Nurseslabs » Decreased Cardiac Output

5 Coronary Artery Disease Nursing Care Plans

NursesLabs — Fri, 03 Feb 2012 18:19:49 +0000

Coronary artery disease (CAD) is a condition in which plaque builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow. When your coronary arteries are narrowed or blocked, oxygen-rich blood can’t reach your heart muscle. This can cause angina or a heart attack. Without quick treatment, a heart attack can lead to serious problems and even death.

CAD is the most common type of heart disease. Lifestyle changes, medicines, and/or medical procedures can effectively prevent or treat CAD in most people. Other names for Coronary Artery Disease are Atherosclerosis, Coronary heart disease, Hardening of the arteries, Heart disease, Ischemic heart disease, and Narrowing of the arteries.

1 Decreased Cardiac Output

Cad causes narrowing of blood vessels. This condition leads to intense pressure exerted on the walls of the blood vessels. The body’s compensatory mechanism is to increase the work load of the heart and thus the patient has decreased cardiac output.

Assessment

Nursing diagnosis

Scientific explanation

Planning

Nursing interventions

Rationale

Expected outcome

S= ∅O=The patient may manifest:

>restlessness

>increased bp

> cold clammy skin

>decreased peripheral pulses

Decreased cardiac output r/t increased vascular resistance

Cad causes narrowing of blood vessels. This condition leads to intense pressure exerted on the walls of the blood vessels. The body’sCompensatory mechanism is to increase the work load of the heart and thus the patient has decreased cardiac output.

Short term:After 2-3 hours of nursing interventions, the patient will verbalize understanding of disease process.Long term:

After two days of nursing interventions the patient will participate in activities to decrease in the heart’s workload

> assess patient’s condition> monitor and record vital signs> encourage patient to verbalize concerns

> encourage patient to change position every two hours

> encourage patient to do relaxation techniques

> encourage patient to engage in divertional activities such as chatting with family and friends.

> reinforced low salt and low fat diet

> to determine possible prolems> for baseline data> to make client express his feelings

> to improve venous return

> to reduce stress

> to divert attention and help patient lessen experienced pain and anxiety

> to prevent further complications of the disease

Short term:The patient shall have verbalizedUnderstanding of disease process.

Long term:

The patient shall have participated in activities to decrease in the heart’s workload

5 Coronary Artery Disease Nursing Care Plans Original source at: Nurseslabs

3 Placenta Previa Nursing Care Plans

NursesLabs — Wed, 01 Feb 2012 11:00:55 +0000

Placenta praevia (placenta previa AE) is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum hemorrhage (vaginal bleeding). It affects approximately 0.5% of all labors.

Read our Placenta Previa Nursing Care Plans below

1 Deficient Fluid Volume

Fluid volume deficit is a state in which an individual is experiencing decreased intravascular, interstitial and/or intracellular fluid. Active Blood Loss or Hemorrhage due to disrupted placental implantation during pregnancy may manifest signs and symptoms of fluid vol. deficient that may later lead to hypovolemic shock and cause maternal and fetal death.

Assessment

Nursing Dx

Planning

Nursing Interventions

Rationale

Expected Outcome

S-O-> Bleeding Episodes (amount, duration)

> Facial Grimace due of Pain

> Complaint of pain

Abdomen soft/hard when palpated

> Manifest Body Weakness

> Low BP

Increased HR

Decreased RR

Fetal HR >120-160 bpm

> Decreased Urine Out

> Increased Urine Concentration

> Pale, Cool Skin

>Increased Capillary Refill

Deficient Fluid Volume r/t Active Blood Loss Secondary to Disrupted Placental Implantation

Short Term:After 4 hours of NI, the pt will verbalize understanding of causative factors.Long Term:

After 4 days of NI, the pt will maintain fluid volume at a functional level AEB individually adequate urinary output and stable vital signs.

1. Establish Rapport2. Monitor Vital Signs3. Assess color, odor, consistency and amount of vaginal bleeding; weigh pads

4. Assess hourly intake and output.

5. Assess baseline data and note changes. Monitor FHR.

6. Assess abdomen for tenderness or rigidity- if present, measure abdomen at umbilicus (specify time interval)

7. Assess SaO2, skin color, temp, moisture, turgor, capillary refill (specify frequency)

8. Assess for changes in LOC: note for complaints of thirst or apprehension

9. Provide supplemental O2 as ordered via facemask or nasal cannula @ 10-12 L/min.

10. Initiate IV fluids as ordered (specify fluid type and rate).

11. Position Pt. in supine with hips elevated if ordered or left lateral position.

12. Monitor lab. Work as obtained: Hgb & Hct, Rh and type, cross match for 2 units RBCs, urinalysis, etc. Scheduled for ultrasound as ordered.

