Cardiomyopathy NCLEX Review Care Plans
Nursing Study Guide on Cardiomyopathy
Cardiomyopathy refers to the disease of the heart muscle known as the myocardium. This condition causes difficulties in the heart’s ability to pump blood in different areas of the body.
Cardiomyopathy can lead to enlargement of the heart muscle, irregular heart rhythm, and even heart failure.
The treatment of cardiomyopathy depends on the severity of the disease and often involves medication therapy and surgery.
The treatment for cardiomyopathy aims to manage symptoms, avoid further complication, and prevent the disease from worsening.
The treatment may include medications, implants, surgery, and non-surgical intervention.
Changes in lifestyle is also beneficial in management of symptoms and prevention of complications.
Types of Cardiomyopathy
Cardiomyopathy can affect all age groups but there are certain individuals who are more vulnerable to certain types of cardiomyopathy.
The types of cardiomyopathy are:
- Dilated cardiomyopathy – the dilation of the left ventricle
- Hypertrophic cardiomyopathy – the abnormal thickening of the myocardium
- Restrictive Cardiomyopathy – the decreased elasticity and increased rigidity of the myocardium, causing its failure to be filled with blood in between heartbeats
- Arrhythmogenic right ventricular dysplasia – a scar tissue replaces the muscle in the right ventricle; rare type of cardiomyopathy that is usually due to genetic mutations
- Unclassified cardiomyopathy – any type of cardiomyopathy that does not fall into the above types
Signs and Symptoms of Cardiomyopathy
Patients tend to be asymptomatic during the early stage of cardiomyopathy, but as the disease progresses, the following signs and symptoms may appear:
- Dyspnea upon exertion and at rest
- Swelling of the lower extremities such as the legs, ankles, and feet
- Coughing while lying down
- Rapid, pounding, or fluttering heartbeat
- Chest discomfort
- Temporary loss of consciousness
- Abdominal bloating
- Jugular vein distention
- Arrhythmias or irregular heartbeat
- Chest pain after physical exertion or heavy meals
- Heart murmurs
These signs and symptoms may get worse if left untreated, and the worsening of the condition also varies per individual.
As cardiomyopathy worsens, signs and symptoms of heart failure may be observed.
Causes and Risk Factors of Cardiomyopathy
Cardiomyopathy is a condition that pertains to the disease of the heart muscles caused by heart valve problems, tissue damage and other conditions.
This results in the enlargement or thickening of the myocardium, which can eventually weaken the heart and disable it to pump adequate blood – a condition known as heart failure.
Arrythmias due to difficulties in sustaining a normal electrical rhythm are also associated with cardiomyopathy.
The cause of cardiomyopathy is often unknown, but it can also be acquired or inherited in some cases.
Although this disease can affect all races, gender and age groups, there are certain types of cardiomyopathy that are more prevalent in men and younger adults.
The following are risk factors that can increase the likelihood of acquiring cardiomyopathy:
- Family history of cardiomyopathy or its complications such as heart failure and cardiac arrest
- Long term hypertension
- Heart attack
- Chronic tachycardia
- Heart valve problems
- Metabolic disorders like diabetes and thyroid problems
- Nutritional deficiencies such as Thiamin deficiency
- Heart infections
- Cocaine use and chronic alcohol consumption
- Radiation therapy
- Certain medications use for chemotherapy
- Other conditions that can cause heart problems such as hemochromatosis (excessive iron), sarcoidosis (formation of granulomas), and amyloidosis (excessive protein buildup)
Complications of Cardiomyopathy
- Heart failure. The heart muscle becomes weaker in cardiomyopathy, making the heart incapable of pumping adequate amount of blood to the rest of the body. This condition can be life threatening if not properly treated.
- Thrombosis. Clot formation happens when the heart is unable to pump blood efficiently. The clots can pass through the bloodstream and obstruct blood circulation to vital organs such as the heart and brain.
- Valve problems. Heart enlargement brought about by cardiomyopathy can cause the valves of the heart to not close smoothly, leading to regurgitation of blood.
