Decreased cardiac output is a reduction in the heart’s ability to generate enough cardiac output. In turn, this leads to reduced blood flow to the brain and other crucial organs. The causes may vary from congenital disability or disease, metabolic dysfunction, and traumatic injury related to the heart. Signs of decreased cardiac output will include dyspnea, orthostatic hypotension, and peripheral edema. Decreased cardiac output can result in death.
In this article, we’ll learn more about the causes of decreased cardiac output, defining characteristics, symptoms, nursing assessment, therapeutic nursing diagnosis, tests, and end with an expert tip. As you read, keep in mind that our nursing writers are ready to help with that nursing assignment in case you get stuck. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
There are several causes of decreased cardiac output as follows:
- A decrease in stroke volume due to reduced peripheral resistance.
- Increased ventricular filling pressures
- Myocardial infarction.
- Decreased cardiac output may be caused by increased intracranial pressure. This is associated with cerebral edema and hypertension-induced renovascular disease.
- A decrease in preload.
- Preload Reduction and Intracranial Pressure Increase (NANDA International, 2005)
- An increased intravascular volume, such as cardiogenic pulmonary edema or following acute blood loss.
- Myocardial ischemia or other decreases in perfusion of the heart.
The nursing process applied to decreased cardiac output will vary according to the cause but generally include a plan for assessment, formulation of differential diagnoses, prioritizing nursing diagnoses, and creating a plan to alleviate or resolve these issues. The main goal is to prevent complications from the decreased cardiac output so that interventions can be made and the patient can improve or recover.
Several factors will affect how a nurse would prioritize their care, but three main factors include:
Patient Manifestations: When you have found out what is causing the decreased cardiac output, then you can decide how to prioritize your care. The three things that will affect this decision are the severity of the decreased cardiac output, time criticality, and whether or not the decreased cardiac output is reversible.
Cause: This is another way of saying what has caused the issue in the first place. What made it happen? What was the reason for it? If we can find this out, then we can decide what to do with our patient. For example, suppose a heart attack has caused the decreased cardiac output. In that case, it will need to be treated differently than if the heart attack is not the issue and instead has something else causing the decreased cardiac output.
Orthostatic Hypotension: The presence of a decrease in blood pressure occurs when a person stands from the supine position.
Pulsus Paradoxus: This condition is experienced when a patient’s blood pressure falls during inspiration by a margin exceeding 10 mm Hg. This condition results in a palpable difference in the second heart sound intensity present when compared to baseline. As a result, the patient experiences a soft, blowing second heart sound usually heard during inspiration and destroyed on expiration.
Pulsus alternans: A palpable difference in the first heart sound intensity that occurs when compared to baseline. The condition denotes alternating hard, and soft systolic heart sounds with a ratio of 2:1 or more between the two.
Oliguria: This condition refers to the unusual reduction in urine output. In an adult, this condition is attributed to the production of less than 400 mL/day of urine.
Dyspnea: Abnormally difficult and labored breathing experienced by the patient. The presence of dyspnea indicates that the person is already experiencing oxygen deprivation into their body with further reduction potentially leading to cardiac arrest.
Common Symptoms of Decreased Cardiac Output:
- Cyanosis: This refers to the presence of a purple discoloration of the skin, mucous membranes, or nail beds related to oxygen deprivation. Cyanosis is usually accompanied by hypotension and tachycardia. In most cases, this condition may be experienced in children with congenital heart defects who have right-to-left shunts.
- Nausea: This is a feeling of uneasiness in the stomach that may be experienced by patients undergoing decreased cardiac output. In some cases, this feeling may progress to vomiting if left untreated or worsen further and become intense abdominal pain accompanied by dizziness.
- Headache: a dull or throbbing pain in the head related to decreased oxygen supply to the brain. Regardless of its Severity, a Headache is an indication that a patient is not experiencing normal levels of oxygen and may require immediate medical attention if continued.
- Hypotension: A sensation of dizziness or fainting experienced by patients with decreased cardiac output. This condition imparts a sudden drop in blood pressure and is accompanied by chest pain, weakness, or difficulty concentrating. In some cases, the patient may also experience nausea.
