Decreased Cardiac Output related to changes in left ventricular contractility, changes in the frequency of rhythm, electrical conduction.
Purpose:
After nursing actions, decreased cardiac output can be overcome.
Expected outcomes:
Clients will show vital signs within acceptable limits and free of heart failure symptoms, reported a decline in epiode dyspnea, angina, participating in activities that reduce the heart's workload.
Intervention:
1. Auscultation apical pulse; examine the frequency, heart rhythm.
Rational: Usually tachycardia (although at rest) to compensate for decreased ventricular contractility.
2. Record heart sounds
Rational: S1 and S2 may be weak due to reduced pumping work. Common Gallop rhythm (S3 and S4) generated as the flow of blood into the auricle distended. Murmurs can indicate incompetence / stenosis.
3. Peripheral pulse palpation
Rationale: Decreased cardiac output may indicate decreased radial artery, popliteal, dorsalis, pedis and posttibial. Pulse may disappear fast or irregular to palpation and pulse alternan.
4. Monitor blood pressure
Rationale: In the early right heart failure, moderate or chronic blood pressure may increase. In advanced CHF, the body can no longer compensate and hypotension can not be normal again.
5. Assess the pale skin and cyanosis
Rational: Pale indicating reduced peripheral perfusion secondary to inadequate cardiac output; vasoconstriction and anemia. Cyanosis can occur as a refractory right heart failure. Often ill areas or in striped blue because of increased venous congestion.
6. Give supplemental oxygen by nasal cannula / mask and drugs as indicated (collaboration)
Rational: raise higher dosage of oxygen to the need to counter the effects of myocardial hypoxia / ischemia. Many drugs can be used to improve the volume sekuncup, improve contractility and reduce congestion.
