Risk for Decreased cardiac output related to Graves' Disease

Nursing Care Plan for Graves' Disease

Risk for Decreased cardiac output related to uncontrolled hyperthyroidism, hypermetabolism circumstances; increase in workload of the heart; , Changes in venous return flow and systemic vascular resistant; changes in the frequency, rhythm and conduction of the heart.

Goal:

• Maintain adequate cardiac output in accordance with the needs of the body,

characterized by;

• stable vital signs,
• normal peripheral pulses,
• normal capillary filling,
• good mental status,
• no dysrhythmias.

Nursing Interventions :

Independent

1. Monitor blood pressure at rest position, sitting and standing, if possible. Consider the magnitude of the pressure pulse.
R /: Orthostatic hypotension is common or may occur as a result of excessive peripheral vasodilation and decrease in circulating volume. The amount of compensation pulse pressure is a reflection of the increase in stroke volume and a decrease in custody vascular system.

2. Monitor CVP if the patient used.
R /: Provides direct measure circulating volume and more accurately and directly measure cardiac function.

3. Check for chest pain experienced by the patient or the patient complained of angina.
R /: It is a sign of the increased oxygen demand by the heart muscle or ischemia.

4. Assess pulse or heart rate while the patient is sleeping.
R /: Gives a more accurate assessment of the tachycardia.

5. Auscultation of heart sounds, note the presence of an extra heart sounds, the presence of a gallop rhythm and systolic murmur.

6. Monitor ECG, record and note the speed or rhythm of the heart and the presence of dysrhythmias.
R /: Tachycardia is a direct reflection of the heart muscle stimulation by thyroid hormone, dysrhythmias often occurs and can harm the function of the heart or cardiac output.

7. Auscultation of breath sounds, note the presence of abnormal noise.
R /: Early signs of pulmonary congestion associated with the onset of heart failure.

8. Monitor the temperature, provide a cool environment, limit the use of linen / clothing, compress with warm water.
R /: Fever occurs as a result of excessive hormone levels and may increase diuresis / dehydration and cause an increase in peripheral vasodilatation, venous buildup and hypotension.

9. Observe the signs and symptoms of severe thirst, dry mucous membranes, weak pulse, slow capillary filling, decreased urine output, and hypotension.
R /: Fast dehydration can occur which would decrease the volume of circulation and decrease cardiac output.

10. Record the input and output, urine specific gravity record.
R /: Losing a lot of fluids (through vomiting, diarrhea, diuresis, diaphoresis) can lead to severe dehydration, concentrated urine and body weight decreased.

11. Measure weight every day, recommend bed rest, limit unnecessary activity.
R /: Activities will increase the metabolic needs / circulation potentially cause heart failure.

12. Note the presence of a history of asthma / bronchoconstriction, pregnancy, sinus bradycardia / heart block progress to heart failure.
R /: This condition affects the choice of therapy (eg, the use of beta-adrenergic blockers are contraindicated).

13. Observation of antagois adrenergic side effects, such as a decrease in pulse and blood pressure dramatically, signs of vascular congestion / CHF, or cardiac arrest.
R /: One indication to reduce or stop the therapy.

Collaboration
1. Give IV fluids as indicated.
R /: Iv fluid administration through quickly need to improve circulation volume but must be balanced with attention to signs of heart failure / requirement for inotropic agent administration.

2. Give O2 as indicated.
R /: It may also be required to meet the increased metabolic needs / requirements for the oxygen.

Tag : Graves' Disease, Nursing Diagnosis and Interventions, Risk for Decreased cardiac output related to Graves' Disease