The nurse establishes a nursing diagnosis of Risk for alteration in cardiac output for the client who had back surgery 3 hours ago. Which is the best goal for the nurse to use with this client?

Question

1. Help the client to turn, cough, and deep breath.
2. Manage client's pain with morphine by mouth.
3. Cool the client's temperature with a cooling mat.
4. Maintain cardiac output with positive fluid balance.

Answer 1

1
1. The client at risk for an alteration in cardiac output is less likely to tolerate pulmo-nary edema or pneumonia because the heart will have a more difficult time compen-sating for a lower PaO2. In addition, the client is likely to have activity restrictions in the immediate postoperative period, increasing the risk for atelectasis, pneumonia, and impaired skin integrity, so the nurse helps the client to turn, cough, and deep breathe to promote re-expansion of the lungs, promote ventilation and gas exchange, mobilize pulmonary secretions to prevent pneumonia, and maintain oxygenation to the tissues.
2. The client at risk for alteration in cardiac output is more likely to have blood pres-sure changes than clients with normal hearts; for pain management, the client benefits from IV morphine because it easier to control. The client can receive small, frequent doses for pain instead of a single, large dose that is more likely to result in hy-potension. Also, the client benefits from the added control offered by a shorter acting opioid such as fentanyl (Sublimaze).
3. The client lacks an indication for a cooling mattress.
4. For the client at risk for alteration in cardiac output, maintaining a positive fluid balance increases the risk of fluid volume overload and can cause heart failure in the client until the fluid is removed