Nursing diagnoses : Decreased cardiac output

Nursing diagnoses
- Decreased cardiac output related to altered contractility and altered heart rate and rhythm
- Acute pain related to an imbalance between myocardial O₂ supply and demand
- Anxiety related to perceived or actual threat of death, pain, and/or possible lifestyle changes
- Activity intolerance related to general weakness secondary to decreased cardiac output and poor lung and tissue perfusion
- Ineffective health management related to lack of knowledge of disease process, risk factor reduction, rehabilitation, home activities, and medications
Planning
- Overall goals
  - Relief of pain
  - Preservation of heart muscle
  - Immediate and appropriate treatment
  - Effective coping with illness-associated anxiety
  - Participation in a rehabilitation plan
  - Reduction of risk factors
Acute interventions: Chronic stable angina
- Upright position
- Supplemental oxygen
- Assess vital signs
- 12-lead ECG
- Administer NTG followed by an opioid analgesic, if needed
- Assess heart and breath sounds
Acute care: Acute coronary syndrome
- Pain: nitroglycerin, morphine, oxygen
- Continuous monitoring
  - ECG
  - ST segment
  - Heart and breath sounds
  - VS, pulse oximetry, I and O
- Rest and comfort
  - Balance rest and activity
  - Begin cardiac rehabilitation
- Anxiety reduction
  - Identify source and alleviate
  - Patient teaching important
- Emotional and behavioral reaction
  - Maximize patient’s social support systems
  - Consider open visitation

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