Susceptible to experiencing insufficient blood volume, pumped by the heart, to meet metabolic demands in individuals with cardiovascular and/or pulmonary conditions or trauma

• Average daily physical activity is less than recommended for age and gender
• Excessive accumulation of fat for age and gender
• Excessive alcohol consumption
• Excessive anxiety
• Excessive stress
• Inadequate arrhythmia treatment self-management
• Inadequate blood pressure self-management
• Inadequate caregiver knowledge of modifiable factors
• Inadequate diabetes self-management
• Inadequate knowledge of modifiable factors
• Inadequate vaccination
• Inappropriate dietary habits
• Inattentive to second-hand smoke
• Ineffective medication self-management
• Ineffective overweight self-management
• Left side position
• Prone position
• Substance misuse
• Tobacco use
• Unaddressed sleep deprivation

• Artificial respiration
• Cardiovascular diseases
• Cardiovascular surgery
• General anesthesia
• Hypoglycemia
• Hypoxia
• Increased metabolic rate
• Infections
• Obstructive sleep apnea
• Oxygen therapy
• Respiratory tract diseases
• Transplantation
• Uremia
• Water-electrolyte imbalance

• History of cardiac disorder
• Mental status, including orientation and level of consciousness (LOC)
• Cardiovascular status, including history of arrhythmias and syncope, valvular disorder, capillary heart disease, or myopathy; skin color, temperature, turgor, and capillary refill time; serum digoxin levels; jugular vein distention; hepatojugular reflux; heart rate and rhythm; heart sounds; blood pressure; peripheral pulses; electrocardiogram (ECG); exercise ECG; echocardiogram; and phonocardiogram
• Respiratory status, including respiratory rate and depth, breath sounds, chest x-ray, and arterial blood gas values
• Renal status, including weight, intake and output, urine specific gravity, and serum electrolytes

• Patient's pulse will be within normal limits.
• Patient's blood pressure will be within normal limits.
• Patient will not exhibit arrhythmias.
• Patient's skin will remain warm and dry.
• Patient will not exhibit pedal edema.
• Patient will show no signs of dizziness or syncope.
• Patient will experience few or no dyspneic episodes.
• Patient will not experience chest pain.
• Patient will express sense of physical comfort after activity.
• Patient will maintain adequate cardiac output.
• Patient will perform stress-reduction techniques.
• Patient will verbalize understanding of reportable signs and symptoms.
• Patient will verbalize understanding of diet, medication, and activity level on cardiac health.

Suggested NOC Outcomes

• Monitor and record LOC, heart rate and rhythm, and blood pressure and report any abnormal results. Changes from normal limits may indicate decreased cardiac output.
• Monitor patient for dyspnea, fatigue, crackles in lungs, jugular venous distention, or chest pain. Any or all of these may indicate impending cardiac failure or other complications. Report them immediately.
• Auscultate for heart and breath sounds. Report abnormal sounds as soon as they develop. Extra heart sounds may indicate early cardiac decompensation; adventitious breath sounds may indicate pulmonary congestion and diminished cardiac output.
• Measure and record intake and output accurately. Decreased urine output without lowered fluid intake might indicate decreased renal perfusion, possibly from decreased cardiac output.
• Promptly treat life-threatening arrhythmias, as ordered, to avoid crisis.
• Weigh patient daily before breakfast to detect fluid retention.
• Inspect for pedal or sacral edema to detect venous stasis and reduced cardiac output.
• Provide skin care as needed to enhance skin perfusion and venous flow.
• Maintain dietary restrictions, as ordered, to reduce risk of cardiac disease.
• Report complaints of dizziness or syncope promptly; these may indicate cerebral hypoxia resulting from a cardiac rhythm disturbance.
• Tell patient to report chest pain right away because it may signal myocardial hypoxia or injury.
• Teach patient stress-reduction techniques to reduce patient's anxiety and provide a sense of control.
• Explain all procedures and tests to enhance understanding and reduce anxiety.
• Teach patient and family about chest pain and other reportable symptoms, prescribed diet, medications (name, dosage, frequency, and therapeutic and adverse effects), prescribed activity level, simple methods for lifting and bending, and stress-reduction techniques. These measures involve patient and family in care.
• Administer oxygen, as prescribed, to increase supply to myocardium.

Suggested NIC Interventions

• Patient's pulse rate remains within set limits.
• Patient's blood pressure remains within set limits.
• Patient's cardiac output remains adequate.
• Patient doesn't exhibit arrhythmias during monitoring or physical examination.
• Patient's skin remains warm and dry to touch.
• Patient experiences fewer dyspneic episodes.
• Patient doesn't experience dizziness or syncope.
• Patient doesn't experience chest pain.
• Patient will not exhibit pedal edema.
• Patient doesn't indicate, either verbally or through behavior, chest pain, dyspnea, fatigue, or other forms of discomfort after activity.
• Patient performs stress-reduction techniques as needed.
• Patient describes signs and symptoms of decreased cardiac output, such as dizziness, syncope, clammy skin, fatigue, and dyspnea.
• Patient understands importance of diet, medications, and activity on cardiac health.

• Patient's needs and perception of problem
• Observations of physical findings
• Patient's response to activity
• Development of skills related to diet, medication, activity, and stress management
• Incidents of chest pain, including location, character, duration, and treatment
• Interventions to control or monitor symptoms and patient's response
• Patient teaching
• Evaluations for expected outcomes

• Bosch, L., Carluccio, E., Coiro, S., Gong, L., Sim, D., Yeo, D., … Ambrosio, G. (2017). Risk stratification of Asian patients with heart failure and reduced ejection fraction: The effectiveness of the Echo Heart Failure Score. European Journal of Heart Failure, 19(12), 1732-1735.
• Demissei, B. G., Cotter, G., Prescott, M. F., Felker, G. M., Filippatos, G., Greenberg, B. H., … Voors, A. A. (2017). A multimarker multi-time point-based risk stratification strategy in acute heart failure: Results from the RELAX-AHF trial. European Journal of Heart Failure, 19(8), 1001-1010.
• Eriksson, B., Wändell, P., Dahlström, U., Näsman, P., Lund, L. H., & Edner, M. (2018). Comorbidities, risk factors and outcome in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics. Scandinavian Journal of Primary Health Care, 36(2), 207-215.
• Papadaki, A., Martínez-González, M. Á., Alonso-Gómez, A., Rekondo, J., Salas-Salvadó, J., Corella, D., … Arós, F. (2017). Mediterranean diet and risk of heart failure: Results from the PREDIMED randomized controlled trial. European Journal of Heart Failure, 19(9), 1179-1185.