Cardiomyopathy Nursing Care Plans Diagnosis and Interventions
Cardiomyopathy NCLEX Review and Nursing Care Plans
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 Diagnosis Cardiomyopathy
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.
|Cardiomyopathy Nursing Interventions||Rationales|
|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.|
Cardiomyopathy 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.
|Cardiomyopathy Nursing Interventions||Rationales|
|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.|
Cardiomyopathy Nursing Care Plan 3
Nursing Diagnosis: Activity Intolerance related to an imbalance between oxygen supply and demand secondary to cardiomyopathy as evidenced by displayed weakness, fatigue, changes in vital signs , and the presence of dysrhythmias.
Desired Outcome: The patient will be able to demonstrate an increase in activity tolerance, as shown by decreased fatigue and weakness and vital signs within acceptable levels during episodes of activity.
|Cardiomyopathy Nursing Interventions||Rationale|
|Assess the patient’s baseline vital signs before and after activity, especially when he receives medications such as vasodilators, beta-blockers, or diuretics.||Patients on vasodilators, beta-blockers, or diuretics are prone to develop orthostatic hypotension during activity by virtue of medication effect (vasodilation), shifting of body fluids (diuresis), or deviations in the cardiac pumping mechanism.|
|Record the cardiopulmonary response of the patient in relation to activity. Document for the presence of dysrhythmias, dyspnea, pallor, and diaphoresis during these activities.||The patient with cardiomyopathy and inefficient stroke volume capabilities during activity can cause a rapidly elevated heart rate and oxygen demands, therefore resulting in antagonizing weakness and undue fatigue.|
|Recognize factors that could influence the required activity level and patient motivation.||Risk factors such as age, pain levels, respiratory issues, impaired visual acuity, hearing deviations, functional decline, etc. can hinder methods of improving activity tolerance levels. The presence of fatigue can both affect the patient’s present and perceived ability to perform planned activities.|
|Record and assess the patient’s response to activities.||Vital signs are crucial in determining the overall health of the patient. The vital signs and oxygen saturation levels should be checked before, during, and immediately after each session to ensure compliance with the desired patient ranges. The heart rate is expected to return to the usual levels within 3 minutes after the desired activity. Once the patient can tolerate activity, utilize the obtained data to improve goals, therefore increasing the magnitude and extent of the activity gradually.|
|Assess the patient for increasing activity intolerance.||Increasing intolerance may mean elevating cardiac decompensation and not simply over-activity alone. Unexpected cardiac arrest during exercise is rare in healthy individuals. However, patients with preexisting cardiac issues are at a greater risk for a sudden heart attack during strenuous exercise when compared to otherwise healthy individuals. The healthcare provider’s role in recognizing early symptoms of cardiac compromise is crucial in reducing patient morbidity and mortality.|
|Help the patient in rendering self-care activities when needed. Allow for patient independence within the allowable limits.||Helping the patient in activities of daily living (ADL) will ensure that needs are met while reducing the patient’s effort that may otherwise compromise cardiac workload. As much as allowed and as tolerated, involve the patient in improving their sense of control and independence and reducing dependability to caregivers.|
|Sort out care activities in order to promote rest periods.||Scheduling activities accordingly with adequate rest periods can promote activity prioritization in order to address the patient’s personal needs without compromising cardiac health and increasing oxygen demand. Clustering nursing care ensures for an adequate recharge time for the patient for other activities set within the day.|
|Utilize a measured cardiac rehabilitation program.||A rehabilitation program guiedes the patient by improving cardiac function and health under stress in the presence of irreversible cardiac malfunction. Measured and unhurried increases in activity evade unwarranted myocardial effort and oxygen consumption. The perceived benefit of Increasing the patient’s activity performance by increasing training intensity from moderate to higher levels should be thoroughly evaluated when compared to the lack of advancement in cardiac health and elevated risk of untoward cardiac events.|
|Employ interventions that can safeguard patient safety and avoid injury risk during activity through the following: |
Aid in patient ambulation as needed.
Determine the patient’s ability to stand and move versus the degree of assistance needed, either with movement aids or tools.
