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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?

Explanation

• 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.

• Vital signs (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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