NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00029 |
|---|---|
| Label | Decreased cardiac output |
| Spanish label | Disminución del gasto cardíaco |
| Domain | 4. Activity / rest |
| Class | 4. Cardiovascular / pulmonary responses |
| Type | Problem-focused |
| Status | Retired in 2024-2026 |
What changed in 2024-2026
In the 2024-2026 edition, 00029 is no longer listed as a current diagnosis and has no replacement code. Many instructors considered it a collaborative problem, because its causes (heart rate, rhythm, preload, afterload and contractility) are managed mainly by the medical team. If your program uses the 2024-2026 edition, address the patient's responses with current diagnoses: Excessive fluid volume (00026), Decreased activity tolerance (00298), Ineffective health self-management (00276) or, if there are no signs yet, Risk for decreased cardiac output (00240). If your program uses the previous edition, 00029 is still valid.
What it means
The heart ejects less blood per minute than the tissues need. It shows in blood pressure, pulses, skin, urine output, breathing and mental status. It is usually caused by a heart rate that is too fast, too slow or irregular, weak contraction or altered filling volume.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Acute decompensated heart failure.
- Acute myocardial infarction with signs of poor perfusion.
- Hemodynamically significant arrhythmias: atrial fibrillation with rapid ventricular response, symptomatic bradycardia.
- After cardiac surgery.
- Severe valve disease or hypertensive crisis with left ventricular failure.
What to assess
- Heart rate and rhythm on the monitor; simultaneous apical and radial pulses if there is an arrhythmia.
- Blood pressure and mean arterial pressure: below 65 mmHg, organs receive too little blood.
- Respiratory rate, SpO2, orthopnea and crackles on auscultation.
- Peripheral pulses, capillary refill, skin temperature and color.
- Hourly urine output: less than 0.5 mL/kg/h for several hours is a red flag.
- Daily weight, edema and jugular venous distension.
- Mental status: new restlessness, confusion or drowsiness.
- Activity tolerance: changes in heart rate, blood pressure and dyspnea with movement.
Defining characteristics
Assessment findings that support the diagnosis. They go in the "as evidenced by" part of the statement.
- Resting heart rate above 100 bpm or a new arrhythmia.
- Systolic blood pressure low for the patient or a narrow pulse pressure.
- Weak peripheral pulses and capillary refill longer than 3 seconds.
- Cool, pale or mottled, diaphoretic skin.
- Urine output below 0.5 mL/kg/h.
- Dyspnea, orthopnea and bilateral basilar crackles.
- Weight gain and leg edema.
- Jugular venous distension.
- Fatigue with minimal exertion.
- Restlessness, confusion or drowsiness with no other cause.
- S3 heart sound on auscultation.
- Reduced ejection fraction on echocardiogram.
Related factors
The causes nursing can act on. They go in the "related to" part of the statement.
- Sodium and fluid intake above the prescribed limit.
- Not following the prescribed treatment at home.
- Physical activity beyond what the heart tolerates during the acute phase.
- Lying flat, which worsens dyspnea.
- Uncontrolled pain and anxiety, which speed up the heart rate.
- Straining at stool due to constipation.
At-risk populations
- Older adults.
- People with ischemic heart disease or long-standing hypertension.
- Patients recovering from cardiac surgery.
- Patients in the ICU or cardiac care unit.
Associated conditions
- Heart failure.
- Acute myocardial infarction.
- Arrhythmias.
- Valvular heart disease.
- Cardiomyopathies.
- Cardiac surgery.
How to write it (PES)
Decreased cardiac output related to altered contractility and increased preload as evidenced by heart rate of 112 bpm, blood pressure of 94/60 mmHg, capillary refill of 4 seconds, urine output of 20 mL/h for 3 hours, bilateral basilar crackles and orthopnea.
Decreased cardiac output (00029).
For this diagnosis the etiology is usually physiological: heart rate or rhythm, preload, afterload or contractility. That is one reason it is viewed as a collaborative problem.
The low-output findings you measured: heart rate, blood pressure, capillary refill, urine output, lung sounds, mental status.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Within the first 24 hours, mean arterial pressure stays at 65 mmHg or higher and heart rate between 60 and 100 bpm.
- Within 24 hours, urine output is at least 0.5 mL/kg/h.
- Within 48 hours, capillary refill is under 3 seconds and the patient is alert and oriented.
- Within 72 hours, crackles decrease and the patient rests with the head of the bed at 30-45° without dyspnea.
