Help! Decreased Cardic Output but....

Nursing Students General Students

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I have the following Case Study:

Case Study #3

Based on Mrs. Gilford's signs and symptoms and results of the STAT diagnostic studies, what is your primary area of concern?

Anna Gilford, a 69-year-old female, presents to the ED with pallor, dyspnea, and distended neck veins. She denies chest pain but admits to chest "pressure." Her husband states she has been short of breath for 3 days, with increasing difficulty sleeping, resulting in her spending the previous night in a recliner chair. He also notes that swelling of her feet is worse this morning and that he could not put her slippers on.

Mrs. Gilford reports her height is 5'1'' and weight 162 lb. In the ED, her current weight is 175 lb, an increase of 13 lb above her stated weight. Mr. Gilford indicates his wife has not been following any specific dietary plan and does not monitor her blood pressure at home.

She has a history of hypertension and coronary artery disease. Medications include Benicar HCT 40/35 daily, Toprol XL 100 mg/d, Lasix 40mg/d, and potassium supplement, which her husband states she needs refilled and has not taken for a week.

Vital signs are 198/102, 120, 34; pulse oximetry reading on room air: 79%. Auscultation of the lungs reveals crackles throughout both lower lobes, and a moist-sounding cough is nonproductive. Mrs. Gilford is placed on oxygen at 4 L/m by nasal canula.

Following a chest x-ray, which shows pulmonary congestion and a moderately enlarged heart.

I was really confident about Decreased Cardiac Output r/t altered afterload AEB dyspnea, pallor, SOB, edema, and elevated blood pressure, heart rate and respirations. But as I continue to research, I realized that Decreased Cardiac Output denotes low blood pressure and this patient blood pressure is 198/102. I looked at Impaired Gas Exchange and Ineffective Breathing, but it just not fit most of her symptoms... Please Help!!

Future Army Nurse!!

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Well the question asks for your primary area of concern...So my primary area of concern would be her breathing. I know it says they put her on 4L, but it doesn't say what her pulse ox is after that, so that needs to be reassessed.

After that I would think to give more Lasix which will get rid of some of the fluid and drop her bp a bit.

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Thanks, the pulse ox is 79%... it was in there, probably to bunched up! Oops I just realized: room air!!

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I saw that it says 79%, but after that it says she was placed on 4L. It should be higher than 79% on 4L or she is in real trouble...

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And if it is ONLY 79% on 4L then your first priority action is to turn up her O2!! :)

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Ok thanks! I will relook at Ineffective breathing or Impairded Gas Exchange.

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I see signs and symptoms of hypervolemia. S/s distended jugular veins, weight gain, dyspnea, crackles to auscultation, increased BP. It sounds like this pt has increased preload and It is possible that this pt has heart failure due to the symptoms listed above. Just so you know, I am just a student nurse. You should get help from RNs. For nursing dx, I would first focus on respiratory and cardiac output. Treat with diuretics :)

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Yeah, I didn't know what forum to post to, but it's good for us future nurses. But all those symptoms did point to the decreased cardiac output, but that high blood pressure is throwing me off:confused:

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Yeah, I didn't know what forum to post to, but it's good for us future nurses. But all those symptoms did point to the decreased cardiac output, but that high blood pressure is throwing me off:confused:

You're fine posting here :) Experienced nurses who like helping with homework drop by regularly :up: You'd get moved over here anyway (more than likely) if you started out on the General Discussion forum.

Healthstar is pointing you in the right direction :)

I would be careful about using the exact words "treat with diuretics" on a NURSING care plan- but administering drugs as ordered, monitoring effects/side effects, etc are OK :D

What happens when there is more volume than the heart is normally used to pumping?

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oh my...is this what i have to look forward to in NS?....i understand what is all being said but putting it all together is whats throwing me....how is one taught this? do you start with the ABC'c?...

thanks for posting this.....good luck...please come back and let us know how you did...i would be very interested....

pre nursing student with one more science pre req(micro spring semester) to go and hopefully being accepted for fall.....

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Thanks, I went to sleep dreaming of this!!

After more research into Preload and Afterload, Contractility and Heartrate, which are all factors that affect Cardiac Output. I will stick with Decreased Cardiac Output r/t altered preload AEB edema, weight gain, distended veins and restlessness. I might add increased CVP.

Thanks healthstar for the preload recommendation...

xtrn - I am leading towards left ventricular heart failure...

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Specializes in ER, progressive care.
I would be careful about using the exact words "treat with diuretics" on a NURSING care plan- but administering drugs as ordered, monitoring effects/side effects, etc are OK :D

Exactly! :up: Although administering medications is a big part of our job, that requires medical input. Nursing diagnoses focuses on nursing problems that nurses can fix ;)

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