1. To gain patient’s trust2. To obtain baseline data3. Provides information about active bleeding versus old blood, tissue loss and degree of blood loss

4. Provides information about maternal and fetal physiologic compensation to blood loss

5. Assessment provides information about possible infection, placenta previa or abruption. Warm, moist, bloody environment is ideal for growth of microorganisms.

6. Detecting increased in measurement of abdominal girth suggests active abruption

7. Assessment provides information about blood vol., O2 saturation and peripheral perfusion

8. To detect signs of cerebral perfusion

9. Intervention increases available O2 to saturate decreased hemoglobin

10. For replacement of fluid vol. loss

11. Position decreases pressure on placenta and cervical os. Left lateral position improves placental perfusion

12. Lab. Work provides information about degree of blood loss; prepares for possible transfusion. Ultra sound provides info about the cause of bleeding

Short Term:The pt shall have verbalized understanding of causative factors.Long Term:

The pt shall have maintained fluid volume at a functional level AEB individually adequate urinary output and stable vital signs.

3 Placenta Previa Nursing Care Plans Original source at: Nurseslabs

10 Congestive Heart Failure Nursing Care Plans

NursesLabs — Tue, 24 Jan 2012 17:32:53 +0000

Heart failure is a physiologic state in which he heart cannot pump enough blood to meet the metabolic needs of the body. Heart failure results from changes in systolic or diastolic function of the left ventricle. The heart fails when, because of intrinsic disease or structural it cannot handle a normal blood volume or, in absence of disease, cannot tolerate a sudden expansion in blood volume. Heart failure is not a disease itself; instead, the term refers to a clinical syndrome characterized by manifestations of volume overload, inadequate tissue perfusion, and poor exercise tolerance. Whatever the cause, pump failure results in hypoperfusion of tissues, followed by pulmonary and systemic venous congestion.

Because heart failure causes vascular congestion, it is often called congestive heart failure, although most cardiac specialist no longer use this term. Other terms used to denote heart failure include chronic heart failure, cardiac decompensation, cardiac insufficiency and ventricular failure (Joyce M. Black, 2008).

1. Decreased Cardiac Output

The heart fails to pump enough blood to meet the metabolic needs of the body. The blood flow that supplies the heart is also decreased thus decrease in cardiac output occurs, blood then is insufficient and making it difficult to circulate the blood to all parts of the body thus may cause altered heart rate and rhythm, weakness and paleness

Assessment

Nursing Diagnosis

Planning

Nursing Interventions

Rationale

Evaluation

Subjective:(none)

Objectives:

The patient manifested the following:

with pale conjunctiva, nail beds and buccal mucosa
irregular rhythm of pulse
bradycardic
pulse rate of 34 beats/min
generalized weakness

Decreased cardiac output r/t altered heart rate and rhythm AEB bradycardia

Short Term:After 3-4 hours of nursing interventions, the patient will participate in activities that reduce the workload of the heart.Long Term:After 2-3 days of nursing interventions, the patient will be able to display hemodynamic stability.

Assess for abnormal heart and lung sounds.

Monitor blood pressure and pulse.

Assess mental status and level of consciousness.

Assess patient’s skin temperature and peripheral pulses.

Monitor results of laboratory and diagnostic tests.

Monitor oxygen saturation and ABGs.

Give oxygen as indicated by patient symptoms, oxygen saturation and ABGs.

Implement strategies to treat fluid and electrolyte imbalances.

Administer cardiac glycoside agents, as ordered, for signs of left sided failure, and monitor for toxicity.

Encourage periods of rest and assist with all activities.

Assist the patient in assuming a high Fowler’s position.

Teach patient the pathophysiology of disease, medications

Reposition patient every 2 hours

Instruct patient to get adequate bed rest and sleep

Instruct the SO not to leave the client unattended
Allows detection of left-sided heart failure that may occur with chronic renal failure patients due to fluid volume excess as the diseased kidneys are unable to excrete water.

Patients with renal failure are most often hypertensive, which is attributable to excess fluid and the initiation of the rennin-angiotensin mechanism.

The accumulation of waste products in the bloodstream impairs oxygen transport and intake by cerebral tissues, which may manifest itself as confusion, lethargy, and altered consciousness.

Decreased perfusion and oxygenation of tissues secondary to anemia and pump ineffectiveness may lead to decreased in temperature and peripheral pulses that are diminished and difficult to palpate.

Results of the test provide clues to the status of the disease and response to treatments.

Provides information regarding the heart’s ability to perfuse distal tissues with oxygenated blood

Makes more oxygen available for gas exchange, assisting to alleviate signs of hypoxia and subsequent activity intolerance.

Decreases the risk for development of cardiac output due to imbalances.

Digitalis has a positive isotropic effect on the myocardium that strengthens contractility, thus improving cardiac output.

