Primary Nursing Diagnosis

Decreased cardiac output related to an ineffective ventricular pump

OUTCOMES. Cardiac pump: Effectiveness; Circulation status; Tissue perfusion: Abdominal organs and peripheral; Vital sign status; Electrolyte and acid-base balance; Endurance; Energy conservation; Fluid balance

INTERVENTIONS. Cardiac care; Circulatory care: Mechanical assist device; Fluid/electrolyte management; Medication administration; Medication management; Oxygen therapy; Vital signs monitoring

U PLANNING AND IMPLEMENTATION Collaborative

The patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requires mechanical ventilation and is usually admitted to an intensive care unit. Patients admitted with heart failure who require specialized treatment such as hemodynamic monitoring may also be admitted to a special care unit.

Specific medical treatment for cor pulmonale consists of reversing hypoxia with low-flow oxygen. In the case of acute cor pulmonale, associated with pulmonary emboli, higher concentrations of oxygen may be used. The physician seeks to correct fluid, electrolyte, and acid-base disturbances and may prescribe fluid and sodium restrictions to reduce plasma volume and the work of the heart. Phlebotomies may be used to reduce a patient's seriously elevated hemoglobin.

SUPPORTIVE CARE. Respiratory therapists provide bronchodilator therapy and may need to teach or reinforce the patient's use of breathing strategies. Therapists may also teach energy conservation. A dietitian confers with the patient and family about the need for low-sodium foods and small, nutritious servings. Specific nutritional deficiencies may need to be corrected as well. Fluids need to be limited to 1000 to 1500 mL per day to prevent fluid retention. Social service agencies will probably be needed for a consultation as well, since cor pulmonale creates long-term disability with the likelihood that the patient has not been employed for some time. Unless the patient is old enough to receive Medicare, hospitalization costs are a serious concern.

Pharmacologic

Highlights

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