- Before discharge, the patient walks in the room without dyspnea and with a heart rate increase of less than 20 bpm over baseline.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Monitor rhythm, heart rate, blood pressure and SpO2 continuously or per unit protocol. | Changes in these numbers are the first sign of improvement or deterioration. |
| Place the patient in Fowler's or semi-Fowler's position. | Reduces venous return and eases breathing when there is pulmonary congestion. |
| Give oxygen as prescribed to keep SpO2 at the ordered target. | Compensates for reduced oxygen delivery to the tissues. |
| Keep strict I&O, hourly urine output and a daily weight before breakfast on the same scale. | Urine output reflects renal perfusion, and weight shows whether treatment is removing fluid. |
| Give prescribed medications and monitor the response: blood pressure before vasodilators, urine output and potassium with diuretics, heart rate with antiarrhythmics. | Allows early detection of hypotension, electrolyte imbalances or bradycardia. |
| Cluster care and protect rest periods during the acute phase. | Reduces myocardial oxygen demand. |
| Prevent constipation and teach the patient not to strain at stool. | Straining causes sudden changes in heart rate and venous return. |
| Manage pain and anxiety. | Both speed up the heart and increase its oxygen consumption. |
| Notify the provider immediately if systolic pressure drops below 90 mmHg, urine output falls, or confusion or chest pain appears. | These signal that low cardiac output is progressing toward shock. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0400Cardiac Pump Effectiveness
- 0401Circulation Status
- 0405Tissue Perfusion: Cardiac
NIC interventions
- 4044Cardiac Care: Acute
- 4254Shock Management: Cardiac
- 6680Vital Signs Monitoring
- 4210Invasive Hemodynamic Monitoring
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Decompensated heart failure in the cardiac care unit
Patient. Jorge, 68, has a prior MI and heart failure with an ejection fraction of 30%. He is admitted to the cardiac care unit for dyspnea at rest that has worsened over 3 days.
Assessment
- Heart rate 112 bpm in sinus rhythm; blood pressure 94/60 mmHg (MAP 71 mmHg).
- Respiratory rate 26 breaths/min and SpO2 89% on room air.
- Bilateral basilar crackles and orthopnea: he can't tolerate the head of the bed below 45°.
- Capillary refill 4 seconds; hands and feet cool and pale.
- Urine output 20 mL/h for 3 hours, weight 78 kg.
- Jugular venous distension at 45°.
- He is restless and asks several times where he is.
Nursing diagnosis
Decreased cardiac output related to altered contractility and increased preload as evidenced by heart rate of 112 bpm, blood pressure of 94/60 mmHg, capillary refill of 4 seconds, urine output of 20 mL/h for 3 hours, bilateral basilar crackles and orthopnea.
Goal
Within 24 hours, Jorge maintains a mean arterial pressure of 65 mmHg or higher and urine output of at least 40 mL/h, and is oriented.
Interventions
- Continuous monitoring of rhythm, blood pressure and SpO2.
- Fowler's position and prescribed oxygen to the ordered SpO2 target.
- Indwelling urinary catheter for hourly output and strict I&O.
- Give prescribed medications while monitoring blood pressure and potassium.
- Clustered care and bed rest for the first 24 hours.
- Notify the provider immediately if systolic pressure drops below 90 mmHg or urine output doesn't improve.
Evaluation
At 24 hours blood pressure is 104/66 mmHg, heart rate 94 bpm and average urine output 55 mL/h. He is oriented and capillary refill is 3 seconds. Basilar crackles persist, so the diagnosis stays active and is reassessed every shift. If your program uses the 2024-2026 edition, this same case is worked up with Excessive fluid volume (00026).
How it differs from similar diagnoses
- Risk for decreased cardiac output (00240): Risk for decreased cardiac output: used when there are no signs of low output yet. It remains current in the 2024-2026 edition data.
- Excessive fluid volume (00026): Excessive fluid volume: focuses on fluid overload (weight, edema, crackles). It is the most widely used current option for heart failure.
- Decreased activity tolerance (00298): Decreased activity tolerance: focuses on fatigue and an abnormal response to exertion.
- Ineffective peripheral tissue perfusion (00204): Ineffective peripheral tissue perfusion: the poor circulation is in the extremities, not in the heart's pumping.
Common mistakes
- Still using 00029 in an assignment that requires the 2024-2026 edition without checking with your instructor.
- Confusing it with excessive fluid volume: edema alone does not prove low cardiac output.
- Writing "related to heart failure": that is the medical condition, not the etiology of the diagnosis.
- Writing goals without blood pressure, heart rate or urine output values.
- Not measuring hourly urine output in a patient with signs of low output.
Other diagnoses in the Cardiovascular / pulmonary responses class
Domain 4, Activity / rest. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for decreased cardiac output?
00029, in Domain 4 (Activity/rest), Class 4 (Cardiovascular/pulmonary responses). In the 2024-2026 edition it is listed as retired.
What nursing diagnosis replaces decreased cardiac output in 2024-2026?
It depends on what predominates: Excessive Fluid Volume (00026) if there is fluid overload, Decreased activity tolerance (00298) if exertion is the problem, Ineffective Health Self-Management (00276) if the decompensation comes from how the condition is managed at home.
Can I still use decreased cardiac output in my care plan?
Yes, if your program or hospital works with the previous edition. For assignments that require the 2024-2026 edition, ask your instructor or use the current diagnoses.
What's the difference between decreased cardiac output and excessive fluid volume?
Cardiac output is about what the heart pumps; excessive fluid volume is about how much fluid is in the body. A patient can have edema with good cardiac output, or low output without edema.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Decreased cardiac output (00029) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1. Reviewed November 2, 2026.