{
  "name": "Decreased Cardiac Output",
  "slug": "decreased-cardiac-output",
  "url": "https://nursingplex.com/care-plans/decreased-cardiac-output",
  "category": "Cardiac",
  "summary": "Insufficient blood pumped for metabolic demand; monitor perfusion signs and optimize preload/afterload.",
  "nursing_diagnoses": [
    "Decreased cardiac output",
    "Activity intolerance",
    "Excess fluid volume"
  ],
  "overview": [
    "Decreased cardiac output is a state in which the volume of blood ejected by the heart each minute is inadequate to meet the metabolic needs of the tissues. Cardiac output is the product of heart rate and stroke volume, and stroke volume depends on preload, afterload and contractility — any of which may fail.",
    "Causes include myocardial infarction and cardiomyopathy (contractility), dysrhythmias and severe bradycardia or tachycardia (rate), hypovolemia or tamponade (preload) and severe hypertension or valve stenosis (afterload). The body compensates with tachycardia, vasoconstriction and fluid retention, which ultimately worsens the failing heart.",
    "Nursing care detects declining perfusion early through mental status, urine output and skin signs, optimizes preload and afterload with prescribed therapy, and reduces the workload placed on the heart."
  ],
  "key_facts": [
    {
      "label": "Earliest sign",
      "text": "Restlessness or a subtle change in mental status often precedes any drop in blood pressure."
    },
    {
      "label": "Urine output",
      "text": "Less than 0.5 mL/kg/hour signals inadequate renal perfusion."
    },
    {
      "label": "Compensation trap",
      "text": "Blood pressure may stay normal until compensation exhausts, then fall abruptly."
    },
    {
      "label": "Positioning",
      "text": "Semi-Fowler reduces preload and eases work of breathing in congestion."
    }
  ],
  "nursing_priorities": [
    "Detect and treat the underlying cause of reduced output.",
    "Maintain adequate tissue perfusion and organ function.",
    "Optimize preload, afterload, rate and rhythm.",
    "Reduce myocardial oxygen demand.",
    "Prevent complications of low flow: renal failure, shock, dysrhythmia."
  ],
  "assessment": {
    "subjective": [
      "Reports of fatigue, weakness or dyspnea with minimal exertion",
      "Complaints of chest discomfort, palpitations or lightheadedness",
      "Reports of confusion or difficulty concentrating",
      "Reports of decreased urination or increasing leg swelling"
    ],
    "objective": [
      "Hypotension, narrow pulse pressure, tachycardia or dysrhythmia",
      "Cool, pale, clammy skin with delayed capillary refill and weak pulses",
      "Jugular venous distention, S3 gallop, crackles or peripheral edema",
      "Urine output below 0.5 mL/kg/hour and rising creatinine",
      "Altered mental status, low SpO2 and elevated BNP or lactate"
    ],
    "related_factors": [
      "Altered contractility from infarction, ischemia or cardiomyopathy",
      "Altered heart rate or rhythm",
      "Altered preload from hypovolemia, tamponade or fluid overload",
      "Increased afterload from hypertension or valve stenosis"
    ]
  },
  "goals": [
    "The client will maintain blood pressure, heart rate and rhythm within acceptable limits.",
    "The client will maintain urine output above 0.5 mL/kg/hour.",
    "The client will remain alert and oriented with warm dry extremities.",
    "The client will report reduced dyspnea and fatigue."
  ],
  "interventions": [
    {
      "title": "Monitor perfusion",
      "points": [
        "Assess mental status, skin temperature, capillary refill and pulses every shift or more often.",
        "Monitor continuous ECG and report new dysrhythmias promptly.",
        "Track hourly urine output, daily weight and strict intake and output.",
        "Review BNP, troponin, lactate, electrolytes and renal function."
      ]
    },
    {
      "title": "Optimize hemodynamics",
      "points": [
        "Administer diuretics, vasodilators, inotropes and rate-control agents as ordered, monitoring response.",
        "Titrate oxygen to maintain saturation targets.",
        "Position semi-Fowler with legs dependent to reduce venous return in congestion.",
        "Correct electrolytes, especially potassium and magnesium, to prevent arrhythmia."
      ]
    },
    {
      "title": "Reduce cardiac workload",
      "points": [
        "Cluster care and provide uninterrupted rest periods.",
        "Assist with ADLs and pace activity to the patient's tolerance.",
        "Maintain a calm environment and treat pain and anxiety, both of which raise oxygen demand.",
        "Restrict sodium and fluids as prescribed."
      ]
    }
  ],
  "patient_teaching": [
    "Teach daily weights and to report a gain of 2–3 pounds in a day or 5 pounds in a week.",
    "Review sodium and fluid restrictions and medication purposes.",
    "Explain when to seek urgent care: worsening breathlessness, chest pain, fainting, palpitations.",
    "Encourage paced activity, smoking cessation and cardiac rehabilitation."
  ]
}