Domain 4. Activity-rest
Class 4. Cardiovascular-pulmonary responses
Diagnostic Code: 00029
Nanda label: Decreased cardiac output
Diagnostic focus: Cardiac output
Nursing diagnosis is the keystone of an effective nursing plan and must be twofold: diagnosis of a nursing experience involving the patient and the diagnosis of an expected response to the patient’s illness. In this regard, the purpose of this article is to discuss the concept of decreased cardiac output, its NANDA nursing diagnosis definition, defining characteristics, related factors, associated conditions, possible treatments, and FAQs.
NANDA Nursing Diagnosis Definition
NANDA or North American Nursing Diagnosis Association defines Decreased Cardiac Output (DCOC) as a “syndrome where the heart is unable to produce enough volume over time to effectively meet the circulatory needs of the body, resulting in decreased oxygen delivery to the tissues and organs”. In other words, it is the functional state where the heart fails to supply sufficient blood flow to the metabolically active tissues and systems of the body.
Defining Characteristics
Nurses should check for the following subjective and objective defining characteristics to accurately identify a DCOC:
Subjectives
- Complaints of chest pain, palpitations, headache and/or lightheadedness
- Feeling fainting or dizziness
- Discomfort when standing due to hypotension
- Shortness of breath with activity
- Fatigue and/or fatigue
Objectives
- Decreased level of consciousness
- Hypotension / Hypertension
- Edema (if present)
- Sinus tachycardia
- Low cardiac output (echocardiography)
- Decreased respiratory rate
- Reduced precordial lifts
- Reduced stroke volume on auscultation
Related Factors
Nurses should take into consideration the following related factors before diagnosing DCOC:
- Cardiomyopathy: is a myopathic disorder that affects the structure, composition and metabolism of the myocardium. It results in reduced contractility and increased wall tension leading to high risk of decompensation and reduced cardiac output.
- Myocarditis: is an inflammation of the myocardium resulting from a viral, bacterial or fungal infection. This leads to reduced contractility and impaired diastolic filling. The decrease in cardiac output further results in hypotension, fatigue, decreased responsiveness and reduced exercise tolerance.
- Aortic Stenosis: is an obstruction of the aortic outflow due to a narrowing of the aortic valve, leading to reduced stroke volume and reduced cardiac output.
- Fluid Volume Excess: refers to an oscillatory imbalance between the intake, output and loss of body fluids. Fluid overload affects myocardial contractility and significantly reduces stroke volume and cardiac output.
- Heart failure: refers to a state of insufficient blood supply to the organs due to reduced effectiveness of the primary organ involved (myocardium). This increases preload and leads to reduced cardiac output.
- Drugs and toxins: such as nicotine, alcohol, cocaine and heroin affect the myocardial performance by causing direct and indirect damage to their host tissue, hence leading to reduced cardiac output.
Associated Conditions
Some associated conditions that might further worsen DCOC include:
- Shock: is a state of pathological hyperlactatemia and profound vasodilation, characterized by reduced cardiac output and relative hypovolemia.
- Respiratory Failure: refers to a condition where the lungs are unable to exchange sufficient amounts of oxygen and carbon dioxide leading to hypoxemia, hypercapnia and acidosis.
- Anemia: deficiency of red blood cells and hemoglobin, described by reduced oxygen carrying capacity, decreased contractility and consequent reduced cardiac output.
- Arrhythmias: signs and symptoms of cardiac arrhythmias include tachycardia, bradycardia, premature contractions and altered repolarization. These arrhythmias further reduce cardiac output due to altered contractility, loss of atrial kick and incomplete ventricular do fillings.
Suggestions for Use of DCOC Nursing Diagnosis
Nurses can use DCOC diagnosis in various clinical settings to improve the quality of care by formulating the most appropriate and validated treatment plans. DCOC nursing diagnosis is applicable when dealing with patients who experience frequent episodes of myocardial infarction, coronary artery disease, cardiac arrhythmias and circulatory disturbances. It is also helpful in nursing practice to recognize patients who need support with developing a lifestyle change to optimize their cardiovascular health.
Suggested Alternative NANDA Nursing Diagnosis
Nursing diagnoses similar to DCOC include;
- Ineffective Tissue Perfusion: is defined as the alteration in systemic circulation that compromises the health of the tissue.
- Impaired Physical Mobility: the state of decreased abilities of independent moving and lack of control of voluntary movements.
- Risk for Activity Intolerance: the potential inability of the patient to cope with physical activities due to functional and/or structural impairment.
- Ineffective Therapeutic Regimen Management: the inability to properly comprehend medical recommendations, therapies and exercises.
- Risk for Imbalanced Fluid Volume: is mainly caused by inadequate intake, excessive output or excessive losses either due to osmotic diuresis or several other conditions.
Usage Tips
When using DCOC nursing diagnosis, nurses should be aware of and follow the following tips:
- The defining characteristics list should provide detailed information about the patient’s symptoms, so as to make accurate assessment.
