Myocarditis is an inflammation of the heart muscle (myocardium) that can affect heart function. Understanding the nursing diagnosis for myocarditis is crucial for providing effective care to patients with this condition.
Causes (Related to)
Myocarditis can result from various factors leading to heart muscle inflammation. The following are common causes of myocarditis:
- Viral infections
- Bacterial infections (Streptococcus, Staphylococcus)
- Fungal infections
- Parasitic infections
- Autoimmune diseases (lupus, rheumatoid arthritis)
- Toxic substances
- Radiation therapy
- Chemotherapy drugs
Signs and Symptoms (As evidenced by)
Myocarditis can present with a variety of signs and symptoms. During a physical assessment, a patient with myocarditis may present with one or more of the following:
Subjective: (Patient reports)
- Chest pain or pressure
- Shortness of breath, especially with exertion
- Fatigue
- Palpitations
- Dizziness or lightheadedness
- Fever
- Flu-like symptoms (in viral myocarditis)
Objective: (Nurse assesses)
- Tachycardia or bradycardia
- Irregular heart rhythm
- Elevated body temperature
- Edema (particularly in lower extremities)
- Decreased oxygen saturation
- Abnormal heart sounds (e.g., S3 gallop, friction rub)
- Hypotension
- Cyanosis
- Elevated cardiac enzymes (e.g., troponin, CK-MB)
- ECG changes (e.g., ST-segment elevation, T-wave inversion)
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for patients with myocarditis:
- The patient will report reduced chest pain and discomfort
- The patient will demonstrate improved cardiac function as evidenced by stable vital signs
- The patient will maintain adequate tissue perfusion
- The patient will show no signs of heart failure or cardiogenic shock
- The patient will verbalize understanding of the disease process and management strategies
- The patient will adhere to the prescribed medication regimen and follow-up care
- The patient will demonstrate improved exercise tolerance without excessive fatigue or shortness of breath
Nursing Assessment
The nursing assessment is crucial for identifying the severity of myocarditis and guiding appropriate interventions. Here are some aspects of the nursing assessment for patients with myocarditis:
- Monitor vital signs
Check and record blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation regularly. Changes in these parameters can indicate a worsening of the condition or response to treatment. - Perform cardiovascular assessment
Assess heart sounds, rhythm, and rate. Listen for any abnormal heart sounds such as S3 gallop or friction rub. Evaluate peripheral pulses and capillary refill time. - Assess respiratory status
Monitor respiratory rate, depth, and pattern. Assess for any signs of respiratory distress, such as using accessory muscles or nasal flaring. - Check for edema
Assess for peripheral edema, especially in the lower extremities. Note the degree and location of any swelling. - Evaluate pain
Assess the character, location, duration, and intensity of any chest pain or discomfort using a standardized pain scale. - Monitor fluid balance
Keep accurate intake and output records. Assess for signs of fluid overload or dehydration. - Review laboratory results
Monitor cardiac enzymes (troponin, CK-MB), inflammatory markers (ESR, CRP), and other relevant blood tests as ordered. - Evaluate ECG findings
Review ECG results for any changes indicative of myocarditis, such as ST-segment elevation or T-wave inversion. - Assess activity tolerance
Evaluate the patient’s ability to perform activities of daily living and note any limitations or exacerbation of symptoms with activity. - Assess psychological status
Evaluate the patient’s emotional state, level of anxiety, and understanding of the condition. Assess for any signs of depression or fear related to the diagnosis.
Nursing Interventions
Nursing interventions play a crucial role in managing patients with myocarditis. Here are key interventions to implement:
Provide continuous cardiac monitoring
Maintain continuous ECG monitoring to detect any arrhythmias or changes in cardiac function promptly.
Administer medications as prescribed
Provide medications as ordered, which may include:
- Anti-inflammatory drugs
- Antiviral medications (if viral etiology is suspected)
- Antibiotics (if bacterial infection is present)
- Diuretics (to manage fluid overload)
- Antiarrhythmic drugs (if needed)
- Pain relievers
Manage pain and discomfort
Administer pain medication as prescribed and use non-pharmacological pain management techniques such as positioning and relaxation exercises.
Implement oxygen therapy
Provide supplemental oxygen as needed to maintain adequate oxygenation. Monitor oxygen saturation levels closely.
Promote rest and limit activity.
Encourage bed rest during the acute phase of illness. Gradually increase activity as tolerated and as directed by the healthcare team.
Monitor fluid balance
Administer IV fluids as prescribed and monitor for signs of fluid overload or dehydration. Maintain accurate intake and output records.
