Nursing Care Plan Circulation

Problem #1 (Nursing Diagnosis): Circulation – Risk for Decreased Cardiac Output r/t ineffective ejection of blood pumped into ventricles secondary to Paroxysmal Atrial Fibrillation General Goal: Client will maintain adequate cardiac output. Expected Outcome Behavioral, measurable, observable, realistic & time-limited Client will maintain adequate cardiac output as evidenced by blood pressure, pulse rates (of equal quality for both radial and pedal), and heart rhythm all within normal parameters throughout clinical shift on 11/7/2019 from 7:00 AM until 2:00 PM. Nursing Interventions Rationale Patient Responses to Interventions Recognize, monitor, and report presence and degree of symptoms including dyspnea at rest, reduced exercise capacity, difficulty with activities of daily living, orthopnea, paroxysmal nocturnal dyspnea, cough, palpitations, chest pain, distended abdomen, fatigue, presyncope, or weakness. Monitor and report signs of JVD, peripheral edema, S3 gallop, rales, heart murmur, narrow pulse pressure, tachycardia with pulses, and irregular heartbeat (auscultate heart soundsnoting rate, rhythm, presence of extra heartbeats). Observe and educate client regarding significant side effects or adverse reactions that may arise from cardiac medications. Older adults can have difficulty with metabolism and excretion of medications because of decreased function of the liver and kidneys; therefore, toxic side effects are more common. Educate client on a diet that promotes cardiovascular health and reduces risk of hypertension, atherosclerotic disease, renal impairment, and hypervolemia, within the context of an individual’s cultural preferences. Assess client for signs of depression, stress, and anxiety (including sadness, irritability, agitation, somatic complaints, tension, loss of concentration, insomnia, poor appetite, apathy, and withdrawn behavior). These are symptoms and signs consistent with heart failure (HF) and decreased cardiac output. Client agreed to allow monitoring of all of her vital signs along with both her radial and pedal pulses to assure that all assessments are within normal range and no cardiac issues are present. During the assessment, she was informed that her pulses were of equal strength in both radial and pedal locations. Demonstrate and encourage use of stress management behaviors; relaxation techniques, guided imagery, slow/deep breathing. Differences in equality, rate, and regularity of pulses are indicative of the effect of altered cardiac output on systemic or peripheral circulation. Specific dysrhythmias are more clearly detected audibly than by palpations. Hearing extra heartbeats helps identify dysrhythmias. Information necessary for Older adults are at increased risk for digoxin toxicity, especially at larger doses, because of lower body mass and impaired renal function. Reduced sodium intake, weight loss, healthy diet, and avoidance of excess caloric intake is recommended for individuals with elevated blood pressure and for prevention of cardiovascular disease. Assessing for signs of depression, stress, and anxiety are important in both enhancing communication with the client, as well as allowing the caregiver to see if the client’s needs are being met psychosocially. Stress can greatly impact cardiac output. Promotes patient participation in exerting some sense of control in a stressful situation. Client agreed to notify provider if she sees a decline in her urinary output, presence of tachycardia, potential edema or clotting. Client verbalized that she is willing to try and follow a better diet with lower sodium options related to helping reduce cardiovascular disease, but that she did not have much say in what food choices were available at the center. Client denied any feelings of depression, sadness, stress, poor appetite, or anxiety. Client verbalized that she finished 100% of her breakfast. Client was observed during lunch and finished 100% of her meal. Client stated she is content and satisfied with where she is at the age of 81. Client stated that she had her own mechanism to deal with stress, which is by praying. She stated that prayer has helped her throughout her entire life, especially in stressful situations. This information was obtained during the psychosocial assessment. Evaluation: Goal Accomplished. Client maintained adequate cardiac output as evidenced by pulse rates (of equal quality for both radial and pedal), and heart rhythm all within normal parameters throughout clinical shift on 11/7/2019 from 7:00 AM until 2:00 PM. *Blood Pressure recorded was 149/64 mmHg- the systolic pressure falls within the Stage 1Hypertension range, but the patient has been prescribed hypertension medication-Furosemide for management. Patient was given medication by nurse during assessment, immediately after lunch.