Nursing Diagnosis: Decreased cardiac output related to increase afterload

Independent Nursing Intervention:

1. Monitor vital signs and cardiac rhythm.

Rationale: This assessment will reveal whether dysrhythmias occur or increase in occurrence.
We also need to assess the BP because one of the signs of decreased cardiac output include
decreased BP and symptoms such as unrelieved and prolonged palpitations, weakened and
rapid pulse (more than 150 bpm)
2. Evaluate quality and equality of pulses.

Rationale: Decreased cardiac output results in diminished, weak, or thready pulses. Irregularities
suggest dysrhythmias, which may require further evaluation and monitoring

3. Note the patient’s skin color, moisture and quality of pulse.

Rationale: It will help in further determination of an impending decrease cardiac output.

Peripheral circulation is reduced when cardiac output falls giving the skin a pale or gray color
(depending on the level of hypoxia), cold, clammy skin and diminishing the strength of
peripheral pulses.
4. Evaluate mental status, noting development of confusion, disorientation.

Rationale: Cerebral perfusion is directly related to cardiac output. Confusion, agitation,

decreased cognition, and coma may occur due to decreased brain perfusion.

5. Auscultate breath sounds and heart sounds. Listen for murmurs.

Rationale: S3, S4, or crackles can occur with cardiac decompensation or some medications
(especially beta-blockers). Presence of murmurs indicates disturbances of normal blood flow
within the heart, such as incompetent valve, septal defect, or vibration of papillary muscle and
chordae tendineae

6. Place client in semi-Fowler's or high Fowler's position with legs down or in a position of comfort.
Elevating the head of the bed and legs in the down position

Rationale: may decrease the work of breathing and may also decrease venous return and
preload

7. Provide a restful environment by minimizing controllable stressors and unnecessary

disturbances.

Rationale: Both stress and pain can increase sympathetic tone and cause dysrhythmias so
reducing stressors decreases cardiac workload and oxygen demand.

8. Provide for adequate rest periods.

 Rationale: Conserves energy therefore reduces cardiac workload.

9. Stress the importance of minimizing activities that can elicit Valsalva response (e.g., rectal
straining, vomiting, spasmodic coughing with suctioning, prolonged breath-holding during
pushing stage of labor) and encourage client to breathe deeply in and out during activities that
increase risk of Valsalva effect.

Rationale: Valsalva response to breath-holding causes increased intrathoracic pressure, reducing

cardiac output and blood pressure

10. Monitor laboratory tests such as complete blood count, sodium level, and serum creatinine and
refer to attending physician
Rationale: It will determine causes of a decrease cardiac output and will initiate immediate
intervention as necessary and as prescribed.

Dependent Nursing Intervention:

1. Administer prescribed medications (e.g., inotropic drug, ACE inhibitor)

2. Administer supplemental oxygen by appropriate route, as indicated

Rationale: (by cannula, mask, endotracheal [ET] or tracheostomy tube with mechanical
ventilation), Supplemental oxygen is indicated to improve cardiac function by increasing
available oxygen and reducing oxygen consumption and for those patient who are experiencing
difficulty in breathing, hypoxic (oxygen saturation). Critically ill client may be on ventilator to
support cardiopulmonary function.

Drugs:

1. Inotropic drugs: digozin

-is used to treat heart failure, usually along with other medications. It is also used to treat
certain types of irregular heartbeat (such as chronic atrial fibrillation). It inhibits the sodium-
potassium ATPase, which make more calcium available for contractile proteins resulting in
increased cardiac output, increases force of contraction, decreases heart rate

Nursing Management:

1. Monitor apical pulse for 1 min before administering; hold dose if pulse < 60 in adult or < 90
in infant; retake pulse in 1 hr.
2. Avoid giving with meals; this will delay absorption.
 2. ACE inhibitor: (Enalapril)
-inhibit the activity of angiotensin-converting enzyme, an enzyme responsible for the conversion
of angiotensin I into angiotensin II, a potent vasoconstrictor.

Nursing management:

1. Assess for the mentioned contraindications to this drug (e.g. renal impairment, hyponatremia,
hypovolemia, etc.) to prevent potential adverse effects
2. Obtain baseline status for weight, vital signs, overall skin condition, and laboratory tests like
renal and hepatic function tests, serum electrolyte, and complete blood count (CBC) with
differential to assess patient’s response to therapy
3. Monitor patient closely in any situation that may lead to a drop in BP secondary to reduced fluid
volume (excessive perspiration and dehydration, vomiting, diarrhea) because excessive
hypotension may occur.