Lecture 9: Nursing Diagnosis: Decreased Cardiac output

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nursing diagnosis: decreased cardiac output
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reduction in amount of blood pumped by the heart, resulting in compromised cardiac functioning
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list three causes of “decreased cardiac output
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1. angina pectoris 2. myocardial infraction 3. congestive heart failure
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angina definition: ND:
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definition: chest pain related to inadequate O2 supply (ischemia) ND: decreased cardiac output
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myocardial infraction definition: ND:
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definition: related to necrosis (death) of the heart muscle ND: decreased cardiac output
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congestive heart failure definition ND
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definition: the heart is an inadequate pump, decreased CO ND: decreased CO
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left HF: blood backs up into the …
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lungs
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right HF: blood backs up into the…
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body
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assessment of a patient with impaired cardiac output would be…
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1. HR and Heard Sounds 2. BP 3. breath sounds 4. presence of edema
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when assessing a patients HR/Heart sounds… what are some abnormals
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1. tachycardia 2. bradycardia 3. dysrhythmia
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during a cardiovascular assessment what are you looking for
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1. apical HR (rate and regularity) 2. heart sounds (S1 and S2) APE To Man
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APE To Man
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APICAL—— 2nd, Right ICS, Sternal boarder PULMONARY —— 2nd, Left ICS, Sternal boarder ERBS POINT ——- 3rd, Left ICS, Sternal boarder TRICUSPID ——- 4th, Left ICS, Sternal boarder MITRAL ———– 5th, Left ICS, Mid-clavicular line
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4 adventitious heart sounds
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1. gallop (S3/S4) 2. murmur (valve incompetency “swishing”) 3. pericardial friction rub (inflammation “scratching”) 4. click (mechanical valve “clicking”)
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Jugular vein distention cause: assessment:
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cause: right atrium, right sided HF Assessment: head of the bed 30-45 degrees, pt turns head away, shine light on neck
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5 diagnostic test to check for Cardiovascular alterations
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1. lipid profile 2. complete blood count (CBC) 3. coagulation studies 4. ECG 5. angiogram
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nursing interventions to improve cardiac output and reduce the work of the heart
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1. alternate rest and activity 2. high/semi fowlers position 3. avoid valsavla maneuver 4. avoid stimulants 5. manage fluid balance 6. increase oxygen supply
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how does high/semi fowlers improve cardiac output and reduce workload on the heart
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decreased venous return and preload
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how does the avoiding the valsalva improve cardiac output and reduce workload on the heart
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bearing down (because of constipation) may cause passing out because the vagus nerve is stimulated and HR decreases
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how does avoiding stimulants improve cardiac output and reduce workload on the heart
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stimulants increased HR increased HR leads to decreased CO because the ventricles font have time to fill completely
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how does managing fluid balance improve cardiac output and reduce workload on the heart
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too much fluid requires the heart to work harder to pump more fluid
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how does increased O2 supply improve cardiac output and reduce workload on the heart
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it can’t hurt… but there are studies being done that its not that beneficial
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causes of hypertension
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poor diet obesity smoking family history stress
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causes of hypotension
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1. bradycardia 2. HF due to decreased CO 3. malnutrition 4. dehydration
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symptoms of hypertension
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often there are no symptoms of hypertension
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symptoms of hypotension
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light headed and dizzy
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treatment of hypertension
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weight reduction healthy diet exercise de stress
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treatment of hypotension
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increase fluids if dehydrated semi/high fowlers (HF) alternate rest and activity (HF) no bearing down (HF)
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what are some symptoms of left sided heart failure
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hard to breath crackles in the lung base low energy level
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what are some symptoms of right sided heart failure
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edema

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