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Risk for Decreased Cardiac Output - NCP for Heart Arrhythmias


Nursing Care Plan for Heart Arrhythmias

Heart rhythm disorder or arrhythmia is a frequent complication of myocardial infarction. Arrhythmia or dysrhythmia is the change in frequency and heart rhythm caused by abnormal electrolyte conduction or automatic (Doenges, 1999).

Arrhythmias arising from myocardial cells electrophysiological changes. These electrophysiological changes manifest as changes in action potential shape ie graphic record of electrical activity of cells (Price, 1994).

Heart rhythm disturbances are not only limited to the irregularity in heart rate but also including rate and conduction disorders (Hanafi, 1996).

Nursing Diagnosis : Risk for Decreased Cardiac Output related to electrical conduction disturbances, decreased myocardial contractility.

Outcomes:
  • Maintain / increase cardiac output adequately evidenced by blood pressure / pulse in the normal range, adequate urine output, the same palpable pulse, normal mental status.
  • Showed a decrease in the frequency / no dysrhythmias.
  • Participate in activities that decrease myocardial work.

Interventions :
  1. Feel the pulse (radial, femoral, dorsalis pedis) record the frequency, regularity, amplitude and symmetrical
  2. Auscultation of heart sounds, note the frequency, rhythm. Note the extra heart rate, decreased pulse.
  3. Monitor vital signs and assess adequacy of cardiac output / tissue perfusion.
  4. Determine the type of dysrhythmia and rhythm note: tachycardia; bradycardia; atrial dysrhythmias; ventricular dysrhythmias; block.
  5. Provide quiet environment. Assess the reasons for limiting the activity during the acute phase.
  6. Demonstrate / encourage use of behavioral stress management eg deep breathing relaxation, guided imagery.
  7. Assess pain report, note the location, duration, intensity and factor relievers / ballast. Note the presence of non-verbal pain, for example; frown face, crying, changes in blood pressure.
  8. Prepare / do CPR as indicated.
  9. Monitor laboratory tests, for example; electrolyte.
  10. Provide supplemental oxygen as indicated.
  11. Give medications as indicated: potassium, anti dysrhythmias.
  12. Prepare for elective cardioversion aids.
  13. Help installing / maintaining the function of the pacemaker.
  14. Enter / maintain input IV - Prepare for invasive diagnostic procedures.
  15. Prepare for the installation of automatic cardioverter or defibrillator.

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