The nurse is caring for a client with decreased cardiac output. Which of the following nursing actions should the nurse implement to monitor this client?

Assess heart rate every hour and watch out for tachycardia.
Assess peripheral pulses for strength, quality, and for pulsus alternans.
Document rhythm strips every 8 hours and inform the physician if dysrhythmias occur.


• Cardiac rhythm strips should be documented at least every 8 hours, and dysrhythmias reported for adequate cardiac management

• Common dysrhythmias include premature atrial contractions (PACs), premature ventricular contractions (PVCs), and paroxysmal atrial tachycardia (PAT). Changes in the ST segment may indicate myocardial ischemia from decreased coronary artery perfusion

• VS should be taken hourly, and tachycardia reported. Tachycardia can increase myocardial and oxygen demands and may be a compensatory mechanism related to the decreased cardiac output (increased heart rate to compensate for decrease in stroke volume). Assessment for this can help in prompt intervention

• Decreased strength of peripheral pulses is often found in clients with decreased cardiac output, and a further decrease in pulses from baseline may indicate further cardiac failure. Pulsus alternans indicates severe heart failure

• Oral care can help with the sensation of thirst without an increase in fluid intake. This promotes oral health maintenance but not cardiac pump effectiveness

• Diuretics are commonly prescribed to promote the diuresis of accumulated fluid in those with fluid volume overload

• Decreased systemic blood pressure can lead to stimulation of aldosterone, which leads to renal retention of sodium. A low-sodium diet is often prescribed to minimize water retention. This will not promote cardiac pump effectiveness

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