- Cardiac arrest and sudden death. This can be a result of irregular, abnormal heart rhythm, or when the heart stops beating completely.
Diagnosis of Cardiomyopathy
- Physical examination and history taking
- Blood tests – Certain blood tests may be done to assess organ function. B-type natriuretic peptide (BNP) levels in the blood may also be examined to check for heart failure
- Treadmill stress test – used to assess exercise capacity and to check if exercise triggers abnormalities in heart rhythm
- Cardiac catheterization – an invasive procedure that checks for any obstruction or blockage in the heart and blood vessels
- Chest X-ray
- Electrocardiogram (ECG)
- Cardiac MRI
- Cardiac CT scan
- Genetic testing or screening
Treatment for Cardiomyopathy
Medications. The doctor may prescribe the following medications to lower the heart rate, regulate the blood pressure, maintain fluid balance, get rid of excess body fluid, prevent clot formation and reduce inflammation. It is important to discuss any adverse effects with the physician.
Angiotensin-converting enzyme (ACE) inhibitors – promote vasodilation of the blood vessels, lowering the pressure and improving the blood flow
Beta blockers – reduce heart rate and blood pressure
Calcium channel blockers – reduce blood pressure; usually used in hypertrophic cardiomyopathy
Angiotensin II receptor blockers – similar to ACE inhibitors and can be used if the patient does not tolerate ACE inhibitors
Anti-arrhythmic, usually digitalis or digoxin – improves the contraction of heart muscles, regulate heart rhythm and reduces heartbeat
Inotropes – improve the function of the heart to pump blood in severe heart failure
Diuretics – facilitate elimination of excess fluid in the body through urination
Anti-coagulants – prevent clot formation
Anti-inflammatory drugs – reduce inflammation
Electrolytes – maintain fluid and electrolyte balance; treat hypocalcemia which is common in cardiomyopathy patients
Implant devices. There are different implant devices that can be surgically inserted to relieve symptoms and improve cardiac function.
Implantable cardioverter-defibrillator (ICD) – a device that monitors for any abnormalities in heart rhythm and delivers electric shock if necessary.
Ventricular assist device (VAD) – helps control blood circulation in the heart
Pacemaker -a small device that uses electric impulse to regulate heart rhythm
Ablation. Non-surgical procedures used in the treatment of cardiomyopathy include:
Septal ablation – the portion of the heart with thickened muscle is destroyed, though the use of injecting ethanol via catheterization; destruction of the affected heart muscles improves blood circulation in the heart
Radiofrequency ablation – a catheter with electrodes is inserted through the blood vessels to correct abnormal heart rhythm
Septal myomectomy. It is an open-heart procedure that involves the removal of the thickened septum which improves coronary circulation. This surgery is recommended for younger age groups and those who are not responding well to medication therapy.
Nursing Care Plans for Cardiomyopathy
Nursing Care Plan 1
Nursing Diagnosis: Decreased Cardiac Output related to damaged heart muscle as evidenced by irregular heartbeat, heart rate of 128, dyspnea upon exertion, and fatigue.
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Assess the patient’s vital signs and characteristics of heartbeat at least every 4 hours. Assess breath sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds of crackles/rales are important signs of heart failure which is a complication of cardiomyopathy. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer the cardiac medications, and diuretics as prescribed.||To alleviate the symptoms of cardiomyopathy and to treat the underlying condition.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target range.|
|Prepare the patient for implant device procedure, ablation, or surgery as discussed with the physician and the multi-disciplinary team.||To orient and support the patient and his/her family regarding the peri-operative process of treating cardiomyopathy or the non-surgical ablation treatment.|
|Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels.|
Nursing Care Plan 2
Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to increased left ventricular pressure as evidenced by shortness of breath, SpO2 level of 85%, and crackles upon auscultation.
Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.
|Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value within the target as set by the physician.|
|Encourage small but frequent meals. He||To avoid abdominal distention and diaphragm elevation which lead to a decrease in lung capacity.|
|Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.||Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Other nursing diagnoses:
- Excess Fluid Volume
- Deficient Knowledge
- Acute Pain
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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