Concept Map decreased cardiac output PDF

Preview

Summary

Concept map on decreased cardiac output related to symptoms of CHF...

Description

Concept Map PERTINENT DATA

Female age 80-O, difficulty breathing-S, increased shortness of breath- S, falls asleep easilyO, blood pressure: 188/54- O, heart rate: 98 and slightly irregular- O, respiratory rate- 24 at rest and 32 with exertion and labored- O, peripheral pulses diminished- O, capillary refill to feet is greater than 3 seconds- O, ankle and pedal edema 3+ pitting- O, patient states very low urine output- S, BUN- 30mg/dL-O, history of congestive heart failure- O, lung sounds diminished with crackles in all four lobes- O NURSING DIAGNOSIS Decreased cardiac output related to altered preload, altered afterload, altered contractility, altered heartrate, rhythm, and conduction as evidence by drowsiness, ankle and pedal edema, hypertension, diminished pulses, prolonged capillary refill, low urine output, shortness of breath, difficulty breathing, and adventitious lung sounds present. OUTCOME CRITERIA Patient will have adequate cardiac output as evidence by systolic blood pressure within 20 mm Hg of baseline before discharge.

OUTCOME EVALUATION Patient was able to achieve a blood pressure withing 20mm Hg of her baseline.

Nursing Intervention - Assess Assess heart rate and blood pressure every 4 hours.

Nursing Intervention - Do For patients with increased preload, restrict fluids daily.

Nursing Intervention - Teaching Explain the drug regimen, purpose, dose, and side effects with each dose of medication given and prior to discharge.

Rationale “Most patients have compensatory tachycardia and significantly reduced blood pressure in response to reduced cardiac output. Older patients have reduced response to catecholamines, thus their response to reduced cardiac output may be blunted, with less increase in heart rate” (Gulanick & Meyers, 2017 pg 38).

Rationale “Fluid restriction decreases extracellular fluid volume and reduces demands on heart” (Gulanick & Meyers, 2017 pg 40).

Rationale “Information provides rationale for therapy and aids the patient in assuming responsibility for self-care later” (Gulanick & Meyers, 2017 pg 40).

Evaluation Patient’s blood pressure remained controlled with medication.

Evaluation Patient’s fluid balance was restored.

Evaluation Patient has verbalized understanding of drug regimen, purpose, dose, and side effects.

Nursing Intervention - Assess Assess peripheral pulses, including capillary refill every shift.

Nursing Intervention - Do Administer medication as doctor has prescribed, noting response, and watching for side effects and toxicity. Clarify with the physician for parameters to withhold medications.

Nursing Intervention - Teaching Explain diet restrictions, with respect to fluid and sodium intake upon admission and prior to discharge.

Rationale “Pulses are weak with reduced stroke volume and cardiac output. Capillary is slow, sometimes absent” (Gulanick & Meyers, 2017 pg 39).

Rationale “Depending on etiological factors, common medications include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmics, angiotensin-

Rationale “Diet changes and restrictions can be especially challenging to patients and may require ongoing monitoring” (Gulanick & Meyers, 2017 pg 41).

converting enzyme inhibitors, and inotropic agents” (Gulanick & Meyers, 2017 pg 40). Evaluation Patient’s pulses are more prominent, capillary refill is 3 seconds.

Evaluation Patient’s response to prescribed medication is appropriate and contributing to improvement of health status.

Evaluation Patient verbalizes understanding importance of diet restrictions and is complying during stay.

Nursing Intervention - Assess Assess urine output and determine how often the patient is urinating every four hours.

Nursing Intervention - Do Maintain hemodynamic parameters at prescribed levels every four hours.

Nursing Intervention - Teaching Explain symptoms and interventions for decreased cardiac output related to etiological factors daily.

Rationale “The renal system compensates for low blood pressure by retaining water. Oliguria is a classic sign of decreased renal perfusion. Diuresis is expected with diuretic therapy” (Gulanick & Meyers, 2017 pg 39).

Rationale “For patients in the acute setting, closely monitoring of these parameters guides titration of fluids and medications.

Rationale “Thorough understanding of specific causes for each patient’s disease is necessary for appropriate followthrough of treatment plan” (Gulanick & Meyers, 2017 pg 40).

Evaluation Patient’s urine output increased to 30mL/hr.

Evaluation Patient’s hemodynamic parameters have improved.

Evaluation Patient verbalizes understanding of symptoms and interventions presented.

Medication Intervention Nursing Intervention - Assess

Nursing Intervention - Do

Nursing Intervention - Teaching

Rationale

Rationale

Rationale

Evaluation

Evaluation

Evaluation...