- Inability to Concentrate: Patients with decreased cardiac output may experience an inability to concentrate when performing routine daily tasks such as doing their jobs or even driving a car. This is due to oxygen deprivation in the brain. Patients with decreased cardiac output often complain of headaches and dizziness that impair their ability to think, concentrate, or focus properly.
- Paroxysmal nocturnal dyspnea: This condition is experienced when a patient experiences difficulty breathing while sleeping at night. It usually occurs due to hypoxia, heavy nocturnal respiratory secretions, or other heart diseases.
- Dyspnea: A condition that describes shortness of breath experienced by patients with decreased cardiac output. This sign can also be described as laboured breathing accompanied by a sensation of heavy breathing.
- Difficulty in thinking: Patients with decreased cardiac output may experience decreased brain function or mental abilities that can impair their ability to perform regular tasks and activities such as driving a car, reading, or writing.
- Pulsus Paradoxus: This refers to a condition wherein the patient experiences an increased systolic blood pressure and a decreased diastolic pressure due to an abnormal heart valve or defect. This condition is often experienced by patients with mitral stenosis, ventricular septal defect, infective endocarditis, pericardial tamponade, and right-to-left shunt in the lungs from pulmonary congestion.
- Pulsus alternans: When a patient’s heartbeat is felt to be irregular and alternating and abnormally larger than average, pulsus alternans may be present. This condition can only be experienced by patients with dangerous arrhythmias or when the parasympathetic nervous system is overactive.
Nurses in critical care, emergency, or cardiology often encounter patients who experience decreased cardiac output due to heart failure and other severe conditions. Therefore, it is the role of these professionals to develop a nursing care plan that meets each patient’s requirements. The nursing process is crucial when it comes to assessing such patients for general wellness and updates on their medical status. It also helps keep nurses updated on the most appropriate interventions related to treatment. Furthermore, the nursing assessment provides nurses with an idea of the patient’s comfort level and the symptoms the patient has been experiencing.
This is the first step in assessing patients who have decreased cardiac output. Nurses achieve this by conducting a thorough interview or obtaining a medical report from other health care providers. This will provide nurses with important information about the patient, their medical history, and signs and symptoms experienced.
This is the second step in assessing patients with reduced cardiac output. A complete physical examination will give the nurse an idea about any abnormal signs and symptoms that have been experienced and how they affect the patient’s quality of life. It also helps nurses determine factors that can influence the severity of the disease or condition by identifying coexisting medical conditions such as diabetes, obesity, and hypertension. The patient’s respiratory system assessment will also provide nurses with information about oxygenation levels and increased work of breathing.
The third step is to review all the findings by comparing them with normal values provided in medical texts or nursing reference books. This will give nurses an idea if there are any discrepancies between the patient’s findings and expectations. It will also help nurses determine if there has been any change in the patient’s condition or if the disease is progressing to a more severe stage.
This is the fourth step in assessing patients with decreased cardiac output. The determination is done based on each of the findings. Assessment findings are classified into broad categories such as physiology, psychosocial factors, or environmental concerns. After identifying the patient’s nursing diagnoses, nurses will then need to develop appropriate interventions related to each of the patient’s nursing diagnoses to improve their quality of life and functioning level.
The final step is for nurses to work with the patient’s health care providers and develop an appropriate plan for treatment. This will include which medications to administer, nursing interventions that need to be implemented and setting goals for each patient’s nursing diagnoses such as decreasing pain or increasing mobility. Nurses find this step to be crucial since it helps determine factors related to a patient’s treatment success.
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Nurses often encounter cardiac conditions that cause reduced cardiac output to occur. One of the most common methods for treating patients with decreased cardiac output is by administering intravenous fluid therapy since it can help expand blood vessels and increase blood flow throughout the body. However, when a patient’s condition becomes life-threatening, other therapeutic interventions such as cardiopulmonary resuscitation may be needed to promote circulation, decrease the work of breathing, and prevent further complications. Therapeutic nursing interventions for decreased cardiac output include:
This type of respiratory therapy involves providing patients with oxygen or other gases through a mask. Patients who are experiencing an increase in carbon dioxide levels, an increase in the work of breathing, or a decrease in oxygen levels may be given inhalation therapy.
