DISCUSSION FORUM

Hi! This is an activity to engage you to learn more about assessment and monitor
ing the critically-ill client. Given a cardiac patient with acute coronary syndr
ome, identify 5 critical assessment factors that nurses have to monitor to help
identify nursing problems related to impaired cardiac output. what competencies
are needed for the nurse to develop the skills in monitoring critically-ill card
iac patients. Thank you.
ANSWER
5 Critical Assessment Factors to Identify Problems Related to Impaired Cardiac O
utput
1. Blood Pressure
The output of each ventricle is the product of the stroke volume (about 70 ml) a
nd the heart rate (about 70 per minute). The output increases with muscular acti
vity, in work or exercise perhaps to a maximum of 4-5 times the resting rate in
an average healthy person; heart rate increases by a greater factor than stroke
volume. The more blood pumped from the heart per minute (that is, the larger the
cardiac output), the higher the blood pressure as long as resistance to blood flo
w in the arteries remains constant. The body can change the amount of blood pump
ed during each heartbeat by making each contraction weaker or stronger. The high
er the volume of blood in the blood vessels, the higher the blood pressure as long
as resistance to blood flow in the arteries remains constant. To increase or de
crease blood volume, the kidneys can vary the amount of fluid excreted in urine.
2. Heart Sounds, Pulse Rate and Peripheral Pulses
Heart sounds may sound distant and have an S3 or S4 sound present with the prese
nce of heart failure
Heart irritability is common with conduction defects and/or ischemia from a poor
ly perfused heart (Tachycardia at rest, atrial fibrillation, bradycardia, or mul
tiple dysrhythmias)
Weak, thready peripheral pulses may reflect hypotension, vasoconstriction, shunt
ing and venous congestion
3. Skin color and temperature
Pallor or cyanosis, cool moist skin and slow capillary refill time may be presen
t from peripheral vasoconstriction and decreased oxygen saturation
4. Level of Consciousness
Changes in behavior and mental status can be early signs of impaired gas exchang
e which will result from decreased cardiac output
5. Weight
Weight gain can be one of the earliest indicators of heart failure as a result o
f impaired ventricular pumping ability. An acute gain in weight of 1kg. can sig
nal a l liter gain in fluid
What competencies are needed for the nurse to develop the skills in monitoring c
ritically-ill cardiac patients?
Nurses should improve that communication skills for Health Education and Promoti
on and continuous learning for improvement in knowledge and skills about critica
l care