Teach the patient some activities that may otherwise be unusual or foreign to the patient. Ensure to start the patient on warm-up exercises and end with cool-down exercises.
Avoid doing any activity in extreme temperatures. Employ a 2-hour rest after having meals before performing activities.
|The various pointers while assisting the patient in doing their personal activities are tailored to prevent unwarranted injury and reduce the risk for a patient with activity intolerance due to pre-existing cardiac conditions (i.e., cardiomyopathy.)|
|Motivate the patient to keep a positive outlook; give progress notes daily or weekly for the patient to see.||Promoting a positive outlook helps the patient in realizing that the road o recovery is attainable. Letting them know the progress made, no matter how small, will increase their sense of well being and minimize frustrations from setbacks in health.|
Cardiomyopathy Nursing Care Plan 4
Nursing Diagnosis: Excess Fluid Volume related to reduced glomerular filtration rate and decreased cardiac output secondary to cardiomyopathy as evidenced by oliguria, presence of edema, jugular vein distention , and positive hepatojugular reflex.
Desired Outcome: The patient will be able to show stabilized fluid volume, achieve balanced intake and output, clearing of breath sounds, vital signs within acceptable limits, maintain stable weight, and regression of edema.
|Cardiomyopathy Nursing Interventions||Rationale|
|Take note of the patient’s urine output, including the amount, color, and the time and frequency of urination occurs.||Patients with cardiomyopathy have compromised kidneys due to the reduction of the heart’s cardiac output, therefore making the heart incapable of sustaining renal health and function. Because of this, urine output may be concentrated and scanty during the day. Because lying in bed (i.e., recumbence) promotes diuresis, increased urine output is noted at night or on periods of bed rest.|
|Measure and take note of the 24-hour intake and output balance of the patient.||Achieving a balanced intake and output will ensure that therapy for cardiomyopathy is addressing the condition adequately. However, diuretics may abruptly increase fluid loss (i.e., circulating hypovolemia) even in the presence of edema or the ascites remaining.|
|Utilize a fluid intake schedule, especially if fluids are restricted for the patient. Ensure to incorporate patient beverage preferences as much as possible. Render frequent oral hygiene. Consider including ice chips in the fluid allowance of the patient.||Active involvement of the patient with beverage choices and the prescribed fluid restriction enables the patient to achieve a sense of control. Furthermore, it also promotes patient cooperation to the restrictive aspect of fluid allowance, as part of the therapeutic management for cardiomyopathy-induced fluid excess.|
|Ensure to take daily weights of the patient. Constantly observe the patient’s blood urea nitrogen, creatinine, serum potassium, chloride, magnesium, and sodium values.||Daily weights are an effective method for determining changes in the patient’s overall available body fluid volume. It also assists in determining changes in edema as a response to therapy. However, the use of diuretics can promote excess elimination and unstable fluid shifts that may result in unnecessary weight loss. Taking note of serum electrolyte levels is necessary to prevent electrolyte imbalances that may have repercussions on the patient’s overall health.|
|Evaluate the patient for distended neck and peripheral vessels. Examine dependent areas for the presence of edema, especially pitting edema. Watch out for the presence of anasarca (i.e., generalized body edema).||Too much fluid retention in the body can manifest by venous engorgement and the formation of edema. The ankles and feet are prone to developing peripheral edema, which may otherwise ascend as the condition worsens. Take note that pitting edema happens when there is fluid retention of at least 10 lbs. Elevating vascular congestion will consequently and slowly result to systemic edema (anasarca).|
|Ensure that the patient complies with a low sodium diet regimen and fluid allocation as medically indicated.||The patient is prone to feeling thirsty because of the nature of the fluid shifts in the body. Rendering oral care may alleviate thirst without compromising the patient’s fluid allowance. Maintaining a low sodium diet prevents unnecessary fluid losses and third space shifting in the interstitial spaces. Following a fluid allocation, regimen prevents unwarranted excesses that may collect as edema.|
|Assist the patient with frequent position changes. Raise the feet when sitting. Ensure and maintain skin integrity by frequently assessing the skin, keeping it dry, and providing support and padding as necessary.||Patients with compromised kidneys, due to cardiomyopathy, will often have slowed circulation, edema formation, altered nutritional intake, and extended immobility that when accumulated would cause undue stress to the integumentary. The patient at risk for altered skin integrity would need closer supervision and preventive measures to avoid untoward complications.|
