Ineffective Tissue Perfusion - Coronary Artery Disease Nursing Care Plans

Nursing Dx: Ineffective tissue perfusion r/t decreased cardiac output 

The oxygen content of arterial blood is almost all bound to hgb. In anemia, the oxygen content will therefore fall in proportion to the reduction in hgb concentration, even through the po2 is normal. The normal compensatory to restore oxygen delivery is an increase in cardiac output.
Assessment:

S oO the patient manifested the following: shortness of breath fatigue The pt. May manifest: pallor cool temperature decrease pulse decrease urine output

Short term:After 3 hours of ni, the pt. Will be able to demonstrate behaviors on how to have effective airways. 
Long term: After 1- 2 days of ni, the patient will free from shortness of breath.


Nursing Interventions:
Assess pt.’s condition.
                 to have base line data
 Monitor and record v/s.
                to get baseline data and this are usually altered in this condition
 Note color and temperature of the skin. 
              cool, pale skin is indicative of decrease peripheral tissue 
Monitor peripheral pulse. 
             decrease pulse is indicative of decreased tissue perfusion from vasoconstriction of the vessels.
Provide a warmth environment. 
            a warm environment promotes vasodilation which decreases preload and promotes tissue perfusion.
Encourage active ROM
          ROM helps decreases venous pooling and promotes tissue perfusion.
Monitor urine output.
         decreased tissue perfusion to the kidneys may result in oliguria.

Short term:The pt. Shall have demonstrated behaviors on how to have effective airways. 

Long term: The patient shall be free from shortness of breath.

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