Decreased Cardiac Output - NCP Heart Failure

Heart failure or congestive heart failure occurs when the heart is unable to provide sufficient pump action to distribute blood flow to meet the needs of the body.

Heart failure can be caused by coronary artery disease, heart attack, cardiomyopathy, and high blood pressure.

Heart failure treatment includes exercise, dietary changes, medicines, and rarely surgery.

There are three main types of heart failure. They are:

  • heart failure due to left ventricular systolic dysfunction (LVSD) - due to the part of the heart that pumps blood around your body (the left ventricle) becoming weak
  • heart failure with preserved ejection fraction (HFPEF) - usually due to the left ventricle become stiff, causing difficulty in filling with blood
  • heart failure due to valve disease

Nursing Diagnosis: Decreased Cardiac Output related to:
  • Changes in myocardial contractility / inotropic changes,
  • Changes in frequency, rhythm and electrical conduction, changes
  • structural,

characterized by;
  • Increased heart rate (tachycardia): dysrhythmias, changes in ECG pattern picture.
  • Changes in blood pressure (hypotension / hypertension).
  • Extra sound (S3 and S4).
  • Decrease in urine output.
  • Peripheral pulse was not palpable.
  • Dull winter skin.
  • Orthopnea, krakles, liver enlargement, edema and chest pain.

Goal:
The client will:
  • Showed vital signs within acceptable limits (dysrhythmias can be in control or lost) and free of heart failure symptoms.
  • Reported a reduction in episodes of dyspnea, angina.
  • Participate in activities that reduce the heart's workload.

Nursing 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). 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 chronic heart failure early, moderate or chronic, blood pressure may rise. 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. Areas affected often blue or striped because of increased venous congestion.

6. Give supplemental oxygen by nasal cannula / mask and drugs as indicated (collaboration)
Rationale: Increase dosage myocardial oxygen to the need to counter the effects of hypoxia / ischemia. Many drugs can be used to improve contractility and reduce congestion.

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