|Employ the assistance of a dietitian.||The dietitian will be helpful in formulating an applicable meal plan for the patient without compromising the caloric and dietary needs despite the sodium and fluid restrictions.|
|Check and assess the patient’s chest x-rays as indicated.||Chest x-rays are initial diagnostic tools utilized in recognizing changes in the patient’s lungs. It can also assist the healthcare team monitor for the progression or regression of pulmonary congestion that could trigger changes in the therapeutic regimen of the patient.|
|Anticipate assisting with phlebotomy, tourniquet application, or dialysis as ordered.||Patients with overwhelming fluid excess that is not responsive to medical therapy may need mechanical removal through dialysis or ultrafiltration. The edematous patient usually is considered a difficult IV insertion due to the presence of excess fluid in the body.|
Cardiomyopathy Nursing Care Plan 5
Nursing Diagnosis: Ineffective Tissue Perfusion related to decreased cardiac output secondary to cardiomyopathy as evidenced by generalized weakness, chest pain, dysrhythmias, compromised breathing, altered vital signs, and the presence of pitting edema on the patient’s limbs.
Desired Outcome: The patient will be able to show improvement in his/her vital signs reaching the acceptable limits, the absence or control of dysrhythmias, and the improvement of edema on the limbs.
|Cardiomyopathy Nursing Interventions||Rationale|
|Evaluate the patient’s pain by taking note of the intensity, pain rating, location and precipitating factors.||Recognizing the characteristics of pain will enable the healthcare team in formulating an accurate diagnosis that is needed to immediately address the patient’s care needs.|
|Observe and record the patient’s vital signs, especially the heart rate and blood pressure, every 5 minutes until the pain minimizes.||Hypertension and tachycardia can appear, together with angina, as a means of the body compensating for the stressors experienced associated with cardiomyopathy as a reflection of sympathetic nervous system stimulation.|
|Evaluate the patient’s vital signs, especially the blood pressure and heart rate.||Obtaining a baseline assessment of the vital signs is crucial in determining and detecting sudden changes that may indicate improvement or degradation in the cardiac output or perfusion status of the patient.|
|Evaluate the cardiac-specific markers – creatinine phosphokinase, total LDH, LDH-1, LDH-2, troponnin, CK-MB and myoglobin as ordered by the doctor.||The mentioned enzymes are released by the body as a response to the cardiac injury or infarct experienced. They may be elevated at different times; thus it is necessary that they are monitored accurately in order to assist in ruling out myocardial infarction as the reason for chest pain.|
|Observe and take note of the patient’s cardiac rhythms by placing the patient on the telemetry and readings of the 12 lead electrocardiogram.||The presence of abnormal rhythms may indicate cardiac compromise that would indicate ischemia, thus necessitating immediate medical interventions.|
|Anticipate administration of vasodilators as ordered.||Vasodilators improve the circulation of blood towards the heart. It also minimizes the amount of blood return to the patient’s heart, thereby reducing both the preload and workload.|
|Administer beta-blockers as ordered and indicated.||Beta-blockers are effective medications in cardiomyopathy due to their action on the heart. They act by reducing the oxygen needs of the heart, and are given for future angina recurrence.|
|Render oxygen supplementation and monitor oxygen saturation levels through pulse oximetry, as indicated.||Oxygenation is often compromised in patients with cardiomyopathy. Giving supplemental oxygen increases the oxygen supply of the body that can decrease myocardial pain and demands.|
|Instruct the patient on relaxation methods and other techniques to reducing undue stress.||Pain associated with angina can sometimes occur due to emotional stress. Employing relaxation techniques, such as deep breathing exercises, can relieve these by non-pharmacological means.|
|Educate the patient on the difference between angina and myocardial infarction manifestations.||Some cases of chest pain may become more dreadful when compared to stable angina. The patient should understand how to distinguish one from another and seek immediate and timely medical care.|
More Cardiomyopathy Nursing Diagnosis
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. (2022). 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. (2020). 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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