Decreased Cardiac output related to Hypertension

Nursing Care Plan for Hypertension - Nursing Diagnosis : Decreased Cardiac output



Hypertension is the term used to describe high blood pressure.

Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure.

• Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.
• High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.
• If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.(nlm.nih.gov)

Decreased Cardiac output

Inadequate blood pumped by the heart to meet metabolic demands of the body

Defining Characteristics:

• Altered heart rate/rhythm: arrhythmias (tachycardia, bradycardia);
• palpitations;
• EKG changes;
• altered preload:
• jugular vein distention;
• fatigue;
• edema;
• murmurs;
• increased/decreased central venous pressure (CVP);
• increased/decreased pulmonary artery wedge pressure (PAWP);
• weight gain;
• altered afterload: cold/clammy skin;
• shortness of breath/dyspnea;
• oliguria;
• prolonged capillary refill;
• decreased peripheral pulses;
• variations in blood pressure readings;
• increased/decreased systemic vascular resistance (SVR);
• increased/decreased pulmonary vascular resistance (PVR);
• skin color changes;
• altered contractility: crackles;
• cough;
• orthopnea/paroxysmal nocturnal dyspnea;
• S3 or S4 sounds;
• behavioral/emotional: anxiety;
• restlessness

Nursing Diagnosis for Hypertension : Decreased Cardiac output related to increased afterload, vasoconstriction, myocardial ischemia, ventricular hypertrophy

Goal: Clients want to participate in activities that lower blood pressure / cardiac workload

Outcomes:

• Blood pressure within an acceptable range of individuals.
• Rhythm and heart rate stabilized in the normal range.

Hypertension Nursing Interventions and Rational :

1. Monitor your blood pressure . Measure in both arms / thighs for initial evaluation . Use the proper cuff size and accurate technique .
R / : Comparison of pressure gives a more complete picture of the involvement / field of vascular problems.

2 . Note the presence , quality of central and peripheral pulses .
R / : pulse on the carotid , jugular , radial and femoral probably observed / palpable . Pulse in the legs may be decreased , reflecting the effect of vasoconstriction ( increased SVR ) and venous congestion .

3 . Auscultation of the heart tone , and breath sounds .
R / : S4 commonly heard in patients with severe hypertension due to atrial hypertrophy ( increase in volume / pressure atrium ) . Development S3 , showed ventricular hypertrophy and malfunction . Cracles existence , wheezing may indicate pulmonary congestion secondary to the occurrence or chronic heart failure .

4 . Observe skin color , moisture , temperature , and capillary refill time .
R / : The pale , cool , moist skin and slow capillary refill time may be related to vasoconstriction or reflect decompensation / decrease in cardiac output .

5. Note the general edema / specific.
R /: May indicate heart failure, kidney or vascular damage.

6. Provide a quiet, comfortable, reduce, activity / environment commotion, limit the number of visitors and length of stay.
R /: Helps to reduce sympathetic stimulation; increase relaxation.

7. Maintain restrictions on activities, such as, resting in bed / chair; schedule rest periods without interruption; aids patients perform self-care activities as needed.
R /: Reduce stress and tension that affect blood pressure and hypertensive disease course.

8. Perform actions that comfortable, such as., Back and neck massage, elevating the head of the bed.
R /: Reduce discomfort and can reduce sympathetic stimulation.

9. Encourage relaxation techniques, manual imagination, vision activities.
R /: to reduce stress design, create a calming effect, so it will decrease blood pressure.

10. Monitor response to medication to control blood pressure.
R /: response to drug therapy "stepped" (which consisted of diuretics, sympathetic inhibitors, and vasodilators) depends on the individual and synergistic effects of the drug. Because of these side effects, it is important to use the drug in the least amount and lowest doses.