Reduces cardiac workload and minimizes myocardial oxygen consumption.

Allows for better chest expansion, thereby improving pulmonary capacity.

Provides the patient with needed information for management of disease and for compliance.

To prevent occurrence of bed sores

To promote relaxation to the body

To ensure safety and reduce risk for falls that may lead to injury

Short Term:After nursing interventions, the patient shall have participated in activities that reduce the workload of the heart.Long Term:After 2-3 days of nursing interventions, the patient shall have been able to display hemodynamic stability.

10 Congestive Heart Failure Nursing Care Plans Original source at: Nurseslabs

Hypertensive Emergency Nursing Care Plan

NursesLabs — Fri, 06 Jan 2012 23:00:25 +0000

A hypertensive emergency is severe hypertension (high blood pressure) with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. In case of a hypertensive emergency, the blood pressure should be lowered aggressively over minutes to hours with an antihypertensive agent.

Several classes of antihypertensive agents are recommended and the choice for the antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated blood pressure and the patient’s usual blood pressure before the hypertensive crisis. In most cases, the administration of an intravenous sodium nitroprusside injection which has an almost immediate antihypertensive effect is suitable but in many cases not readily available. In less urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed onset of action by several minutes compared to sodium nitroprusside, can also be used.

Decreased Cardiac Output

Hypertension is defined as a condition wherein there is an increase in BP beyond the normal range. Hypertensive emergency is used for BPs above 160/100mmHg. With hypertension, the blood vessels constrict. When blood vessels are constricted, there is a decrease in blood volume, decrease in cardiac output and increase in BP as blood passes through the narrowed lumen of the vessels.

Assessment

Nursing Diagnosis

Objectives

Nursing Interventions

Rationale

Expected Outcome

S> (none)

The pt. Manifested:

> dysrrhythmias

> prolonged capillary refill

> cold clammy skin

> dyspnea

> variations in BP

> restlessness

> BP of 190/150

The pt. May manifest

Decreased cardiac output r/t altered stroke volume secondary to hypertensive emergency

Short Term:

After 6 hours of NI, the pt will manifest hemodynamic stability (BP, CO, UO, PR) pt shall also verbalize understanding of the disease process & risk factors

Long Term:

After 4 days of NI, the pt will participate in activities that decrease blood pressure

Establish Rapport

Monitor Vital Signs

History Taking

Assess patient’s condition

Review lab data

Review ECG strip

Monitor BP, PR frequently

Provide information on test procedures

Explain dietary restrictions

Encourage rest & reposition client q2

Encourage relaxation techniques

Provide PM care

Encourage to increase activity level as tolerated

Teach home BP reading & monitoring

Administer anti hypertensives

To gain pt’s trust

To obtain baseline data

To determine contributing factors

To determine present condition

For comparison with normal values

To determine alterations in electrical activity of the heart

To note response to activity

To gain pt’s participation & decrease anxiety level

To inform patient of contributing factors

To decrease stress and promote venous return

To alleviate anxiety & stress

To promote hygiene & comfort

To maintain functional ability

To detect change in VS & seek timely intervention

To decrease BP within normal ranges

The pt shall have manifested hemodynamic stability (BP, CO, UO, PR) pt shall have also verbalized understanding of the disease process & risk factors.

The pt shall have participated in activities that decrease blood pressure

Source: Wikipedia> Hypertensive Emergency

Image Source: (1)

Hypertensive Emergency Nursing Care Plan Original source at: Nurseslabs

5 Congestive Heart Failure Nursing Care Plans

NursesLabs — Sat, 17 Dec 2011 02:18:32 +0000

Congestive heart failure (CHF), or heart failure, is a condition in which the heart can’t pump enough blood to the body’s other organs. To fully understand CHF, see the pathophysiology here.

Use the navigation below to cycle thru the different nursing care plans for heart failure.

1 Fluid Volume Excess

Goals:

Body weight will remain within normal limits
Electrolyte levels will be within normal limits
Will demonstrate adequate knowledge concerning medical condition.
Will maintain optimal fluid balance
Will verbalize less dyspnea and be more comfortable.

Interventions:

Administer Oxygen as ordered
Asess for symptoms such as dizziness, weaknes/fatigue, nausea/vomiting, confusion, sweatiness, cyanosis. Notify physician as appropriate.
Assess for presence of edema
Check breath sounds and assess for labored breathing.
Check Vital Signs
Keep head of bed elevated
Monitor fluid intake, restrict sodium intake as ordered.
Monitor Lab work; K+, NA, BUN, Creatinine
Observe for signs and symptoms of malnutrition, Do not force resident to eat. Offer small frequent feedings. Assess food preferences.
Weigh patient daily

5 Congestive Heart Failure Nursing Care Plans Original source at: Nurseslabs