Problem: Decreased Cardiac Output NURSING ASSESSMENT DIAGNOSIS S> O Decreased Cardiac Output O> The patient manifested

the following: increased r/t to EXPLANATION Rhabdomyosarcoma located in the GU tract may also cause compression in the blood may vessels. This After 2 to 3 hours of nursing interventions, the client will have no elevation in blood pressure above normal limits and will maintain blood pressure within the acceptable range. Provide in-depth monitoring and documentation Long term: related to the following: These factors constitute the basic measures utilized in monitoring for The client shall have Long term: Assess for all possible contributing factors, especially known underlying cardiac anomaly. Provides realistic basis for plan of care. Short term: SCIENTIFIC OBJECTIVES INTERVENTIONS Monitor BP every hour. Changes in BP may indicates changes in patient status requiring prompt attention. The client shall have no elevation in blood pressure above normal limits and shall have maintained blood pressure within the acceptable range. NURSING RATIONALE OUTCOMES Short term: EXPECTED

compression of the vessels evidenced increased blood pressure blood as by

cause

blood pressure - tachycardia - fatigue - anxiety

inadequate amount of blood pumped by the heart in order to meet the metabolic demands of the body.

After 2 to 3 days of nursing interventions, the client will maintain adequate cardiac output and cardiac index.

Intake and output hourly and as ordered. Notify the physician if below 10 mL/h or as specified for size of the child Excessive bleeding. If in postoperative status, notify the physician if more than 50 mL/h or as specified. Tolerance of feedings

decompensation of cardiac status. Closely related are respiratory function, hydration status, and

maintained adequate cardiac output and cardiac index.

hemodynamic status.

Notify the physician for: Premature ventricular

contractions (PVCs) or other arrhythmias Limits of pulse, respiratory rate, output criteria as specified for the individual patient

Encourage patient to decrease intake of caffeine, cola and chocolates.

Caffeine is a cardiac stimulant and may adversely affect cardiac function.

Allow time for the parents to voice concern on a regular basis. Set aside 10 to 15 minutes per shift for this purpose.

Verbalization of concerns helps reduce anxiety. Attempting to set aside time for this verbalization demonstrates the value it holds

for the patients care.

Encourage parental input in care, such as with feeding, positioning, and monitoring intake and output as appropriate.

Parental input assists in meeting the emotional needs of both the parents and child, and supports the care given by health care personnel. This action also allows for learning essential skills in a supportive environment.

Encourage the patient, as applicable, to participate in care.

Self-care enhances sense of autonomy and empowerment.

Support the parents in usual appropriate coping mechanisms.

Emotional security may be afforded by encouragement of usual coping mechanisms for age and developmental status.

Maintain appropriate technique in dressing change (asepsis and cautious handwashing).

Standard care requires universal precautions, which minimize risk factors for infection.

Limit visitors in immediate postoperative status as applicable.

Visitation may prove overwhelming to all when unlimited

in immediate postoperative period. Remember that numerous nursingmedical therapies must be attended to during this time also.

Help reduce patient and parental anxiety by touching and allowing the patient to be held and comforted.

Comforting allows the parent and child to feel more secure and decreases feelings of intimidation the parents might experience from seeing numerous pieces of equipment and

activity. Human caring helps offset perceptions of impersonal high tech.

Provide teaching with sensitivity to patient and parental needs regarding equipment, procedures, or routines.

Individualized teaching with appropriate aids will most likely serve to reinforce desired learning and enlist the patients cooperation.

Address the need for the parents to continue with ADLs with confidence regarding knowledge of

Aim should be for normalcy within parameters dictated by the childs condition.

restrictions in the childs status.

Instruct client & family on fluid and diet requirements and restrictions of sodium.

Restrictions can assist with decrease in fluid retention and hypertension, thereby improving cardiac output.

Administer medicines as prescribed by the physician.

This will promote wellness.