- It is important to consider both the subjective and objective findings with particular reference to the patient’s ideal usual values for age and gender.
- Assessment should consider both traditional metrics of cardiac performance (cardiac output and stroke volume) as well as clinical signs and symptoms.
- Be sure to use a patient-specific approach; this will include involving the patient in the nursing process as much as possible.
- Proper documentation should be done to ensure accuracy and clarity between healthcare providers.
NOC Outcomes
NOC or Nursing Outcomes Classification is a standardized classification system developed to measure the expected outcomes of interventions, particularly nursing interventions. The NOC outcomes of DCOC nursing diagnosis includes;
- Tissue Perfusion: Cardiac: a measure of the heart’s effectiveness in delivering oxygen-rich blood to the organs and tissues.
- Activity Tolerance: an evaluation of the patient’s ability to engage in activities without becoming excessively fatigued or overexerted.
- Fluid Balance: a measure of the difference between the amount of fluid taken in and the amount lost during a specific period.
- Cardiac Output: a measure of the volume of blood pumped in one minute.
- Respiration Rate: measure of the number of breaths taken per minute.
Evaluation Objectives and Criteria
Once DCOC nursing diagnosis has been developed, nurses should evaluate the patient’s progress to reach these outcome-based goals. Evaluation should be done by monitoring the following variables:
- Blood pressure: should remain in the normal range for corresponding age and sex.
- Cardiac output: should be well-managed to reach a steady normal rate.
- Level of consciousness: should remain conscious and alert.
- Respiration rate: should be regular and within the normal range.
- Heart rate: should be within the normal range.
- Oxygen saturation: should remain within the required range.
- Circulation status: should remain stable.
- Nutritional status: should remain within the target range.
NIC Interventions
NIC stands for Nursing Interventions Classification. These interventions are evidence-based practices that nurses should adhere to when dealing with a decreased cardiac output. Nurses should carry out the following interventions:
- Monitor vital signs: involves recording patient’s pressures and pulse rate on a regular basis to detect changes in patient’s clinical status.
- Administer prescribed medications: Give medications or solutions according to doctor’s orders, including those for treating decreased cardiac output.
- Supply supplemental oxygen: Ensure that oxygen is available when needed.
- Evaluate for adverse reactions: Monitor patient for side effects of drugs, such as dizziness and breathing difficulty.
- Encourage active participation in care: Provide education and guidance to patient and family to ensure effective compliance and proper self-care.
- Monitor fluid and electrolyte balance: Monitor adequate electrolyte level and hydration status to ensure the safety of the patient.
- Monitor nutrition intake: Track the amount of food and beverages taken by patient to maintain a balanced diet.
Nursing Activities
Nurses should also focus on patient-centered and outcome-based activities to promote improved health. These activities tailored to the patient’s care should involve optimal patient instruction, emotional support, and open communication. These activities are divided into three successive phases:
- Comprehensive assessment: assess the patient’s condition and identify the risk factors related to decreased cardiac output.
- Intervention and Treatment: develop and implement the necessary drug and non-drug interventions to improve cardiac output.
- Patient education and follow-up: provide patient-centered education on self-management, lifestyle changes, and precautionary measures to minimise the risk of recurrent cardiac events.
Conclusion
Decreased cardiac output is a major concern in cardiovascular medicine and nursing practice. The nurse plays a massive role in the management and care of patients affected by this pathology. Nurses should investigate pertinent clinical signs, relate them to actual and potential causes, and intervene appropriately to effect the best possible outcomes.
FAQs
- What is decreased cardiac output?
Answer: Decreased cardiac output (DCOC) is a syndrome where the heart is unable to produce enough volume over time to effectively meet the circulatory needs of the body, resulting in decreased oxygen delivery to the tissues and organs. - What are common symptoms of decreased cardiac output?
Answer: Major symptoms of decreased cardiac output include chest pain, palpitations, headache, lightheadedness, feeling faint or dizzy, discomfort when standing due to hypotension, shortness of breath with activity, fatigue and/or fatigue. - What are related factors to decreased cardiac output?
Answer: The related factors include cardiomyopathy, myocarditis, aortic stenosis, fluid volume excess, heart failure and drugs and toxins. - What are suggested interventions for decreased cardiac output?
Answer: Suggested interventions include monitoring vital signs, administering prescribed medications, supplying supplemental oxygen, evaluating for adverse reactions, encouraging active participation in care, monitoring fluid and electrolyte balance and nutrition intake. - What is the significance of decreased cardiac output?
Answer: Decreased cardiac output is a major concern in cardiovascular medicine and nursing practice. The nurse plays a massive role in the management and care of patients affected by this pathology. Nurses should investigate pertinent clinical signs, relate them to actual and potential causes, and intervene appropriately to effect the best possible outcomes.