00029 Decreased cardiac output

Domain 4: activity/rest
Class 4: cardiovascular/pulmonary responses
Diagnostic Code: 00029
Nanda label: decrease in cardiac spending
Diagnostic focus: cardiac spending
approved 1975 • Revised 1996, 2000, 2017

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « decrease in cardiac spending » is defined as: the amount of blood pumped by the heart is inadequate to meet the metabolic demands of the organism.

Definite characteristics

Cardiac frequency/rhythm alteration

  • Bradycardia
  • Electrocardiographic changes
  • Cardiac palpitations
  • Tachycardia

Pre

  • Decrease in central venous pressure
  • Decreased plotting pressure of the pulmonary artery
  • edema
  • Fatigue
  • Cardiac murmur
  • Increased central venous pressure
  • Increased plotting pressure of the pulmonary artery
  • Jugular Ingurgitation
  • Weight increase

Post alteration

  • Abnormal skin color
  • Alteration of blood pressure
  • Cold and sweaty skin
  • Decrease in peripheral pulses
  • Decrease in pulmonary vascular resistance
  • Decrease in systemic vascular resistance
  • Dyspnea
  • Increased pulmonary vascular resistance
  • Increased systemic vascular resistance
  • Oliguria
  • Prolongation of hair filling time

Alteration of contractility

  • Abnormal respiratory sounds
  • cough
  • Decrease in cardiac index
  • Decrease in the ejection fraction
  • Decrease in the left ventricular systolic work index
  • Decrease in the systolic volume index
  • Orthopnea
  • Night paroxysmal dyspnea
  • Presence of heart noise S 3
  • Presence of heart noise S 4

Prew/emotional

  • Anxiety
  • Psychomotor agitation

Related factors

  • To develop

Associated problems

  • Post alteration
  • Alteration of contractility
  • Heart rate alteration
  • Heart rhythm alteration
  • Alteration of the preload
  • Systolic volume alteration

Suggestions of use

  • This diagnosis does not indicate independent nursing actions. It is included because it is in the Taxonomy of Nanda-I and many nurses use it.
  • However, nursing staff cannot diagnose this problem with certainty or treat it definitively. For those patients with a reduction in physiological cardiac output, it could be more useful to use a diagnosis that represents the reaction to this pathophysiology (for example, intolerance to activity related to decreased cardiac output). If the patient has a risk of complications, it is preferable

Suggested alternative diagnostics

  • Activity, intolerance to
  • Self -care, deficit of

NOC Results

  • Effectiveness of cardiac pumping: sufficiency of the blood volume expelled by the left ventricle to maintain the systemic perfusion pressure
  • Circulation status: Unidirectional blood flow without obstacles, with adequate pressure, through the large vessels of systemic and pulmonary circuits
  • Status of vital signs: measure that temperature, pulse, breathing and blood pressure are within normal values ??
  • Service of blood loss: gravity of bleeding/internal or external bleeding
  • Tissue perfusion: cardiac: sufficiency of blood flow of coronary vessels to maintain cardiac function
  • Tissue perfusion: cell phone: sufficiency of the blood flow of the vasculature to maintain the function at the cellular level
  • Tissue perfusion: cerebral: sufficiency of blood flow of brain vessels to maintain brain function
  • Tissue perfusion: abdominal organs: sufficiency of blood flow of the vessels of abdominal viscera to maintain visceral function
  • Tissue perfusion: peripheral: sufficiency of blood flow of small limb vessels to maintain tissue function
  • Tissue perfusion: pulmonary: sufficiency of blood flow of pulmonary vessels to perfuse the alveolus/capillary unit

Evaluation objectives and criteria

Note : The objectives of decreased cardiac expenditure are not nursing dependent. That is, nursing staff does not act independently to achieve them; a collaboration effort is required.

Examples with the use of terms no c

  • It demonstrates a satisfactory cardiac output, revealed by the effectiveness of cardiac pumping; state of circulation; tissue perfusion (abdominal, cardiac, brain, cellular, peripheral and pulmonary organs), and vital signs
  • Demonstrate status of the circulation, manifested by the following indicators (specify from 1 to 5; serious, substantial, moderate, mild or without deviation from normal limits):
    • Systolic, diastolic and medium blood pressure
    • LEFT AND RIGHT CAROT GROUP PULSE
    • Pulse strength (peripherals) rights and left (for example, brachial, radial, femoral, pedio)
    • Central venous pressure and pulmonary artery trunk pressure
    • Pa02 and Paco,
  • Demonstrate status of circulation, as stated by the following indicators (specify from 1 to 5: severe, substantial, moderate, mild or absent)
    • Intermittent claudication
    • Spring veins distension
    • Peripheral edema
    • Ascitis
    • Supples in the big vessels
    • Angina on chest
    • Cognitive deterioration
    • Ulcers in the lower extremities

Other examples

The patient will be able to:

  • Maintain the heart index and ejection fraction within normal limits
  • Have a volume of urinary urine, uric nitrogen and plasma creatinine within normal limits
  • Have a normal skin coloration
  • Demonstrate greater tolerance to the increase in physical activity (for example, without dyspnea, chest pain or syncope)
  • Describe the requirements of the diet, medicines, activity and limitations (for example, for heart disease)
  • Identify the signs and symptoms that indicate that the disease is worsening

