Priority nursing Dx: Decreased cardiac output R/T dysfunction of left ventricle AEB

shortened ejection fraction, abnormal rhythm of heart rate

Goal: Patient will have an improved cardiac output
Outcome
1.PT will have a
systolic blood
pressure of 75100 throughout
hospitalization

Intervention
1a. Monitor
BP q4h and
PRN

2. PT will have
a heart rate of
100-150 bpm
throughout
hospitalization

2a. monitor
heart rate
q4h and PRN

Scientific rationale
Blood pressure monitoring is
important because a
variation may arise many
different complications. IF
blood pressure is increased
there is extra strain on the
heart and arteries. This will
increase workload and
decrease cardiac output. If
the blood pressure is too
low, it is also an indication of
decrease work effort by the
heart which in turn
decreases cardiac output.
-Own words
Monitoring the patients
heart rate is important
because a variation may
cause unwanted
complications. If the HR is
increased it causes strain on
the heart which causes
ineffective pumping, directly
decreasing cardiac output. A
decrease in heart rate also
decreases cardiac output by
the heart simply not
pumping an adequate
amount.
-own words

evaluation
Ongoing, this
patient was not
discharged,
however during
this clinical
rotation her
blood pressure
maintained
within
appropriate
range.

Ongoing,
However the
patients heart
rate remained
within normal
limits
throughout the
clinical rotation.

3.Patient will
have a
respiratory rate
of 25-35 rpm
throughout
hospitalization

3a. Monitor
respirations
q4h and PRN

4.PT will have

an ejection
fraction of 5570% by follow
up
appointment.

4a. Obtain
order for
cardiac echo
per MD order

5. PT will have
a normal sinus
rhythm
throughout
hospitalization

5a.
Administer
amiodarone
50mg q12h

6. Pts urine
output will be
5.85ml11.7ml/hr. at all
times

6a. Monitor
strict I&O q4h

Monitoring respirations is
extremely important here is
an abundance of reasons
why monitoring respirations
is important. The patient
may have an abnormal
rhythm indication a
complication. The biggest
complication of having a
decreased cardiac output is
CHF. This happens when the
heart cannot pump
effectively causing back up
into the lungs. This causes
irregular respirations
-Own words
Monitoring ejection fraction
is extremely important
because it can indicate
complications of the heart.
An increase in ejection
fraction causes an increase
in work load directly causing
ineffective pumping. A
decrease in ejection fraction
can result in under perfusion
of the organs.
-own words
Heart rhythm extremely
affects cardiac output. This
patient in particular had
ventricular arrhythmias.
Ventricular arrhythmias are
extremely dangerous and
can lead to cardiac arrest
and potentially death.
-Own words
Monitoring the patients
intake and output is
extremely important to
determine cardiac output. A
decrease in urine output is
an indication that the heart
Is not pumping efficiently
possibly causing back up
into the lungs or third
spacing causing edema.

Ongoing,
However the
patients
respirations rate
was abnormal
rate during the
clinical rotation.

Ongoing,
throughout the
hospitalization
the patients
ejection fraction
was below
normal ranges.

Ongoing,
however this
patient had a
normal sinus
rhythm during
the clinical
rotation

Ongoing,
however the
patients urine
output was
about 11ml/hr.
throughout the
clinical rotation

7. Pt will be
free from any
adventitious
lung sounds
throughout
hospitalization

7a. Monitor
lung sounds
qshift and
PRN

-own words
Monitoring lung sounds are
extremely important for
determining a DX. This can
be direct relation to
ineffective pumping action
and decreased cardiac
output. If the heart is not
pumping effectively it can
cause back up of fluids into
the lungs resulting in
adventitious lung sounds
such as rhonchi.

Ongoing,
patients lung
sounds were
clear throughout
the clinical
rotation.