The nursing care plan addresses a client with decreased cardiac output related to cardiovascular disorder. Short term goals include demonstrating hemodynamic stability through improved vital signs within 30 minutes. Long term goals aim to maintain stability over 7 hours. Nursing actions include frequent assessment and documentation of mental status, lung/heart sounds, blood pressure, and peripheral perfusion, as well as elevating the client's legs to facilitate circulation. Goals were partially met after 30 minutes and endorsed for continued care.
The nursing care plan addresses a client with decreased cardiac output related to cardiovascular disorder. Short term goals include demonstrating hemodynamic stability through improved vital signs within 30 minutes. Long term goals aim to maintain stability over 7 hours. Nursing actions include frequent assessment and documentation of mental status, lung/heart sounds, blood pressure, and peripheral perfusion, as well as elevating the client's legs to facilitate circulation. Goals were partially met after 30 minutes and endorsed for continued care.
The nursing care plan addresses a client with decreased cardiac output related to cardiovascular disorder. Short term goals include demonstrating hemodynamic stability through improved vital signs within 30 minutes. Long term goals aim to maintain stability over 7 hours. Nursing actions include frequent assessment and documentation of mental status, lung/heart sounds, blood pressure, and peripheral perfusion, as well as elevating the client's legs to facilitate circulation. Goals were partially met after 30 minutes and endorsed for continued care.
DIAGNOSIS Decreased Cardiac Short Term Goal: Assessed for and document the At the end of 7-hour Objective Cues: Output related to At the end of 30- ff: Cerebral perfusion is Nursing Interventions, Generalized CardioVascular min Nursing o Mental Status directly r/t cardiac the goal was partially paleness Disorder Interventions, the output and aortic met as evidenced by: noted client will be able perfusion pressure and is Irregular to: influenced by hypoxia PR = 66 rhythm of Demonstrate and electrolyte and acid- BP=100/60 pulse noted hemodynamic base variation Slowed stability (blood o Lung sounds Crackles may develop r/t Endorsed to the next Capillary refill pressure and alterations in CAD shift NOD for further Poor Skin cardiac output) o Blood Pressure Hypotension r/t interventions and Turgor by 20% 30% as hypoperfusion, vagal revisions of NCP for BP=90/60 revealed in the stimulation, continuity of care PR = 60bpm cardiac monitor dysrhythmias, or ventricular dysfunction Long Term Goal: may occur At the end of 7- o Heart Sound Bradycardia may be hour Nursing present because of vagal Interventions, the stimulation or client will be able conduction disturbances to: r/t area of MI Demonstrate o Peripheral Perfusion Decreased may indicate hemodynamic a decreased cardiac stability (Blood output pressure and -MSN, Black and Hawks, cardiac output) Vol. 2, 7th edition Maintain stable BP of 100/80 Elevate Lower extremities above Facilitate oxygenation the level of the heart. and proper circulation -NANDA, Doenges, Moorhouse, Murr, 11th edition