Myocarditis Nursing Care Plans Diagnosis and Interventions
Myocarditis NCLEX Review and Nursing Care Plans
Myocarditis is a medical condition described as the inflammation of the muscular middle layer of the heart wall called the myocardium.
Myocarditis also involves the necrosis of cardiac myocytes or cardiac muscle cells.
It can cause a cascade of signs and symptoms which may include fatigue, dyspnea, palpitations, and may lead to death.
Myocarditis is often idiopathic; however, it can also occur because of other illnesses.
Signs and Symptoms of Myocarditis
The signs and symptoms of myocarditis are often non-specific and can mimic any other heart condition.
The signs and symptoms are dependent on the etiology of the disease and the degree of myocardial inflammation.
- Signs of heart failure
- Signs of fluid overload
- Elevated jugular venous pulses
- Presence of 3rd and 4th heart sounds
- Systolic murmurs
- Chest pain – the pain may be described as a dull or sharp precordial or substernal pain which may radiate to the neck, left trapezius ridge, or shoulders. Pain may also be eased by sitting up and leaning forward.
- Arrhythmias or abnormal heart rhythm
- Signs and symptoms of a viral infection such us:
- Myalgia or body aches
- Joint pain
- Sore throat
Causes of Myocarditis
The cause of myocarditis may not always be known. The disease will then be referred to as idiopathic myocarditis.
However, the following are possible causes of the disease:
- Viral infection – many viruses are known to cause myocarditis such as common cold or adenoviruses, hepatitis B and C, and parvoviruses.
- Bacterial infection – bacteria are also known to cause myocarditis. Staphylococcus and streptococcus bacteria are commonly associated with the disease.
- Parasitic infection – parasites that cause Chagas disease are also linked to myocarditis. They are often recorded in Central and South America although they can occur in travelers and immigrants from those places as well.
- Fungal infection – fungi can easily infect people with weak immunity. Fungi such as candida, aspergillus, and histoplasmosis can also cause myocarditis.
- Medication or Illegal Drug Use – Use of drugs can start an allergic or toxic reaction which can lead to heart muscle involvement.
- Chemicals or radiation – chemicals such as carbon monoxide and radiation are also known to cause myocarditis.
- Other diseases are also linked to myocarditis. They include lupus, Wegener’s granulomatosis, giant cell arteritis and Takayasu’s arteritis.
Complications of Myocarditis
Myocarditis is a serious medical condition because of the possible damage it can cause the heart. The following are the possible complications of myocarditis:
- Heart failure – myocarditis causes ineffective pumping of the heart muscles which may lead to a significant reduction in heart function.
- Heart attack or stroke – myocarditis can also cause pooling of blood in the chambers of the heart which can lead to the formation of clots. Blood clots can travel and clog blood vessels in the heart and brain.
- Serious arrhythmias – due to the damage to the heart muscles, the pumping ability of the heart weakens, causing irregular heart rhythm.
- Sudden cardiac death – this is a serious condition where the heart muscles stop working altogether.
Diagnosis of Myocarditis
- Electrocardiography (ECG) – the ECG tracings may be normal in myocarditis. In other cases, an ST segment abnormality may be noted. Other common readings are nonspecific ST-T wave changes, sinus tachycardia, ventricular tachycardia, and ventricular fibrillation.
- Cardiac enzymes – cardiac enzymes are often measured through a blood test. Troponin and CK-MB are cardiac enzymes which may be elevated in the presence of cardiac cell necrosis.
- Cardiac imaging
- Echocardiogram – early and mild myocarditis may not present any abnormalities in this procedure. However, other cases may suggest the presence of dilated cardiomyopathy which can likely occur secondary to myocarditis.
- MRI – MRI images will normally show gadolinium enhancement, myocardial edema, and myocardial hyperemia which can all suggest myocarditis.
- Endomyocardial biopsy – A tissue sample showing inflammatory infiltrate of the myocardium with the presence of necrosed myocytes is gold standard in the diagnosis of myocarditis. To do this, a sample is obtained from the myocardium. However, this procedure carries serious risks hence it is not routinely done. Also, a negative result does not necessarily rule out myocarditis.
- Other diagnostic tests may be performed to help identify possible causes of myocarditis: Complete blood count (CBC) – a simple test can identify peripheral eosinophilia which may be present in hypersensitivity myocarditis.
- Biopsy of myocardial tissue to be subjected for acid-fast staining and samples can also be checked for giant cells.
