After noticing an older man's extremities are cool and the cardiac monitor is showing a heart rate of 120 bpm, the nurse determines that these findings warrant further investigation

Question

Rank the pa-tient' parameters the nurse should examine to assess cardiac output in order of importance, be-ginning with the first assessment the nurse should complete. A. Hypoxemia B. Hypotension C. Irregular rhythm D. Low urine output

Answer 1

A, C, B, D
The nurse assesses the SaO2 because airway and breathing are the two most basic human needs on Maslow's Hierarchy of Human Needs. Assessing the SaO2 is also the first step for this indi-vidual because hypoxemia can explain the cool extremities and tachycardia with an adequate cardiac output. The nurse then examines the heart's rhythm; with adequate oxygenation, the cool extremities and increased heart rate can be explained by a low cardiac output as a result of dys-rhythmia; the heart becomes an ineffective pump when it beats too quickly, too slowly, or in an irregular pattern. Next, the nurse examines the blood pressure; hypotension as a result of low cardiac output and with adequate oxygen and a regular heart rhythm can explain the cool extrem-ities and tachycardia as the body tries to compensate by shunting blood to the vital organs and increasing the heart rate. Finally, the nurse examines the urine output to assess renal perfusion. With adequate oxygenation and a regular heart rhythm, urine output will drop with a low cardiac output because it decreases renal perfusion. The kidneys need a minimum systolic blood pressure of 80 mm Hg to produce urine.