Selecting appropriate oral fluid therapies that other health care providers order can have therapeutic effects on patients with decreased cardiac output. Oral therapies may prevent dehydration, relieve pain, reduce excessive thirst, assist with swallowing, and promote oral hygiene.
Therapeutic nursing interventions designed to promote relaxation, such as therapeutic touch, can help lower a patient’s blood pressure and heart rate while reducing anxiety, leading to frequent breathing or peripheral pulses.
This therapy prevents hypoxic vasoconstriction, which reduces blood flow to the heart that occurs when a patient experiences decreased oxygen levels. Administering inhaled nitric oxide through an endotracheal tube or nasal cannula allows it to dilate the patient’s blood vessels and improve circulation, leading to increased cardiac output.
Therapeutic nursing interventions for reduced cardiac output may also involve administering intravenous fluids and medications by giving patient care through the use of an endotracheal tube, Ambu bag, or other respiratory devices such as a ventilator. This can be done to treat low blood pressures that occur when patients are experiencing dehydration or hypotension, providing relief for mucous membranes that are irritated or damaged, and giving patients supplemental oxygen.
This is a treatment used to remove toxins from the blood. It consists of an artificial kidney machine that uses filters to separate clean fluid from the blood’s waste products to help patients with chronic kidney disease maintain healthy levels of chemicals and solids in their blood. Patients who experience acute kidney disease are also given hemodialysis if they have symptoms of renal failures, such as an increase in metabolic wastes that result from decreased cardiac output since it can cause damage to the kidneys.
This is the most common diagnostic test for decreased cardiac output. This will show how many red blood cells, white blood cells, and platelets a patient has. Since these numbers can be affected by decreased cardiac output (especially if the values are low), it’s essential to know what they should be since this will help the health care team understand what therapeutic interventions to use.
These are diagnostic tests that are used primarily for cardiac output levels. This can help a health care team determine if fluid is collecting around the lungs or if any abnormalities are present such as tumours, abnormal blood vessels (aneurysms), heart defects, and heart disease.
This test is used to check for any arrhythmias that may occur due to decreased cardiac output since this can affect heartbeat patterns and rhythms. These tests are shown on an ECG waveform graph display, indicating if the heart rate is irregular, such as atrial fibrillation or an abnormal heart rhythm shown on the baseline ECG line graph. This can be associated with decreased cardiac output, and it can cause ventricular arrhythmias, tachycardia, or bradycardias. It may also be used to check for any disturbances in heart rhythms or conduction.
These are also diagnostic tests used for cardiac output levels to look at any abnormalities present in the lungs or heart. This can help a health care team determine what kind of treatment is necessary if decreased cardiac output is current.
Diagnostic tests such as a metabolic panel, serum electrolytes, blood urea nitrogen (BUN), creatinine, and ammonia may also be ordered since these are all affected by decreased cardiac output levels. Suppose fluids aren’t being properly filtered through the kidneys as they should be due to decreased cardiac output. In that case, the ammonia levels can increase, causing a patient’s urine to have a strong odour and be dark yellow.
Diagnostic tests that assess for electrolyte imbalances associated with decreased cardiac output include arterial blood gases, ionized calcium levels, serum potassium levels, and blood glucose or sugar test results. Some of these values may be low or high, depending on the patient’s condition.
Other diagnostic tests used for decreased cardiac output include echocardiograms which help a health care team see if the heart has any abnormalities with its valves or chambers. It can show if there’s any dilation of the heart or any defects in the heart muscle and how well it is contracting. It can also show any leaks in the heart valves that may affect cardiac output levels and a patient’s condition, such as vegetation attached to the aortic valve, mitral valve prolapse, or regurgitation of blood flow back into the left ventricle.
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It’s important to note that diagnostic tests for decreased cardiac output usually are ordered depending on the patient’s condition and how health care team members think a patient is doing. This can help identify what type of interventions, such as intravenous fluids or treatments with medications may be needed to address this problem.
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