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Nursing Care Plan for Decreased Cardiac Output

Definition: The state in which the blood pumped by an individual’s heart is sufficiently reduced to the extent that it is inadequate to meet the needs of the body’s tissues.

Preload Risk Factors:

  • Bleeding
  • Coagulopathy
  • Surgery
  • Sepsis with vasodilation
  • Hypovolemic shock

Defining Characteristics:

  • Systolic blood pressure  (SBP) < 90 mmHg
  • Mean arterial pressure (MAP) < 60 mmHg
  • Cardiac index (CI) < 2.2 L/min/m2
  • Urine output <0.5 ml/kg/hr or < 30 ml/hr
  • PAWP <6 mmHg and PAD < 6 mmHg or significantly below patient’s baseline
  • Bibasilar fluid crackles
  • Faint peripheral pulses
  • Ventricular gallop rhythm
  • Skin cool, pale, moist
  • Activity intolerance

Desired Outcomes:

  • Cardiac index is 2.2-4.0 L/min/m2
  • Heart rate is < 100bpm
  • SBP is >90 mmHg
  • MAP is > 60 mmHg
  • PAWP, PAD, and CVP are > 6 mmHg to <15 mmHg

Nursing Interventions and Rationale:

  1. Assess reason for low preload and reverse process or stop patient bleeding.
  2. Calculate the patient’s 24-hour fluid requirements per body surface area (BSA), and replace with the appropriate electrolyte solution.
  3. Administer solutions using the fluid challenge technique: infuse precise amounts of fluid (usually 5 to 20 ml/min) over 10-minute periods and monitor cardiac loading pressure serially to determine successful challenging. If the PAWP or PAD elevates more than 7 mmHg above beginning level, the infusion is stopped. If the PAWP or PAD rises only to 33 mmHg above baseline or falls, another fluid challenge is given.
  4. If the patient is bleeding, assess whether this is from a coagulopathy or represents loss of blood volume from trauma or GI bleeding, or at an arterial cannulation site. If from coagulopathy, fresh frozen plasma, platelets, and other clotting factors are infused. If from bleeding, surgical or other procedures may be required.
  5. If Hgb is < 9 g/dL or Hct is < 25%, in collaboration with physician, infuse red blood cells (RBCs).
  6. Assess for signs and symptoms of fluid overload once fluid replacement has begun. These may include elevations of PAP or CVP to above normal levels, pulmonary crackles, or dyspnea.
  7. Monitor intake and output balance.
  8. Monitor daily weight.