Decreased Cardiac Output, Altered electrical conduction

Nursing Care Plan

Medical Diagnoses: Decreased Cardiac Output, Altered electrical conduction

Assessment

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders and Rationale

*I

Evaluation

Goals

Interventions

Subjective

N/A

Objective

Diagnosis of chronic atrial fibrillation

Upon arrival, pt HR was 114 BPM

EKG reveals atrial fibrillation with rapid ventricular response

Problem

Decreased Cardiac Output

Long Term:

Pt will demonstrate adequate cardiac output as evidence by BP, HR, and rhythm within normal parameters by discharge.

*Schedule rest periods after meals and activities.

Rationale: “Rest helps lower arterial pressure and reduce the workload of the myocardium by diminishing the requirements for cardiac output” (Ackley & Ladwig, 2008, p. 195).

*Place client in semi-Fowler’s or high Fowler’s position with legs down or position of comfort.

Rationale: “Elevating the HOB and legs down position may decrease the work of breathing and may also decrease venous return and preload” (Ackley & Ladwig, 2008, p. 194).

ü

R/T

Altered electrical conduction

Short Term:

Pt will remain free of side effects from the medications used to achieve adequate cardiac output throughout this shift, by 1900.

*Check BP, HR, and condition before administering cardiac medications.

Rationale: “It is important that the nurse evaluate how well the client is tolerating current medications before administering cardiac medications, do not hold medications without physician input” (Ackley & Ladwig, 2008, p. 194).

ü



AEB

Hxn of chronic atrial fibrillation

Pt HR upon arrival was 114 BPM

Tachycardia

EKG reveals atrial fibrillation with rapid ventricular response

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*I = Implementation. Check those interventions/actions/orders that were implemented.

References

Ackley, B.J., & Ladwig, G.B. (2008). Nursing diagnosis handbook: An evidence-based guide to planning care (8^th ed.). St. Louis: Mosby Elsevier.

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Assessment	Nursing DX/Clinical Problem	Client Goals/Desired Outcomes/Objectives	Nursing Interventions/Actions/Orders and Rationale	*I	Evaluation
					Goals	Interventions
Subjective N/A Objective Diagnosis of chronic atrial fibrillation Upon arrival, pt HR was 114 BPM EKG reveals atrial fibrillation with rapid ventricular response	Problem Decreased Cardiac Output	Long Term: Pt will demonstrate adequate cardiac output as evidence by BP, HR, and rhythm within normal parameters by discharge.	Schedule rest periods after meals and activities. Rationale: “Rest helps lower arterial pressure and reduce the workload of the myocardium by diminishing the requirements for cardiac output” (Ackley & Ladwig, 2008, p. 195). Place client in semi-Fowler’s or high Fowler’s position with legs down or position of comfort. Rationale: “Elevating the HOB and legs down position may decrease the work of breathing and may also decrease venous return and preload” (Ackley & Ladwig, 2008, p. 194).	ü
	R/T Altered electrical conduction	Short Term: Pt will remain free of side effects from the medications used to achieve adequate cardiac output throughout this shift, by 1900.	*Check BP, HR, and condition before administering cardiac medications. Rationale: “It is important that the nurse evaluate how well the client is tolerating current medications before administering cardiac medications, do not hold medications without physician input” (Ackley & Ladwig, 2008, p. 194).	ü
	AEB Hxn of chronic atrial fibrillation Pt HR upon arrival was 114 BPM Tachycardia EKG reveals atrial fibrillation with rapid ventricular response