Cardiac Output Decreased: Nursing Care Plan Overview

Written by: Marie Hasty, BSN, RN Content Writer

Is your patient’s cardiac output decreased? Nursing care plan examples for decreased cardiac output (CO) can help you feel more confident when caring for these patients. Let’s explore what this nursing diagnosis means, its signs and symptoms, and an example of a decreased cardiac output nursing care plan.

For review, nursing care plans are systems that help guide nursing care. They may be influenced by medical care plans, but they are distinct in that they include independent nursing diagnoses and interventions that can be carried out without physician oversight. Now, let’s dig into what it means to have a patient with low CO, and what you can do about it as a nurse.

What Is Cardiac Output?

Cardiac output is the amount of blood pumped out by the left ventricle, measured in liters per minute. It’s calculated by measuring the stroke volume, or the amount of blood pumped out with each beat, by the heart rate. Every tissue and organ in the body relies on cardiac output, and abnormal decreases can result in illness and death.

Decreases in CO can be age-related, but there are also many diagnoses and illnesses that can contribute. These include the following:

Heart failure
Hypertension
Hyperlipidemia
Diabetes
Obesity
Myocardial infarction (MI or heart attack)
Abnormal heart rhythms (such as atrial fibrillation)
Aortic stenosis
Pericarditis

Decreased Cardiac Output Symptoms

What are the signs that a patient’s cardiac output decreased? Nursing care plan steps always start with assessment. Here are the signs to watch out for:

Low energy or weakness
Arm and leg swelling (edema)
Shortness of breath (dyspnea)
Abdominal or chest pain
Nausea and vomiting
Diminished pulses
Decreased urine output
Restlessness
Anxiety
Alterations in mental status

Other symptoms may indicate an acute and dangerous drop in CO. When output plunges abruptly, such as in a massive myocardial infarction, an inability to perfuse tissue can quickly result in shock. If your patient is unresponsive, has a weak pulse, experiences extremely low blood pressure, or is not breathing, alert your rapid response team (RRT) or code team.

Clinical Areas Where You Might Use a Nursing Care Plan for Decreased Cardiac Output

Nearly 30 million Americans experience heart disease each year, and it’s the leading cause of death in the U.S. Where might you see patients who have a decrease in cardiac output? Check out the clinical areas below:

Cardiac Output Decreased: Nursing Care Plan Example

Let’s explore the care plan for a sample patient with decreased cardiac output. We’ll review the nursing process steps below.

1. Assessment

Mr. Davis was transferred from the ICU to a cardiac unit yesterday after an admission diagnosis of a cardiac infarction. This morning, he is complaining of weakness, swelling, and shortness of breath. He has a history of diabetes and hypertension.

In addition to this subjective report, the nurse assesses the following:

Vital signs, including heart rate and blood pressure
Edema on the extremities
Weak or irregular pulses in the hands and feet
Crackles on lung auscultation
Decreased oxygen saturation
Cool, clammy skin
Reduced urine output
Activity tolerance and fatigue
Mental status
Labs for cardiac enzymes, lactate levels, and signs of kidney failure

2. Diagnoses

Due to the damage Dr. Davis’ cardiac tissue sustained during his MI, his heart is having trouble meeting the oxygen demands of the body. This is leading to poor tissue perfusion and fluid buildup. The main nursing diagnosis for Mr. Davis is:

Decrease in cardiac output related to impaired contractility secondary to myocardial infarction, as evidenced by weakness, edema, shortness of breath, and abnormal vital signs.

3. Planning

Using Mr. Davis’ diagnosis, the nurse plans care to address his low cardiac output. The nurse outlines the following goals for Mr. Davis:

The patient will experience reduced symptoms of fluid overload, as evidenced by decreased edema and shortness of breath.
The patient will improve oxygenation, as evidenced by oxygen saturation within normal limits.
The patient will verbalize understanding of the condition and self-management strategies.

4. Intervention

Now it’s time to enact the plan of care. My. Davis’ nurse implements the following decreased cardiac output interventions:

Monitoring vital signs frequently to detect instability early.
Assessing for signs of worsening heart failure, including increased edema, crackles, and weight gain.
Administering prescribed medications such as diuretics, beta-blockers, and ACE inhibitors.
Obtaining weight daily to monitor fluid status.
Positioning the patient in semi-Fowler’s or high-Fowler’s position to improve lung expansion and decrease cardiac workload.
Monitoring intake and output closely.
Encouraging rest, limiting activity, and clustering care to reduce cardiac demand.
Providing supplemental oxygen as needed.
Educating the patient on a low-sodium diet, medication adherence, daily weights, and when to seek care.

5. Evaluation

Evaluation is an ongoing process that helps determine whether the plan needs to be altered. In Mr. Davis’ case, his nurses will be looking for the following signs that his status is improving:

Stable vital signs
Decreased edema and improved lung sounds
Improved oxygen saturation levels without supplemental oxygen
Increased urine output
Lessened shortness of breath and fatigue
Improved activity tolerance
A demonstrated understanding of discharge instructions and self-care

Make a Plan to Find Your Next Nursing Job

If your patient’s cardiac output is decreased, nursing care plan examples like these can help. Need help finding a new workplace, too? The first step is signing up for personalized job notifications from Credenza. We make it easy to find nursing roles that fit your life. Learn more today.