Treatment of Myocarditis
The treatment for myocarditis is focused on addressing the main cause of the disease and preventing further heart damage.
Mild myocarditis may not need treatment, but the following may be required in more serious cases:
- Medications to help preserve cardiac function:
- Angiotensin-converting enzymes – these drugs will relax blood vessels in the heart and help the flow of blood.
- Angiotensin II receptor blockers – these drugs help the heart by also relaxing the blood vessels in the heart which helps the blood to flow more easily.
- Beta blockers – these medications help treat heart failure and control arrhythmias.
- Diuretics – diuretics help ease fluid retention.
In severe cases, some of these drugs may need to be given intravenously to promote immediate response in improving heart function.
- Ventricular assist devices (VADs) – these are machines that help the ventricles of the heart to pump more blood to supply the body. VADs are used in people with weak hearts and had heart failure. They allow the heart to recover while waiting for other treatments.
- Intra-aortic balloon pump – a catheter is inserted from the groin to the aorta to help increase the blood flow into the rest of the body and reduce the strain in the heart muscles.
- Extracorporeal membrane oxygenation (ECMO) – this involves the use of a machine that will supply oxygen to the body in support of the reduced blood flow from myocarditis.
Nursing Diagnosis for Myocarditis
Myocarditis Nursing Care Plan 1
Nursing Diagnosis: Decreased Cardiac Output related to impaired cardiac contractility secondary to myocarditis, as evidenced by irregular heartbeat or arrhythmia, heart rate of 128, dyspnea upon exertion, fatigue, chest pain, and palpitations.
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Myocarditis Nursing Interventions||Rationales|
|Assess the patient’s vital signs and characteristics of heart beat 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 fluid overload and myocarditis. 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 myocarditis 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 set target range.|
|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.|
|Prepare the patient for ventricular assist devices (VADs) by educating the patient and carer and gaining consent.||These are machines that help the ventricles of the heart to pump more blood to supply the body. VADs are used in people with weak hearts and had heart failure. They allow the heart to recover while waiting for other treatments.|
Myocarditis Nursing Care Plan 2
Nursing Diagnosis: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressures secondary to myocarditis, as evidenced by shortness of breath, SpO2 level of 85%, dyspnea, and crackles upon auscultation.
Desired Outcome: The patient will have improved oxygenation and will not show any signs of respiratory distress.
|Myocarditis 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 range set by the physician.|
|Encourage small but frequent meals. 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.|
Myocarditis Nursing Care Plan 3
Nursing Diagnosis: Hyperthermia related to the disease process of viral myocarditis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Myocarditis Nursing Interventions||Rationales|
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the fever-reducing drugs administered.|
|Remove excessive clothing, blankets, and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed anti-pyretic medications.||Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Myocarditis Nursing Care Plan 4
Nursing Diagnosis: Activity Intolerance related to an imbalance of oxygen supply and generalized weakness secondary to myocarditis as evidenced by fatigue, difficulty of breathing, and changes in vital signs.
- The patient will show active participation in desired activities.
- The patient shows an increase in activity levels within his/her capabilities.
- The patient’s vital signs will be within the target range.
- The patient will identify the factors to reduce activity intolerance.
- The patient will verbalize knowledge and uses the techniques for energy conservation.