NIC Interventions

  • Hemorrhage control: reduction or suppression of rapid and excessive blood losses
  • Neurological control and monitoring: Patient data collection and analysis to prevent or minimize possible neurological complications
  • Cardiac care: limitation of complications resulting from the imbalance between the contribution and the oxygen needs of the myocardium, with symptoms of alteration of cardiac function
  • Cardiac care: Acute: limitation of complications in a patient who has recently suffered an episode of imbalance between the contribution and the oxygen needs of the myocardium, which has caused an alteration of cardiac function
  • Circulatory care: mechanical help device: Temporary maintenance of circulation by using mechanical devices or pumps
  • Circulatory care: Arterial insufficiency: promotion of arterial circulation
  • Circulatory care: venous insufficiency: promotion of venous circulation
  • Embolism care: Peripheral: Limitation of complications in a patient who has suffered a occlusion in peripheral circulation or is at risk of suffering from it
  • Embolism care: pulmonary: limitation of complications for the patient who suffers, or is at risk of suffering, an occlusion of pulmonary circulation
  • Shock management: cardiac: promotion of adequate tissue perfusion in a patient whose cardiac pumping function is severely compromised
  • Shock management: Volume: Promotion of adequate tissue perfusion in a patient whose intravascular volume is severely affected
  • Improvement of brain perfusion: Promotion of adequate perfusion and limitation of complications in a patient with inadequate brain perfusion or risk of suffering it
  • Lower limb monitoring: Collection, analysis and use of patient data to evaluate risk and prevent lower extremities lesions
  • Monitoring of vital signs: collection and analysis of cardiovascular, respiratory data, as well as body temperature to determine and prevent complications
  • Hemorrhage reduction: limitation of blood volume loss during an episode of bleeding
  • Hemodynamic regulation: Optimization of the rhythm of the heart, before the load, after loading and contracting
  • Intravenous therapy (IV): administration and control of intravenous liquids and medications

Nursing Activities

In general, nursing activities in this diagnosis focus on monitoring the signs and symptoms of decreased cardiac expend for the treatment of the decrease in cardiac spending, and carry out support measures such as placement and hydration.

Valuations

  • Evaluate and record blood pressure, the presence of cyanosis, respiratory state and mental state
  • Monitor the appearance of signs indicators of fluid overload (orthostatic edema, weight gain)
  • Evaluate patient tolerance to activity, observing the appearance of dyspnea, pain, palpitations or dizziness
  • Assess the patient’s response to oxygen
  • Assess if there is cognitive impairment
  • (NIC) Hemodynamic regulation:
    • Control the operation of the pacemaker, if adequate
    • Monitor peripheral pulses, capillary filling, temperature and limb color
    • Control income and expenses, urine discharge and patient weight, if necessary
    • Monitor the systemic and pulmonary vascular resistance, if necessary
    • Pulmonary auscultation: search rales and other abnormal noises
    • Monitor and register heart and pulses frequency and rhythm

Patient and family education

  • Explain why oxygen is administered by nasal tips or mask
  • Give instructions about maintaining adequate intake and excretion
  • Instruct on the use, dose and frequency of side effects of medicines
  • Teach to communicate and describe palpitations and pain: beginning, duration, precipitating factors, location, characteristics and intensity
  • Teach the patient and family the home care plan, including the limitations of the activity, dietary restrictions and the use of therapeutic equipment
  • Inform about stress reduction techniques, such as bioretro -food, progressive muscle relaxation, meditation and exercise
  • Teach that it is necessary to weigh daily

Collaboration activities

  • Consult the doctor the parameters to administer or not blood pressure medications
  • Administer and adjust the dose of antiarrhythmic, inotropics, nitroglycerin and vasodilators to maintain the contractility, preload and aftercarga, according to medical treatment orders or protocols
  • Administer anticoagulants to prevent the formation of peripheral thrombi, according to treatment orders or protocols
  • Promote postcard reduction (for example, through the intraaortic ball pump), according to medical orders or protocols
  • refer to an expert nurse to track, if necessary
  • Consider the possibility of channeling an person in charge of the case, social work or community or home health services
  • Derive to social work to assess whether the patient can pay the prescribed medications
  • Channel to cardiac rehabilitation, if appropriate

Others

  • Place the patient in a horizontal position or trendelemburg when their blood pressure is lower than normal
  • In case of sudden, severe or prolonged hypotension, establish IV access to administer IV liquids or medications that raise blood pressure
  • Correlation the effects of laboratory values, oxygen, medications, activity, anxiety and pain on arrhythmia
  • Do not take rectal temperatures
  • Make postural changes every two hours or maintain other adequate or precise activities to reduce the peripheral circulation stasons
  • (NIC) Hemodynamic regulation:
    • Decrease or delete environmental stressors
    • Insert an urinary probe, if required

At home

  • Help to obtain home services for daily life activities, food preparation, domestic tasks, transportation for medical consultation and other needs
  • Assess possible obstacles to therapeutic compliance (for example, side effects of medicines)
  • Help the patient and his family to plan what to do in urgency cases, such as blackouts (in case of using respiratory assistance devices) or the need for cardiopulmonary resuscitation
  • Make sure that the patient has a home scale to weigh daily

Older people

  • Keep in mind that older people often have jaw pain (or even no pain) during a myocardial infarction
  • Keep in mind that older people may have altered renal and liver function; Ensure to assess the side effects of heart medications
  • Look for signs and symptoms of arrhythmias (dizziness, weakness, syncope, palpitations, etc.)
  • Assess possible signs of depression and social isolation; refer to mental health services if necessary
  • Assess the understanding of the instructions and therapeutic compliance of medicines and other treatments (for example, activity, diet). Older people may need frequent repetitions and information reinforcement
  • Fragile elders may need case management to continue living independently