Provide emotional support
Offer reassurance and emotional support to the patient and family. Address any concerns or fears they may have about the condition.
Educate the patient and family.
Provide information about myocarditis, its management, and potential complications. Teach about medication regimen, activity restrictions, and follow-up care.
Implement infection control measures.
Follow standard precautions and any additional isolation measures if an infectious cause is suspected.
Prepare for potential complications.
Be prepared to respond to potential complications such as heart failure, arrhythmias, or cardiogenic shock. Have emergency equipment readily available.
Collaborate with the healthcare team.
Work closely with cardiologists, infectious disease specialists, and other healthcare providers to ensure comprehensive care.
Monitor for signs of improvement or deterioration.
Regularly assess for changes in the patient’s condition and promptly report any significant findings to the healthcare team.
Nursing Care Plans
Here are five detailed nursing care plans for patients with myocarditis:
Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis: Decreased Cardiac Output related to inflammation of the myocardium secondary to myocarditis as evidenced by tachycardia, fatigue, and decreased exercise tolerance.
Related factors/causes:
- Inflammation of the heart muscle
- Reduced contractility of the myocardium
- Alterations in preload and afterload
Nursing Interventions and Rationales:
- Monitor vital signs, especially heart rate and blood pressure, every 2-4 hours or as ordered.
Rationale: Changes in vital signs can indicate worsening cardiac function or response to treatment. - Assess for signs of decreased tissue perfusion (e.g., cool extremities, decreased urine output, altered mental status).
Rationale: These signs can indicate inadequate cardiac output and need for immediate intervention. - Position the patient in a semi-Fowler’s position unless contraindicated.
Rationale: This position can help reduce cardiac workload and improve oxygenation. - Administer medications as prescribed (e.g., inotropes, diuretics).
Rationale: These medications can help improve cardiac contractility and manage fluid balance. - Implement oxygen therapy as ordered and monitor oxygen saturation.
Rationale: Supplemental oxygen can help improve tissue oxygenation in the face of decreased cardiac output.
Desired Outcomes:
- The patient will demonstrate improved cardiac output as evidenced by stable vital signs within normal limits.
- The patient will report decreased fatigue and improved exercise tolerance within 48 hours.
- The patient will maintain adequate tissue perfusion as evidenced by warm extremities and urine output >30 mL/hour.
Care Plan 2: Acute Pain
Nursing Diagnosis: Acute Pain related to inflammation of the myocardium secondary to myocarditis as evidenced by patient’s report of chest pain rated 7/10 and guarding behavior.
Related factors/causes:
- Inflammation of the heart muscle
- Stretching of the pericardium
- Reduced blood flow to the myocardium
Nursing Interventions and Rationales:
- Assess pain characteristics (location, intensity, duration, quality) every 2-4 hours and as needed.
Rationale: Regular pain assessment helps evaluate the effectiveness of pain management strategies. - Administer analgesics as prescribed and evaluate their effectiveness.
Rationale: Pain management can reduce myocardial oxygen demand and improve patient comfort. - Provide non-pharmacological pain relief measures (e.g., relaxation techniques, positioning).
Rationale: These measures can complement medication and enhance overall pain management. - Monitor for signs of pain relief or exacerbation and report significant changes to the healthcare provider.
Rationale: Prompt reporting of changes in pain status can lead to timely adjustments in the pain management plan. - Educate the patient about pain management strategies and the importance of reporting pain.
Rationale: Patient education promotes active participation in pain management and timely intervention.
Desired Outcomes:
- The patient will report pain level reduced to 3/10 or less within 4 hours of intervention.
- The patient will demonstrate the use of non-pharmacological pain relief techniques.
- The patient will verbalize understanding of pain management strategies.
Care Plan 3: Activity Intolerance
Nursing Diagnosis: Activity Intolerance related to imbalance between oxygen supply and demand secondary to myocarditis as evidenced by excessive fatigue and shortness of breath with minimal exertion.
Related factors/causes:
- Decreased cardiac output
- Compromised oxygen delivery to tissues
- Inflammatory process affecting the myocardium
Nursing Interventions and Rationales:
- Assess the patient’s activity tolerance using a standardized scale (e.g., Borg Scale of Perceived Exertion).
Rationale: This helps objectively evaluate the patient’s activity tolerance and guide activity progression. - Implement a gradual activity progression plan as tolerated and prescribed by the healthcare team.
Rationale: Gradual increase in activity helps prevent overexertion while promoting cardiovascular reconditioning. - Teach energy conservation techniques (e.g., sitting while performing tasks, using assistive devices).
