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CUES Objective: Decreased cardiac output BP: 200/120 T:39.0 C Vomiting Lethargic

NURSING DIAGNOSIS Decreased cardiac output related to malignant hypertension as manifested by low stroke volume

ANALYSIS Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood pressure is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary. About 9095% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause can be found. The remaining 5 10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system. Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a




EVALUATION Effectiveness: After 8 hours of nursing intervention, was the client able to maintain blood pressure with inacceptable limits Yes_ No_ Why ?_

After 6 hrs Monitor BP General and of nursing lying, sitting, orthostatic interventions, t and standing, if hypotension may he client will have able. Note occur as a result of no elevation in widened pulse excessive blood pressure pressure. peripheral vasodil above normal ation and limits and will decreased maintain circulating blood pressure volume. Widened with pulse pressure inacceptable reflects limits compensatory increase in stroke After 5 days volume and of nursing decreased SVR. interventions t he client will maintain adequate cardiac output and cardiac index . Monitor Provides more central venous direct measure of afterload is pressure (CVP), circulating not increased, if available. volume and vasoconstricti cardiac function on does not occur, May reflect myocardial increased ischemia does Investigate reports of chest myocardial not occur.

Efficiency: Were the resources of the nurse and patient efficient and be able to maximize? Yes_ No_ Why ?_ Appropriateness: Were all the interventions to the client are appropriate for her to attain the desired goal? Yes_ No_ Why ?_

leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.

pain and angina.

oxygen demands and ischemia. Acceptability: Were all the interventions to the client are acceptable for her ? Yes_ No_ Why?_ Adequacy: Were the interventions adequate for her to attain the desired goal? Yes_ No_ Why?_

>Assess pulse and heart rate while client is sleeping.

>Provides a more accurate assessment of tachycardia.

>Auscultate heart sounds, noting extra heart sounds and development of gallops and systolic murmurs.

>Prominent S1 and murmurs are associated with forceful cardiac output of hyper metabolic state; development of S3 may warn of impending cardiac failure. >Fever, which may exceed 104F (40.0C), can occur as a result of excessive hormone levels increasing diuresis and dehydration, causing increased peripheral

>Monitor temperature, provide cool environment, limit bed linens and clothes, and administer tepid sponge baths.

vasodilatation, venous pooling, and hypotension.

>Observe for signs and symptoms of severe thirst, dry mucous membranes, weak and thready pulse, poor capillary refill, decreased urinary output, and hypotension.

>Rapid dehydration can occur, which reduces circulating volume and compromises cardiac output.