Sample Care Plan Template Page 39
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51Nursing Diagnosis and Priority # 2:
Decreased cardiac output R/T altered heart rate and altered heart rhythm AEB patient on Levophed due to cardiogenic shock caused
by sedation medication, bradycardia, ECG changes with PVC/PAC, abnormal atrial blood gases values of 7.369, 101.7 (H), 57.8 (H),
32.6 (H), 6.2, & 97.4, BP 118/56 on Levophed, suspected alcoholic cardiomyopathy pending doctor interpretation of echocardiogram.
General Goal:
The patient will maintain a systolic blood pressure of 80-120 or 30-40 mm Hg below previous systolic.
Outcome Objective(s): (use SMART format)
1. During the nursing shift, the patient will demonstrate adequate cardiac output by maintaining a systolic BP between 80-120 mm Hg,
a pulse less than 110, and strong peripheral pluses while on Levophed.
2. The patient will remain free the following Levophed side effects during the nursing shift: Arrhythmias, decreased urine output,
hypertension, metabolic acidosis, and fever.
3. The patient will tolerate his sedation vacation trial this nursing shift so that he can be titrated off of the Levophed.
Patient Responses
Interventions with time frames/frequency
Rationale (for each intervention)
(subjective/objective data)
1) Observe the patient for signs of cardiogenic
1) The patient is at risk for cardiogenic
1) The patient did not experience
shock throughout the nursing shift. Cardiogenic
shock as long as he is on sedation
any signs of cardiogenic shock
shock signs are impaired mental status,
medications that require vasoactive
during the day of care and
hypotension with blood pressure lower than 90
medication management. Cardiogenic shock
maintained a systolic BP greater
mm Hg, decreased peripheral pulses, cold
is a state of circulatory failure and needs to
than 90.
clammy skin, signs of pulmonary congestion,
be recognized early and studies show these
and decreased organ function. Notify physician
signs are good indications for it (Oliva &
is signs on present (Ackley & Ladwig, 2011).
Monteiro da Cruz, 2003).
2) By following the doctor’s parameters for
2) The nurse will titrate the patients Levophed
2) The nurse was able to titrate the
patient’s Levophed dosage
within the define parameters to maintain
the Levophed the nurse ensures there is a
contractility, preload, and afterload per
good balance of the medication for
throughout the nursing shift to
physicians orders (Ackley & Ladwig, 2011).
stimulating the heart to increase
maintain the systolic BP between
contractility, while maintaining adequate
80-120 and pulse lower than 110 ;
perfusion of the body (Ackley & Ladwig,
except for sedation vacation.
2011).
F:\group\MEPN\MEPN Level III\NURS610B\2013NURS 610B\610BCarePlan
12/17/2012
page 19
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