Risk for Decreased Cardiac Output | Nursing Care Plan for Hyperthyroidism

Nursing diagnosis: risk for decreased Cardiac Output

Risk factors may include
Uncontrolled hyperthyroidism, hypermetabolic state
Increasing cardiac workload
Changes in venous return and systemic vascular resistance (SVR)
Alterations in rate, rhythm, conduction

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Circulatory Status
Maintain adequate cardiac output for tissue needs as evidenced by stable vital signs, palpable peripheral pulses, good capillary refill, usual mentation, and absence of dysrhythmias.

Nursing intervention with rationale:
1. Monitor BP lying, sitting, and standing, if able. Note widened pulse pressure.
Rationale: General and orthostatic hypotension may occur as a result of excessive peripheral vasodilation and decreased circulating volume. Widened pulse pressure reflects compensatory increase in stroke volume and decreased SVR.

2. Monitor central venous pressure (CVP), if available.
Rationale: Provides more direct measure of circulating volume and cardiac function.

3. Investigate reports of chest pain and angina.
Rationale: May reflect increased myocardial oxygen demands and ischemia.

4. Assess pulse and heart rate while client is sleeping.
Rationale: Provides a more accurate assessment of tachycardia.

5. Auscultate heart sounds, noting extra heart sounds and development of gallops and systolic murmurs.
Rationale: Prominent S1 and murmurs are associated with forceful cardiac output of hypermetabolic state; development of S3 may warn of impending cardiac failure.

6. Monitor ECG, noting rate and rhythm. Document dysrhythmias.
Rationale: Tachycardia greater than normally expected, with fever and increased circulatory demand, may reflect direct myocardial stimulation by thyroid hormone. Dysrhythmias often occur and may compromise cardiac function and output.

7. Auscultate breath sounds, noting adventitious sounds such as crackles.
Rationale: Early sign of pulmonary congestion, reflecting developing cardiac failure.

8. Monitor temperature, provide cool environment, limit bed linens and clothes, and administer tepid sponge baths.
Rationale: Fever, which may exceed 104°F (40.0°C), can occur as a resultof excessive hormone levels increasing diuresis and dehydration, causing increased peripheral vasodilation, venous pooling, and hypotension.

9. Observe for signs and symptoms of severe thirst, dry mucous membranes, weak and thready pulse, poor capillary refill, decreased urinary output, and hypotension.
Rationale: Rapid dehydration can occur, which reduces circulating volume and compromises cardiac output.

10. Record intake and output (I&O). Note urine specific gravity.
Rationale: Significant fluid losses through vomiting, diarrhea, diuresis, or diaphoresis can lead to profound dehydration, concentrated urine, and weight loss.