8 February 2012

What is Cardiomyopathy?Nursing Diagnosis and Intervention

What is Cardiomyopathy?
The middle layer of the heart wall that contains cardiac muscle (myocardium) weakens and stretches, causing the heart to lose its pumping strength and become enlarged. The heart remains functional; however, contractions are weak, resulting in decreased cardiac output. Most are idiopathic and not related to the major causes of heart disease. The three types of cardiomyopathy are:
1. Dilated cardiomyopathy (common): The heart muscle thins and enlarges,which leads to congestive heart failure. Progressive hypertrophy and dilatation result in problems with pumping action of ventricles.
2. Hypertrophic cardiomyopathy: The ventricular heart muscle thickens, resulting in outflow obstruction or restriction. There is some blood flow present.
3. Restrictive cardiomyopathy (rare): The heart muscle becomes stiff and restricts blood from filling ventricles, usually as a result of amyloidosis, radiation,or myocardial fibrosis after open-heart surgery.

Nursing Goal for Cardiomyopathy

  • Patient alert and oriented
  • Skin warm and dry
  • Pulses strong and equal bilaterally
  • Absence of life-threatening dysrythmias
  • Urine output 30 ml/hr
  • CVP 2 to 6 mm Hg
  • Capillary refill < 3 sec
  • BP 90 to 120 mm Hg
  • Pulse pressure 30 to 40 mm Hg
HR 60 to 100 beats/min

Nursing Assessment Cardiomyopathy
  • Obtain vital signs every 15 minutes during acute phase.
  • Assess the patient for changes in neurological function hourly and as clinically indicated.
  • Assess for skin warmth, color, and capillary refill time.
  • Assess for chest discomfort because myocardial ischemia may result from poor perfusion.
  • Assess heart and lung sounds to evaluate the degree in heart failure.

NURSING DIAGNOSES for Cardiomyopathy
• Activity intolerance
• Impaired gas exchange
• Decreased cardiac output

• Place patient in a semi-Fowler’s position for comfort, which eases respiratory

• Record intake and output of fluids.
• Monitor vital signs to assess for increased respiratory rate, arrythmias.
• Monitor electrocardiogram to look for changes from previous tracing.
• Explain to the patient: fluids restriction may be necessary as heart failure is
a concurrent disease with dilated cardiomyopathy.
• Record daily weight and call physician if weight increases 3 lbs (1.4 kg).
• No smoking or drinking alcohol.
• No straining during bowel movements.
• Increase exercise.
Medical-Surgical Nursing Demystified