Nursing Care Plan for Morbus Basedow
Nursing Diagnosis: Risk for Decreased Cardiac Output
related to:
- uncontrolled hyperthyroidism,
- state of hyper-metabolism;
- increased workload of the heart;
- changes in venous return flow and systemic vascular resistance; frequency changes, cardiac rhythm and conduction.
The purpose of nursing care: to 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 Risk for Decreased Cardiac Output - Nursing Care Plan Morbus Basedow:
Independent
1. Monitor your blood pressure at the position of lying, sitting and standing if possible. Note the magnitude of the pressure pulse.
Rationale: Hypotension may occur as a result of excessive peripheral vasodilatation and a decrease in circulating volume.
2. Monitor CVP if patients use them.
Rationale: To provide a direct measure of the volume of circulation and more accurate and direct measure of cardiac function.
3. Check for chest pain or angina are complained of by the patient.
Rationale: It is a sign of increased oxygen demand by the heart muscle or ischemia.
4. Assess pulse or heart rate while the patient sleeps.
Rationale: Provides a more accurate assessment of the presence of tachycardia.
5. Auscultation of heart sounds, note the extra heart sounds, a gallop rhythm and a systolic murmur.
Rational: S1 and prominent murmur associated with cardiac output increased in hypermetabolic state, the S3 as a sign of possible heart failure.
6. ECG monitor, record and note the speed or rhythm of the heart and the presence of dysrhythmias.
Rational: Tachycardia is a direct reflection of the heart muscle stimulation by thyroid hormone, dysrhythmias are common and can harm cardiac function or cardiac output.
7. Auscultation breath sounds, note any abnormal noise.
Rationale: Early signs of lung congestion associated with the onset of heart failure.
8. Monitor temperature, provide a cool environment, limit the use of linens / clothing, compress with warm water.
Rationale: Fever occurs as a result of excessive levels of hormones can increase diuresis / dehydration and cause an increase in peripheral vasodilatation, venous buildup, and hypotension.
9. Observation of signs and symptoms of severe thirst, dry mucous membranes, weak pulse, slow capillary filling, decreased urine output, and hypotension.
Rationale: Dehydration can occur quickly which will reduce the volume of circulation and decrease cardiac output.
10. Record input and output, record the specific gravity of urine.
Rationale: Loss of fluid a lot (through vomiting, diarrhea, diuresis, diaphoresis) can cause severe dehydration, concentrated urine and weight loss.
11. Measure your weight every day, suggest bed rest, limit unnecessary activity.
Rationale: Activities will increase metabolic needs / circulation potentially heart failure.
12. Record a history of asthma / bronchoconstriction, pregnancy, sinus bradycardia / heart block which continues to be heart failure.
Rationale: 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 decreased pulse and blood pressure were drastic signs of vascular congestion / CHF, or cardiac arrest.
Rationale: An indication to decrease or discontinue therapy.
Collaboration
14. Give iv fluids as indicated.
Rationale: Giving fluids via iv quickly need to improve circulation volume but must be balanced with attention to signs of heart failure / need for inotropic agent administration.
15. Give O2 as indicated
Rationale: It may also be necessary to meet the increased metabolic demands / needs for oxygen.
