Nursing Dx

Taxonomy II: Activity/Rest—Class 4 Cardiovascular/Pulmonary Responses (00029)
[Diagnostic Division: Circulation]
Submitted 1975; Revised 1996, 2000

Definition: Inadequate blood pumped by the heart to meet the metabolic demands of the body. [Note: In a hypermetabolic state, although cardiac output may be within normal range, it may still be inadequate to meet the needs of the body’s tissues. Cardiac output and tissue perfusion are interrelated, although there are differences. When cardiac output is decreased, tissue perfusion problems will develop; however, tissue perfusion problems can exist without decreased cardiac output.]

Related Factors
Altered heart rate/rhythm, [conduction]
Altered stroke volume: altered preload [e.g., decreased venous return]; altered afterload [e.g., systemic vascular resistance]; altered contractility [e.g., ventricular-septal rupture, ventricular aneurysm, papillary muscle rupture, valvular disease]

Defining Characteristics
SUBJECTIVE
Altered Heart Rate/Rhythm: Palpitations
Altered Preload: Fatigue
Altered Afterload: Shortness of breath/dyspnea
Altered Contractility: Orthopnea/paroxysmal nocturnal dyspnea
[PND]
Behavioral/Emotional: Anxiety
OBJECTIVE
Altered Heart Rate/Rhythm: [Dys]arrhythmias (tachycardia, bradycardia); EKG [ECG] changes
Altered Preload: Jugular vein distention (JVD); edema; weight gain; increased/decreased central venous pressure (CVP); increased/decreased pulmonary artery wedge pressure (PAWP); murmurs
Altered Afterload: Cold, clammy skin; skin [and mucous membrane] color changes [cyanosis, pallor]; prolonged capillary refill; decreased peripheral pulses; variations in blood pressure readings; increased/decreased systemic vascular resistance (SVR)/pulmonary vascular resistance (PVR); oliguria; [anuria]
Altered Contractility: Crackles; cough; cardiac output, 4 L/min; cardiac index, 2.5 L/min; decreased ejection fraction, stroke volume index (SVI), left ventricular stroke work index (LVSWI); S3 or S4 sounds [gallop rhythm]
Behavioral/Emotional: Restlessness