After noticing an older male adult's extremities are cool and the cardiac monitor is show-ing a heart rate of 120 bpm, the nurse determines that these findings warrant further in-vestigation

Question

Rank the patient parameters the nurse should examine to assess cardiac output in order, beginning 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
a. First, the nurse assesses the oxygen saturation (SaO2) because airway and breathing are the two most basic human needs on Maslow's Hierarchy of Human Needs. This is also the first step for this individual because hypoxemia can explain the cool extremities and tachycardia with an adequate cardiac output.
b. Third, the nurse examines the blood pressure because hypotension due to low cardiac out-put, with adequate oxygen and a regular heart rhythm, can explain cool extremities and tachycardia as the body tries to compensate by shunting blood to vital organs and increas-ing the heart rate.
c. Second, the nurse examines the heart's rhythm because, with adequate oxygenation, the cool extremities and increased heart rate can be explained by a low cardiac output due to a dysrhythmia. This is because the heart becomes an ineffective pump when it beats too quickly, too slowly, or in an irregular pattern.
d. Finally, the nurse examines the urine output to assess renal perfusion. With adequate oxy-genation and a regular heart rhythm, urine output will drop with a low cardiac output be-cause it decreases renal perfusion. The kidneys need a minimum systolic blood pressure of 80 mm Hg to produce urine.