|Myocarditis Nursing Interventions||Rationale|
|1. Take the initial vital signs of the patient, and take note if there are signs and symptoms of difficulty of breathing and tachycardia. Assess for the patient’s age, breathing problems, impaired vision, and hearing problems.||Assessing the vital signs of the patient will serve as baseline data in assessing the cardiopulmonary status of the patient. The patient’s age, breathing problems, impaired vision, and hearing may hinder the interventions to improve tolerance to the activities.|
|2. Assess the patient’s tolerance to activities of daily living. Establish goals with the patients and significant others.||This aims to define the patient’s capacity and level of mobility to help the nurse to set goals before the interventions. Goals can inspire and motivate the patient is tolerating the activities.|
|3. Explore the possible causes of activity intolerance. Review the medications, procedures, and treatment of the patient that may affect the patient’s activity level.||Some medications and procedures may cause side effects; Pain in procedures and medication side effects may cause fatigue that will decrease the patient’s mobility. Orthostatic hypertension may occur during the activity because of the side effects of the medications.|
|4. Teach the patient about the self-care activities within his/her limits. The nurse may also involve the patient’s significant others and/or caregivers in encouraging the patient to do activities of daily living.||Activities of daily living are very important to promote a patient’s health. The nurse should allow self-care activities to promote a sense of control as tolerated by the patient.|
|5. Encourage the patient to do activities with rest periods. Ensure that the patient rest in between activities.||Developing a schedule for activities promotes pacing and will help in prioritizing activities may help to avoid myocardial stress and increase oxygen demand. Extra activities may trigger difficulty in breathing.|
|6. Evaluate the patient’s need for ambulatory aids. The nurse should also maintain the patient’s safety to avoid injury during the activity.||Ambulation aids such as cane, walker, and crutches may help in enhancing mobility. Assisting the patient during ambulation should always be observed as needed. The nurse may also teach the relatives and significant others the ways to assist the patient during ambulation while maintaining the safety of the patient.|
|7. Observe the patient’s emotional response to the limitation of physical activities. Encourage the patient to verbalize feelings towards the situation by talking to relatives, significant others, or other patients that have the same condition.||Anxiety and depression due to the inability to perform activities can be a cause of stress and frustration. Anxiety might cause feeling restless and tense which may cause a rapid heartbeat.|
|8. Teach the patient about the techniques for energy conservation. Encourage the patient to do deep breathing exercises and range in motion exercises as tolerated.||Range of motion exercises may help to improve the flexibility and the mobility of the joints to reduce stiffness. Deep breathing exercises help in clearing the lungs and will help the patient to breathe well. Encourage return demonstration of the techniques.|
|9. Provide a comfortable and calm environment and advise adequate rest and sleep.||The patient’s environment promotes comfort and helps the patient to relax. Sleep is very important to conserve energy and decrease fatigue.|
|10. Evaluate the patient’s attitude and progress towards the activities. Provide positive feedback on the progress of the patient.||Evaluating the progress of the activities will enhance the patient’s well-being and motivations. Providing positive feedback helps to decrease patients’ frustrations. Positive feedback may also strengthen the achievements and success of the interventions.|
Myocarditis Nursing Care Plan 5
Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to the decreased expansion of the lungs secondary to myocarditis as evidenced by productive cough and abnormally rapid breathing.
- The patient will maintain a normal breathing rate and breathing pattern.
- The patient will verbalize comfort when breathing.
- The patient will demonstrate deep breathing exercises and techniques for relaxation properly.
|Myocarditis Nursing Interventions||Rationale|
|1. Check the vital signs of the patient and watch out for the patient’s respiratory rate, oxygen level, depth, and presence of abnormal rapid breathing.||Checking the initial vital signs will help in detecting the patient’s current status. The normal rate of an adult’s respiration is 10-20 breaths per minute. It is important to assess if there are alterations in the pattern of breathing to assess if the respiratory system is functioning well.|
|2. Note the patient’s breathing pattern and monitor it from time to time. Monitor for possible warning signs.||Abnormal breathing patterns may suggest respiratory dysfunctions. Constantly monitoring the patient may help to configure the needs for the patient’s condition.|
|3. Provide a calm and relaxing environment. Position the patient in a comfortable position, and keep the head elevated.||A calm environment will provide comfort to the patient. A comfortable position and environment will help improve breathing patterns.|
|4. Check for the arterial blood gases (ABG) level. Report any abnormal results and refer to the physician accordingly.||Arterial blood gases(ABG) level helps to identify the level of oxygen, carbon dioxide, and the balance of acid in the blood. This test will help to evaluate how the lungs, kidneys, and heart are working.|
|5. Check the patient’s airway to detect secretions and obstructions. Suction the secretions if needed. Check for the presence of sputum, color, amount, and consistency.||Assessing the airways is needed to determine the proper management needed by the patient. The presence of sputum and the inability of releasing it may cause changes in breathing patterns.|
|6. Encourage to do techniques that may help maintain effective breathing such as coughing, and deep breathing exercises.||Breathing techniques may help maintain proper lung capacity, improve breathing, and promotes comfort and relaxation for the patient. The comfort of the patient is very important to lessen the stress and anxiety.|
|7. Observe the patient’s skin color, capillary refill, temperature, and cyanosis.||Cyanosis of the lips, tongue, and fingers indicates a lack of oxygen. This condition may indicate a medical emergency.|
|8. Assess the patient’s level of anxiety, consciousness restlessness, and confusion.||Anxiety that is caused by stress may lead to restlessness, sweating, increase rapid breathing and heartbeat. Anxiety may trigger abnormal breathing pattern whi ch needs immediate medical attention.|
|9. Gain the patient’s trust and maintain a good relationship with the patient and significant others. Involve the patient’s relatives and significant others in the interventions.||Showing compassion, spending time, and actively listening to the patient and significant others will help in building trust. A high level of trust will help in the recovery of the patient because the patient will more likely to cooperate with the procedures if the nurse gains the patient’s trust.|
|10. Provide oxygen and medications as needed and as prescribed by the physician.||Medications such as beta-adrenergic agonist are medications that relax airways and acts in open-air passages as prescribed by the physicians.|
|11. Advise the patient to ambulate as tolerated with minimal supervision and ensure that the patient will do frequent rest periods as tolerated by the patient.||Strenuous activities may worsen the breathing pattern, rest between activities should be maintained.|
|12. Reassess the condition of the patient for changes in breathing pattern, and depths and note the patient’s response to interventions. And refer the condition of the patient to the physician accordingly.||Reassessment is important to evaluate the overall patient’s condition after the interventions; through evaluation, the nurse will be able to plan for additional interventions if needed that will help for the improvement of the patient’s health outcome.|
|13. Evaluate the patient’s response to pharmacological treatment.||To determine the response of the patient to medications and compare the response with the patient’s therapy goals.|
Myocarditis Nursing Care Plan 6
Nursing Diagnosis: Deficient Knowledge/ Knowledge Deficit related to myocarditis as evidenced by the patient’s questions about the condition and treatment.
