Cardiac Care Plan help Please!!!!

Daytonite, BSN, RN · Feb 19, 2009

The only cardiac diagnosis you can use is Decreased Cardiac Output. Blood pressure consists of two main components:

cardiac output
- heart rate - beats per minute :redbeathe
- stroke volume - amount of blood pumped per beat
[*]peripheral resistance - resistance of the arteries against the flow of blood through them

Ineffective Tissue Perfusion covers all the other organs that have oxygenation issues. Decreased Cardiac Output is used exclusively for oxygenation and perfusion issues with the heart. Ineffective Tissue Perfusion, cardiopulmonary should only be used when a primary lung problem such as a blood clot in the lung is causing a heart problem that was never there to begin with. That isn't the case here. This patient has heart disease, so just use Decreased Cardiac Output. He has cardiomegaly because his heart is overworked. Is he obese? Hypertension is caused because the heart is overworked for a number of reasons. His peripheral resistance could be increased because of underlying CAD (especially if he was a smoker for many years) or there could be a lot of cardiopulmonary congestion as a result of his disease. Because he also has COPD and bronchitis he will also have respiratory problems of Impaired Gas Exchange and either Ineffective Airway Clearance or Ineffective Breathing Pattern. It's interesting that the patient has anemia and is still hypertensive. Cor pulmonale is often a coexisting problem with COPD and that is where the hypertension comes from. The anemia is obviously not a blood loss anemia, but more of a nutritional type of anemia. Were there any electrolyte and iron values? It is not uncommon for COPDers to have nutrition issues. If you do a websearch for "COPD and nutrition" you should get websites with nutrition information and issues on them pertaining specifically to these patients. This would make it an Imbalanced Nutrition: less than body requirements. With anemia and low RBCs it is also contributing to his low oxygen sats. If this patient is on anticoagulants he is at Risk for Injury R/T altered clotting factors

sleepy1010 · Feb 19, 2009

thank you for responding:) To answer some of your questions the pt is not a smoker or obese, its a 93 yr old female. I do not have Iron values but the patient is on iron suplements. What is this related to? I am thinking risk for decreased cardiac output related to decreased oxygenation as evidenced by low hemoglobin levels and abnormal ABGs. Does that make sense?

rpbsnrn · Feb 20, 2009

One thing to consider is that H and H levels are usually lower in female patients. A Hgb of 11 is actually within normal range for this patient. Considering the patient is sat'ing at 92% and seems to show adequate levels of perfusion, maybe a "risk for ineffective tissue perfusion r/t low O2 pressures?"

The lower P02 lab value would be better to utilize however in older patients it is typical to see lower O2 pressure values in the ABGs. The general rule is to subtract 1 mmHg per year over 65. So a patient who is 93 is almost 30 years over that. 100 - 28 = an approximate normal pressure value of 72 mmHg. She is still below that figure however.

Hope that helps

truern · Feb 20, 2009

I have a careplan I did for an elderly pt w/COPD and diet issues to r/t Daytonite's post.

NCP imbalanced nutrition less than body requires copd.doc

Daytonite, BSN, RN · Feb 20, 2009

to answer some of your questions the pt is not a smoker or obese.

how is it that she came to have copd if she is not a smoker or does not have a history of smoking?

the patient is on iron supplements. what is this related to?

an iron deficiency. recall the anatomy and physiology of the blood cell and its role in the transportation of oxygen around the body and to the cells of the body. if there aren't enough red blood cells to carry oxygen then the cells of the body won't get enough oxygen no matter how much supplemental o2 is pumped into the patient.

i am thinking risk for decreased cardiac output related to decreased oxygenation as evidenced by low hemoglobin levels and abnormal abgs.

the taxonomy gives specific information about what the related factors for this diagnosis can be. they need to be things that are going to be the cause of messing up the cardiac output. decreased oxygenation is the

result

, or evidence, of decreased cardiac output and if you look at the defining characteristics (signs and symptoms) of this diagnosis (

decreased cardiac output

) you will find all kinds of manifestations of decreased oxygenation. your related factor must be what is the underlying cause for the decreased oxygenation. it needs to be more reflective of the disease pathophysiology of the heart such as a low heart rate, an arrhythmia or decreased stroke volume--things directly affected cardiac output, the name of this diagnosis. low hemoglobin levels are not a result of decreased cardiac output. they are caused by some other pathology going on. abnormal abgs are due to a problem with gas exchange in the alveoli and not a cardiac output problem. please look at the defining characteristics (signs and symptoms) of this diagnosis before formulating a diagnostic statement so you are diagnosing correctly. you need to look at your cardiac assessment data. you didn't really list any. however, with the patient's medical diagnoses i assume they have cardiac symptoms and you just didn't post them.

irish_fiddler747 · Apr 15, 2010

I have a similar question r/t cardiac output. I have to have 6 prioritized nsg dx for my pt, the top 3 being the ones I have to write interventions etc for. She was in the hospital simply because she had fractured her patella. My #1 is Ineffective tissue perfusion: peripheral and renal r/t immobility & type 2 DM. (mostly bed/chair-bound, hematuria, hi BG, inc BUN & creatinine etc). #2 is Impaired mobility for obvious reasons, and I have #3 as Impaired GI function r/t immobility and GERD AEB constipation, c/o nausea, etc.

For 4 I'm thinking about Risk for infection r/t altered immune status, immobility, and intermittent urinary incontinence AEB dec WBC, anemia. After that I wanted to put risk for decreased cardiac output because she had been hospitalized several times for severe tachycardia and had been on propanolol forever because of heart rhythm problems. I also found in her chart that she had had CHF but she didn't really present with symptoms of CHF. I'm afraid that I'll get in trouble for not having in in the top 3 b/c of ABCs, but that's not the reason she was in the hospital and her heart issue seemed to be well controlled and not giving her any trouble. Thoughts? Is "risk for" dec CO even a valid dx?