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Nursing Care Plans

Problem: Decreased Cardiac Output
Nursing Diagnosis: Decreased cardiac output related to fluid imbalances affecting circulating volume myocardial workload and systemic vascular resistance (SVR)
alterations in rate, rytm, cardiac conduction (electrolyte imbalances, ypo!ia) accumulation of to!ins (urea), soft"tissue calcification (deposition of calcium pospate)
Taxonomy: #ctivity"$!ercise %attern
Cause Analysis: &oss of e!cretory renal function tat may lead to decreased pospate e!cretion and calcium absorption causes tissue calcifications' Decreased e!cretion
of nitrogenous wastes accumulate urea in te system' Decreased sodium reabsorption in tubule affects fluid balances' &osses of none!cretory renal function of te kidney
will lead to failure to produce erytropoietin' (us leads to anemia' )n order to pump more blood into te body, te eart muscle re*uires more o!ygenated blood to meet
own needs' Calcifications of te involuntary muscles affects contractility tus affects volume of blood e+ected per minute (p,,-,.-/0, .--. 1edical"Surgical 2ursing by
3lack et'al)
Cues Goal Nursing Intervention Rationale Evaluation
 increased eart rate
 dysrytmias
 canges in 3%
(ypotension4ypertens
ion)
 e!tra eart sounds
 Diminised periperal
pulses
 Diaporesis
 Cest pain
 $dema
STO: #fter 5 rs of effective
nursing intervention, patient would
be able to become knowledgeable
and knowledgeable about te
diagnostic tests e will undergo'
LTO: #fter , rs of effective
nursing interventions, patient would
be able to maintain cardiac output
as evidenced by 3% and eart rate
witin patient6s normal range7
periperal pulses strong and e*ual
wit prompt capillary refill time'
Ine!enent
#uscultate eart and lung sounds' $valuate
presence of periperal edema4vascular
congestion and reports of dyspnea'
#ssess presence4degree of ypertension8 monitor
3%7 note postural canges, e'g', sitting, lying,
standing'
)nvestigate reports of cest pain, noting location,
radiation, severity (9:.9 scale), and weter or
not it is intensified by deep inspiration and
supine position'
$valuate eart sounds (note friction rub), 3%,
periperal pulses, capillary refill, vascular
congestion, temperature, and
sensorium4mentation'
S/4S- eart sounds wit muffled tones,
tacycardia, irregular eart rate,
tacypnea, dyspnea, crackles, wee;es,
and edema4+ugular distension suggest
<='
Significant ypertension can occur
because of disturbances in te renin"
angiotensin"aldosterone system (caused
by renal dysfunction)' #ltoug
ypertension is common, ortostatic
ypotension may occur because of
intravascular fluid deficit, response to
effects of antiypertensive medications,
or uremic pericardial tamponade'
#ltoug ypertension and cronic <=
may cause 1), appro!imately alf of
CR= patients on dialysis develop
pericarditis, potentiating risk of
pericardial effusion4tamponade'
%resence of sudden ypotension,
parado!ic pulse, narrow pulse pressure,
diminised4absent periperal pulses,
marked +ugular distension, pallor, and a
rapid mental deterioration indicate
tamponade, wic is a medical
emergency'
#ssess activity level, response to activity'
Collaborative
1onitor laboratory4diagnostic studies, e'g'8
$lectrolytes (potassium, sodium, calcium,
magnesium), 3>24Cr7
Cest !"rays'
#dminister antiypertensive drugs, e'g', pra;osin
(1inipress), captopril (Capoten), clonidine
(Catapres), ydrala;ine (#presoline)'
%repare for dialysis'
#ssist wit pericardiocentesis as indicated'
?eakness can be attributed to <= and
anemia'
)mbalances can alter electrical
conduction and cardiac function'
>seful in identifying developing cardiac
failure or soft"tissue calcification'
Reduces systemic vascular resistance
and4or renin release to decrease
myocardial workload and aid in
prevention of <= and4or 1)'
Reduction of uremic to!ins and
correction of electrolyte imbalances and
fluid overload may limit4prevent cardiac
manifestations, including ypertension
and pericardial effusion'
#ccumulation of fluid witin
pericardial sac can compromise cardiac
filling and myocardial contractility,
impairing cardiac output and
potentiating risk of cardiac arrest'