Nursing Assessment for Cardiomyopathy

### Nursing Assessment and Care for Cardiomyopathy

• Patient Education: Vital for management, emphasizing symptom recognition and disease understanding.
• Activity Restriction: May be needed, encourage energy conservation during activities of daily living (ADLs) by alternating periods of activity with rest.
• Lifestyle Modifications:
  • Limit salt, fat, and fluids in the diet.
  • Engage in regular exercise.
  • Maintain an appropriate weight.
  • Quit smoking.
  • Limit or eliminate alcohol.
  • Manage stress.
• HCM-Specific Care:
  • Similar to myocardial ischemia care.
  • Avoid nitrates and vasodilators due to worsening heart failure.
  • Surgical intervention requires similar post-operative care as open-heart surgery.
• Genetic Counseling: Important for identifying family members at risk.

### Assessment for Cardiomyopathy

• Subjective and Objective Data:
  • Observation and Patient Interview:
    • Review history for hypertension, diabetes, cardiac disease, previous heart failure, and family history of cardiomyopathy.
    • Note shortness of breath, dyspnea on exertion, decreased activity tolerance, sleep patterns (paroxysmal nocturnal dyspnea, pillow use), recent weight gain, coughing, chest or abdominal pain, anorexia, nausea.
    • Review current medications, diet, activity, and recent health changes.
  • Physical Examination:
    • Assess vital signs (apical and peripheral pulses).
    • Observe general appearance (work of breathing, ease of conversation, position changes, anxiety).
    • Examine skin and mucous membranes (color), jugular venous distension (JVD), capillary refill, edema.
    • Auscultate heart and breath sounds.
    • Palpate chest for heart size.
    • Examine abdomen (contour, right upper quadrant tenderness, liver enlargement), and auscultate bowel sounds.
    • Obtain blood for testing as needed.

Cardiomyopathy Diagnosis

• Appropriate problem identification for patients with cardiomyopathy includes:
  • Decreased cardiac output (CO)
  • Fatigue
  • Fluid volume excess
  • Inability to tolerate activity
  • Lacks knowledge of disease process
  • Grieving

Cardiomyopathy Planning

• The plan of care is based on the type and severity of cardiomyopathy.
• Goals may include:
  • Maintaining blood pressure (BP) within specified limits.
  • Altering lifestyle to adjust to reduced activity level caused by the disease process.
  • Modifying diet to support long-term management of the condition.

Cardiomyopathy Implementation

• Nurses must monitor for subtle changes in vital signs and level of consciousness (LOC):
  • Alterations in peripheral capillary refill time, pulse rate or volume, and LOC may be early warning signs of decreased perfusion.
• In many cases, the patient and family manage the condition in the home.
• Monitor Cardiac Output
  • Nursing interventions that address decreased stroke volume (SV) and tissue perfusion include:
    • Encourage periods of rest throughout the day.
    • Elevate the head of the bed to reduce work of breathing (WOB).
    • Provide a bedside commode and assist with activities of daily living (ADLs).
    • Instruct the patient to avoid the Valsalva maneuver.
  • These interventions reduce cardiac workload.
  • Medications that increase CO and increase contractile effectiveness should be administered as ordered.
  • Oxygen therapy is indicated when hypoxia has been found.
  • Deliver oxygen therapy per prescription to reduce ischemia and improve perfusion.
• Vital signs and oxygen saturation should be monitored.
  • It is common for these patients to experience tachycardia due to the sympathetic nervous system (SNS) stimulation in response to low CO.
  • Vasoconstriction may cause early elevations in diastolic BP; however, as compensatory mechanisms fail, BP falls.
• Brain natriuretic peptide (BNP) is a cardiac neurohormone secreted from the ventricles when they are under stress.
  • Levels and trends should be monitored as an indicator of heart failure (HF) severity.
• Regular heart and lung sound auscultation provides important clinical information.
  • Poor cardiac function can result in diminished S1 and S2 sounds; S3 (ventricular gallop) or S4 (atrial gallop) may be present in early HF.
  • Basilar crackles can indicate deteriorating HF.