NURSING DIAGNOSIS: Decreased cardiac output

related to:

1.

pre-existing compromise in cardiac function;

2.

trauma to the heart during surgery;

3.

increased afterload associated with:

4.

5.

A.

vasoconstriction resulting from hypothermia and an increase in catecholamine output

and plasma renin levels (these increases occur with cardiopulmonary bypass and the
effect of stressors [e.g. pain, anxiety])

B.

fluid overload;

decreased preload associated with:

A.

hypovolemia (can result from blood loss, fluid shifting from the intravascular to
interstitial space, loss of fluid from nasogastric tube, decreased fluid intake, and
excessive diuresis)

B.

hypotension (can occur if body is warmed rapidly following surgery and as a result of
the effect of anesthesia and certain medications [e.g. narcotic analgesics, betaadrenergic blockers, vasodilators]);

effects of hypothermia, hypoxemia, and acid-base and/or electrolyte imbalances on

contractility and conductivity of the heart.

Desired Outcome

The client will maintain adequate cardiac output as evidenced by:

1. B/P within range of 130 - 100/80 - 60
2. apical pulse regular and between 60 -100 beats/minute
3. absence of or no increase in intensity of gallop rhythm
4. increased strength and activity tolerance
5. unlabored respirations at 12 - 20/minute
6. absence of adventitious breath sounds
7. usual mental status
8. absence of dizziness and syncope

9. palpable peripheral pulses

10.

skin warm and usual color

11.

capillary refill time less than 3 seconds

12.

urine output at least 30 ml/hour

13.

absence of edema and jugular vein distention

14.
hemodynamic measurements such as pulmonary artery pressure
(PAP), pulmonary capillary wedge pressure (PCWP), and central
venous pressure (CVP) within normal limits.