monitor Symptoms Daily

    Keep track of symptoms such as shortness of breath, fatigue, and swelling in the legs. Monitoring can help identify worsening conditions early, allowing for timely medical intervention.

  • Adopt a Heart-Healthy Diet

    Focus on fruits, vegetables, whole grains, and lean proteins while limiting salt and saturated fats. A heart-healthy diet can help manage blood pressure and improve overall heart function.

  • Stay Hydrated

    Drinking adequate fluids is important, but consult your healthcare provider about the right amount for you. Proper hydration supports optimal blood volume and helps maintain cardiac output.

  • Limit Physical Strain

    Engage in gentle activities like walking or stretching, and avoid high-intensity workouts. Balancing rest and activity is vital to prevent overexertion that can further decrease cardiac output.

  • Manage Stress Levels

    Incorporate relaxation techniques such as deep breathing, meditation, or yoga into your daily routine. Reducing stress can enhance heart function and improve your overall quality of life.

  • Follow Prescribed Medications

    Take medications as directed by your healthcare provider and discuss any side effects or concerns. Adhering to your medication plan ensures better management of heart function.

  • S Schedule Regular Check-ups

    Maintaining regular appointments with your healthcare team allows for continuous assessment and adjustments to your care plan, ensuring the management of decreased cardiac output is on track.

Practical Example / Illustrative Case Study

To illustrate how the NANDA-I diagnosis "Decreased cardiac output" is applied in clinical practice and how it is addressed, let's consider the following case:

Patient Presentation and Clinical Context

A 72-year-old male with a history of chronic hypertension and recent myocardial infarction presents to the emergency department with shortness of breath and edema in the lower extremities. He reports a gradual increase in fatigue over the past week and experiences dizziness upon standing. The patient is diaphoretic and appears anxious, leading to immediate nursing assessment.

Nursing Assessment

During the assessment, the following significant data were collected:

  • Heart Rate: 112 beats per minute, irregular rhythm.
  • Blood Pressure: 88/54 mmHg, indicating hypotension.
  • Respiratory Rate: 26 breaths per minute, with labored breath sounds.
  • Edema: +3 pitting edema in bilateral lower extremities.
  • Oxygen Saturation: 90% on room air, requiring supplemental oxygen.
  • Patient Report: “I feel so weak and can’t catch my breath.”

Analysis and Formulation of the NANDA-I Nursing Diagnosis

The analysis of the assessment data leads to the identification of the following nursing diagnosis: Decreased cardiac output. This conclusion is based on the patient's hypotension, elevated heart rate, and signs of decreased peripheral perfusion evidenced by pitting edema. The presence of pulmonary congestion is indicated by the shortness of breath and low oxygen saturation levels, collectively supporting the diagnosis.

Proposed Care Plan (Key Objectives and Interventions)

The care plan will focus on addressing the "Decreased cardiac output" diagnosis with the following priority elements:

Objectives (Suggested NOCs)

  • Maintain adequate cardiac output as evidenced by stable blood pressure and heart rate within normal limits.
  • Improve oxygenation as demonstrated by oxygen saturation levels above 92% on room air.

Interventions (Suggested NICs)

  • Monitor Hemodynamics:
    • Assess vital signs every hour and note any changes.
    • Evaluate cardiac rhythm via ECG and report any abnormalities.
  • Promote Fluid Balance:
    • Administer prescribed diuretics and monitor output closely.
    • Implement fluid restriction as ordered and assess daily weights.

Progress and Expected Outcomes

With the implementation of the proposed interventions, it is expected that the patient will show improvement in relation to the 'Decreased cardiac output' diagnosis, including an increase in blood pressure within normal range, stabilization of heart rate, reduction in edema, and improved oxygen saturation levels. Continuous monitoring will allow evaluation of the plan's effectiveness.

Frequently Asked Questions (FAQ)

Below are answers to some frequently asked questions about the NANDA-I diagnosis "Decreased cardiac output":

What does "decreased cardiac output" mean?

"Decreased cardiac output" refers to the heart's inability to pump sufficient blood to meet the body's needs, which can lead to inadequate oxygen and nutrient delivery to tissues.

What are the common signs and symptoms of decreased cardiac output?

Common signs and symptoms include fatigue, weakness, shortness of breath, dizziness, rapid or irregular heartbeat, and swelling in the legs or abdomen.

What are the potential causes of decreased cardiac output?

Potential causes include heart conditions like heart failure or myocardial infarction, severe dehydration, excessive blood loss, or conditions affecting the heart's electrical conduction.

How is decreased cardiac output diagnosed?

Diagnosis often involves a physical examination, review of symptoms, and diagnostic tests such as echocardiograms, electrocardiograms (ECGs), or blood tests to assess heart function.

What treatments are available for decreased cardiac output?

Treatment may include medications to improve heart function, lifestyle changes (such as diet and exercise), and in some cases, medical procedures or surgery to address underlying causes.

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