NURSING CARE PLAN PROBLEM: NURSING DIAGNOSIS: Risk for decreased cardiac output related to inotropic changes (transient/prolonged

myocardial ischemia, effects of medications) CAUSE ANALYSIS: CUES OBJECTIVE NURSING RATIONALE EVALUATION INTERVENTIONS SUBJECTIVE: STO; After 3-4 hours of nursing intervention the patient report/display decreased episodes of dyspnea, angina, and dysrhythmias. 1.Monitor vital signs (e.g., heart rate, BP) and cardiac rhythm. 2. Auscultate breath sounds and heart sounds. Listen for murmurs. 1. Decreases oxygen consumption/demand, reducing myocardial workload and risk of decompensation. 2. S3, S4, or crackles can occur with cardiac decompensation or some medications (especially beta-blockers). Development of murmurs may reveal a valvular cause for chest pain (e.g., aortic stenosis, mitral stenosis) or papillary muscle rupture. 3. Conserves energy, reduces cardiac workload. 4. Valsalva maneuver causes vagal stimulation, reducing heart rate (bradycardia), which may be followed by rebound tachycardia, both of which may impair cardiac output. 5. Timely interventions can reduce oxygen consumption and myocardial workload and may prevent/minimize cardiac complications.

OBJECTIVE: 3. Provide for adequate rest periods. Assist with/perform self-care activities, as indicated. 4. Stress importance of avoiding straining/ bearing down, especially during defecation. 5. Encourage immediate reporting of pain for prompt administration of medications as indicated.

LTO;

6. Note skin color and

presence/quality of pulses.

7. Monitor pulse oximetry or ABGs as indicated.

8. Monitor laboratory studies e.g., PTT, aPTT.

6. Peripheral circulation is reduced when cardiac output falls, giving the skin a pale or gray color (depending on level of hypoxia) and diminishing the strength of peripheral pulses. 7. Determines adequacy of respiratory function and/or O2 therapy. 8. Evaluates therapy needs/effectiveness.