- The patient will demonstrate an understanding of the condition.
- The patient will verbalize thoroughly his understanding of the condition.
- The patient will interact with the nurse to develop plans for his condition.
- ● The patient will verbalize his willingness to learn.
|Myocarditis Nursing Interventions||Rationale|
|1. Assess the patient’s physical and psychological condition. Take note of the age of the patient, ability to learn, or any hindrances that might affect learning. Determine the patient’s understanding of myocarditis.||Assessing the patient’s ability to learn and hindrances that might hinder learning should be recognized to arrange a proper intervention for the patient. Hospitalization may affect the ability of the patient to understand information.|
|2. Observe the patient’s willingness and motivation to learn. The readiness of the patient to learn should also be observed.||Ask the patient how he or she acts about the health care condition. The patient’s willingness and readiness to learn can improve compliance with the treatment regimen.|
|3. Encourage the patient as well as the patient’s significant others and family to participate in developing teaching plans.||Active participation in decision-making and teaching plans by expressing opinions and sharing thoughts and feelings will empower the teaching plans and outcome.|
|4. Prepare for different teaching methods that may help for an easier understanding of the condition. Offer educational materials through social media and use aids such as videos, images, and articles.||Provide information that the patient will easily understand. Use terminologies that the patient and his family will easily understand. Showing useful media such as images and videos while teaching makes it easier to remember the information.|
|5. Generate goals and objectives before the interventions. Begin interventions through step by step approach.||Setting goals lets the patient know what to expect during the teaching sessions.|
|6. Teach the patient as well as the family about the warning signs of myocarditis, and its signs and symptoms, and report episodes of difficulty of breathing and chest pain.||Awareness of warning signs will help avoid medical emergencies and may help in the early diagnosis of complications.|
|7. Instruct the patient on ways to cope with anxiety and different techniques such as deep breathing exercises and relaxation techniques.||Patients with myocarditis may experience anxiety and stress because of elevated levels of cortisol, an increase in cortisol is common in patients with cardiac problems. Encouraging these techniques may reduce the level of anxiety that the patient may experience.|
|8. Screen for the patient’s capacity to continue basic activities of daily living. Inform the patient and his family about the limitations patients limitations to avoid complications.||Allow the patient to continue activities of daily living such as self-care as tolerated with minimal help if needed. Make sure patients’ safety is a priority9. Acknowledge the involvement of the patient and the patient’s family and the significant others during learning periods. Allow queries to terms that are difficult to understand and give positive feedback on patients’ involvement.||Giving positive feedback will motivate the patient and the family and will permit them to express their perception of the condition. The patient’s family involvement in interventions provides a sense of comfort for the patient during the patient’s difficult times.|
|10. Encourage the patient and the patient’s relative and significant others to ask questions. Answer the questions in an understandable way.||Open conversation between the patient and the nurse will verify the understanding of the condition. Learning in a friendly environment is very important for the patient learning method.|
|11. Assess and document the progress of learning. Measure the knowledge of the patient after the interventions and learning process.||Assessment and documentation will evaluate the achievement of goals and objectives. This will allow the nurse to formulate new interventions if needed. Return demonstrations should be encouraged to know to evaluate patient understanding.|
More Myocarditis 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. (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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