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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.

Excessive Preload Risk Factors:

  • Acute heart failure or cardiomyopathy
  • Decreased cardiogenic shock
  • Acute renal failure

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
  • Pulmonary artery wedge pressure (PAWP) > 15 mmHg
  • Pulmonary artery diastolic pressure (PAD) > 15 mmHg

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. Monitor the assessment paramters listed under the defining charateristics, and with physician collaboration, administer diuretics.
  2. Titrate venous vasodilators and inotropic dripds, per protocol, to desired SBP, MAP, PAWP, and/or PAD. Withhold and/or change drip rate when SBP, MAP, PAWP, PAD, and CVP begin to normalize.
  3. Implement fluid restriction.
  4. Double concentrate intravenous drug drips when possible to decrease the amount of volume infused to the patient.
  5. Monitor intake and output balance.
  6. Monitor daily weight.