Nursing Diagnosis: Decreased cardiac output related to fluid imbalances affecting circulating volume myocardial workload and systemic vascular resistance (SVR) alterations in rate, rytm, cardiac conduction (electrolyte imbalances, ypo!ia) accumulation of to!ins (urea), soft"tissue calcification (deposition of calcium pospate) Taxonomy: #ctivity"$!ercise %attern Cause Analysis: &oss of e!cretory renal function tat may lead to decreased pospate e!cretion and calcium absorption causes tissue calcifications' Decreased e!cretion of nitrogenous wastes accumulate urea in te system' Decreased sodium reabsorption in tubule affects fluid balances' &osses of none!cretory renal function of te kidney will lead to failure to produce erytropoietin' (us leads to anemia' )n order to pump more blood into te body, te eart muscle re*uires more o!ygenated blood to meet own needs' Calcifications of te involuntary muscles affects contractility tus affects volume of blood e+ected per minute (p,,-,.-/0, .--. 1edical"Surgical 2ursing by 3lack et'al) Cues Goal Nursing Intervention Rationale Evaluation increased eart rate dysrytmias canges in 3% (ypotension4ypertens ion) e!tra eart sounds Diminised periperal pulses Diaporesis Cest pain $dema STO: #fter 5 rs of effective nursing intervention, patient would be able to become knowledgeable and knowledgeable about te diagnostic tests e will undergo' LTO: #fter , rs of effective nursing interventions, patient would be able to maintain cardiac output as evidenced by 3% and eart rate witin patient6s normal range7 periperal pulses strong and e*ual wit prompt capillary refill time' Ine!enent #uscultate eart and lung sounds' $valuate presence of periperal edema4vascular congestion and reports of dyspnea' #ssess presence4degree of ypertension8 monitor 3%7 note postural canges, e'g', sitting, lying, standing' )nvestigate reports of cest pain, noting location, radiation, severity (9:.9 scale), and weter or not it is intensified by deep inspiration and supine position' $valuate eart sounds (note friction rub), 3%, periperal pulses, capillary refill, vascular congestion, temperature, and sensorium4mentation' S/4S- eart sounds wit muffled tones, tacycardia, irregular eart rate, tacypnea, dyspnea, crackles, wee;es, and edema4+ugular distension suggest <=' Significant ypertension can occur because of disturbances in te renin" angiotensin"aldosterone system (caused by renal dysfunction)' #ltoug ypertension is common, ortostatic ypotension may occur because of intravascular fluid deficit, response to effects of antiypertensive medications, or uremic pericardial tamponade' #ltoug ypertension and cronic <= may cause 1), appro!imately alf of CR= patients on dialysis develop pericarditis, potentiating risk of pericardial effusion4tamponade' %resence of sudden ypotension, parado!ic pulse, narrow pulse pressure, diminised4absent periperal pulses, marked +ugular distension, pallor, and a rapid mental deterioration indicate tamponade, wic is a medical emergency' #ssess activity level, response to activity' Collaborative 1onitor laboratory4diagnostic studies, e'g'8 $lectrolytes (potassium, sodium, calcium, magnesium), 3>24Cr7 Cest !"rays' #dminister antiypertensive drugs, e'g', pra;osin (1inipress), captopril (Capoten), clonidine (Catapres), ydrala;ine (#presoline)' %repare for dialysis' #ssist wit pericardiocentesis as indicated' ?eakness can be attributed to <= and anemia' )mbalances can alter electrical conduction and cardiac function' >seful in identifying developing cardiac failure or soft"tissue calcification' Reduces systemic vascular resistance and4or renin release to decrease myocardial workload and aid in prevention of <= and4or 1)' Reduction of uremic to!ins and correction of electrolyte imbalances and fluid overload may limit4prevent cardiac manifestations, including ypertension and pericardial effusion' #ccumulation of fluid witin pericardial sac can compromise cardiac filling and myocardial contractility, impairing cardiac output and potentiating risk of cardiac arrest'