Decreased cardiac output help!

[CallieBennett]

Hi everyone! Working on my care plan for clinicals this past week and have settled on decreased cardiac output r/t altered heart rate & rhythm. Pt was tachycardic (SVT) but cardioverted back into regular rhythm. We have to use SMART goals and interventions. My goal is the pt will demonstrate adequate cardiac output as evidenced by normal heart rate (60-100 bpm) q2h by1200 on 2/26/16. So far I've got interventions that relate specifically to the goal of heart rate only: monitor hr and rhythm q2h, palpate peripheral pulses q2h, and teach patient about signs to report immediately such as fast heart rate, dizziness, confusion, weakness, or fatigue. I'm having a really hard time coming up with 2 more and our instructors seemed stumped too ( everyone was doing deceased c.o. this week 😕) Any ideas here?? They won't allow us to do any "medical" interventions, i.e. administer meds or o2. TIA.

[Summer Days]

You can include instructing the pt to avoid activities that promote valsalva response such as bearing down or holding breath. Or instruct pt on activities that will promote rest

[akulahawkRN, ADN, RN, EMT-P]

I'm glad you've provided what you have done so far. I would also suggest teaching the patient to avoid foods/substances that could increase the heart rate or promote cardiac irritability. Caffeine and analogs to it (like stuff found in many "energy" drinks) can very easily promote an increased heart rate. There are lots of foods that contain caffeine in various concentrations. There are more substances that are easily obtainable that will also lead to an increased heart rate, some are legal and some aren't...

[Valcorie34, BSN, MSN, RN]

My question how are you going to 'fix' this decreased cardiac output with a goal of pt. will demonstrate adequate cardiac output AEB normal heart range (60-100bpm)

A nursing intervention alone doesn't seem to be able to cure it. so my thinking is perhaps you need a different ACHIEVABLE goal.

Pt. will monitor heart rate and rhythm for 24 hours AEB 1 hour checks of pulse rate written on log book by Pt.

Interventions- teach pt how to rack pulse and what tachycardia is

IDK- just my thoughts this doesn't seem achievable.

[/username, BSN, RN]

Without an aline/flowtrack or swan, you really don't know what their CO is. Sure you can get it from BP cuffs, but my point is that tachycardia does not always equate to decreased CO.