Rationale: These techniques help the patient accomplish necessary activities without excessive fatigue. - Monitor vital signs before, during, and after activities.
Rationale: This helps identify adverse responses to activity and guides activity prescription. - Collaborate with physical therapy for an appropriate exercise program.
Rationale: Physical therapists can provide expert guidance on safe and effective exercise progression.
Desired Outcomes:
- The patient will demonstrate improved activity tolerance as evidenced by the ability to perform ADLs with minimal fatigue within five days.
- Patient will maintain stable vital signs during and after activities.
- Patient will verbalize understanding of energy conservation techniques and activity progression plan.
Care Plan 4: Risk for Decreased Cardiac Tissue Perfusion
Nursing Diagnosis: Risk for Decreased Cardiac Tissue Perfusion related to inflammatory process affecting the coronary arteries secondary to myocarditis.
Related factors/causes:
- Inflammation of coronary arteries
- Potential for coronary artery spasm
- Risk of thrombus formation
Nursing Interventions and Rationales:
- Monitor for signs of decreased cardiac perfusion (e.g., new onset chest pain, ECG changes, elevated cardiac enzymes).
Rationale: Early detection of decreased cardiac perfusion allows for prompt intervention. - Administer anticoagulants or antiplatelet agents as prescribed.
Rationale: These medications can help prevent thrombus formation and maintain coronary blood flow. - Maintain the patient on continuous cardiac monitoring.
Rationale: Continuous monitoring allows for early detection of arrhythmias or ST-segment changes indicative of ischemia. - Educate the patient about the signs and symptoms of decreased cardiac perfusion to report immediately.
Rationale: Patient awareness promotes early reporting of significant symptoms. - Ensure readiness of emergency equipment (e.g., crash cart, defibrillator).
Rationale: Being prepared for potential cardiac emergencies ensures rapid response if needed.
Desired Outcomes:
- Patient will maintain adequate cardiac tissue perfusion as evidenced by absence of chest pain and stable ECG findings.
- Patient will demonstrate no elevation in cardiac enzymes indicative of myocardial damage.
- Patient will verbalize understanding of signs and symptoms to report immediately.
Care Plan 5: Anxiety
Nursing Diagnosis: Anxiety related to uncertainty of prognosis and fear of complications secondary to myocarditis diagnosis as evidenced by verbalization of worries and increased heart rate when discussing condition.
Related factors/causes:
- Lack of knowledge about the disease process
- Fear of potential complications
- Uncertainty about long-term prognosis
Nursing Interventions and Rationales:
- Assess the patient’s level of anxiety using a standardized scale (e.g., Hamilton Anxiety Scale).
Rationale: Objective assessment helps in evaluating the severity of anxiety and the effectiveness of interventions. - Provide clear, concise information about myocarditis, its treatment, and prognosis.
Rationale: Accurate information can help alleviate fears stemming from misconceptions or lack of knowledge. - Teach relaxation techniques such as deep breathing exercises and progressive muscle relaxation.
Rationale: These techniques can help reduce anxiety and promote a sense of control. - Encourage expression of feelings and concerns.
Rationale: Allowing the patient to verbalize fears can help in addressing specific concerns and providing targeted support. - Involve the patient in decision-making processes regarding their care when appropriate.
Rationale: This can help the patient feel more in control of their situation, potentially reducing anxiety.
Desired Outcomes:
- Patient will report decreased anxiety levels within 48 hours of interventions.
- Patient will demonstrate use of at least one relaxation technique effectively.
- Patient will verbalize accurate understanding of their condition and treatment plan.
Conclusion
Effective nursing care for patients with myocarditis requires a comprehensive approach addressing both physical and psychological aspects of the condition.
By implementing these nursing diagnoses, interventions, and care plans, nurses can significantly contribute to improved patient outcomes and quality of life.
References
- American Heart Association. (2021). Myocarditis and Pericarditis. Retrieved from https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/myocarditis-and-pericarditis
- Caforio, A. L., Pankuweit, S., Arbustini, E., Basso, C., Gimeno-Blanes, J., Felix, S. B., … & Elliott, P. M. (2013). Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. European heart journal, 34(33), 2636-2648.
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme.
- Kindermann, I., Barth, C., Mahfoud, F., Ukena, C., Lenski, M., Yilmaz, A., … & Böhm, M. (2012). Update on myocarditis. Journal of the American College of Cardiology, 59(9), 779-792.
- Lynne, S. B. (2019). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Wolters Kluwer Health.
