Cardiomyopathy is a chronic or subacute disease process that involves the heart muscle and causes either systolic dysfunction

or diastolic dysfunction, or both; it most commonly involves the endocardium and occasionally the pericardium. Signs and Symptoms Dyspnea Fatigue Dysrhythmias or conduction disturbances Onset may be insidious or exhibited by sudden death. Physical Examination Vital signs HR: increased, irregular rhythm BP: increased or decreased, depending on underlying disease or degree of heart failure RR: may be increased Cardiovascular Murmurs S3 and/ or S4 Ectopy Jugular vein distention Pulmonary Crackles Dry cough History 1. Establish a history of signs, symptoms, and potential causes. 2. Determine the patients patterns of alcohol consumption. 3. Inquire if the patient has been previously diagnosed with amyloidosis, vitamin deficiencies, hemochromatosis, metastatic carcinoma affecting the myocardium, myocarditis, an immune disorder, or an infiltrative disorder. 4. Determine if the patient has had a recent viral or bacterial infection. Ask female patients if they are pregnant. 5. Question the patient about any hypersensitive reactions to medications or any exposure to radiation. Assessment 1. Check vital signs for baseline data. 2. Check for altered mental status as a result of poor cerebral perfusion, and observe for anxiety or restlessness. 3. Note if the patients skin is cool or damp, and observe it for mottling, pallor, or cyanosis. Inspect the patient for peripheral edema, ascites, jugular venous distension, and hepatojugular reflux.

4. Palpate the patients abdomen for signs of hepatomegaly. 5. Assess the patients breathing patterns for shortness of breath, dyspnea, tachypnea, or crackles. 6. Note a decreased blood pressure and bounding or alternating strength of peripheral pulses. 7. Auscultate for heart sounds, and note the presence of an S3 or S4 gallop, valvular murmurs associated with mitral or tricuspid regurgitation, or an outflow obstruction of hypertrophy, tachycardia, and dysrhythmias. Nursing care plan primary nursing diagnosis: Decreased cardiac output related to reduced myocardial contractility. Nursing care plan intervention and treatment plan The treatment for cardiomyopathy is palliative rather than curative. Control of the symptoms of CHF is the primary goal in treatment. Medical management may vary, depending on the type ofcardiomyopathy present. Surgical treatment most commonly consists of excision of part of the hypertrophied septum to reduce the outflow obstruction (septal myotomy-myectomy). The patient with restrictive cardiomyopathy usually undergoes surgery to implant a permanent cardiac pacemaker. Nursing Interventions 1. Elevate the head of the patients bed 30 to 45 degrees to help alleviate dyspnea. Rationale: The elevation lowers pressure on the diaphragm, which is caused by the contents of the abdomen, and decreases venous return, thereby decreasing preload. 2. Assist the patient with the activities of daily living. Although the patient requires frequent rest periods, maintain some level of activity. Rationale: Prolonged periods of little or no activity can be very difficult to reverse. 3. Teach the patient and family how to prevent exacerbation and worsening of the condition. Explain the disease process clearly, using audiovisual aids whenever possible to help the patient understand the necessity of the prescribed medications, activity restrictions, diet, fluid restrictions, and lifestyle changes. Provide written material for the patient to take home and use as a reference; however, before giving the patient this material, be sure to assess his or her literacy level.

Case: Bacterial Endocarditis

Clinical History J.F. is a 50-year-old married homemaker with a genetic autoimmune deficiency; she has suffered from recurrent bacterial endocarditis. The most recent episodes were a Staphylococcus aureus infection of the mitral valve 16 months ago and a Streptococcus mutans infection of the aortic valve 1 month ago. During this latter hospitalization, an ECG showed moderate aortic stenosis, moderate aortic insufficiency, chronic valvular vegetations, and moderate left atrial enlargement. Two years ago J.F. received an 18-month course of parenteral nutrition (PN) for malnutrition caused by idiopathic, relentless nausea and vomiting (N/V). She has also had coronary artery disease (CAD) for several years, and 2 years ago suffered an acute anterior wall myocardial infarction (MI). In addition, she has a history of chronic joint pain. She will be scheduled for dental procedure(root canal) due to toothache. Prophylactic Antibiotic Therapy Standard general prophylaxis Amoxicillin Adults: 2 g Taken orally one hour before the procedure Rationale: Alpha-hemolytic streptococci are the most common cause of endocarditis following dental and oral procedures, certain upper respiratory tract procedures, bronchoscopy with a rigid scope, esophageal procedures and surgical procedures involving the respiratory mucosa. The recommended standard prophylactic regimen for all of these procedures is a single dose of oral amoxicillin (2.0 g in adults and 50 mg per kg in children). A follow-up dose is no longer recommended, both because of the prolonged serum levels above the minimal inhibitory concentration of most oral streptococci25 and the prolonged serum inhibitory activity induced by amoxicillin against such strains (six to 14 hours)

Retrieved from: http://www.essaydepot.com/doc/37949/Case-Study-15-Endocarditis

Ramirez, Era Mae M. BSN III- A

Myocarditis
Myocarditis is a condition where the muscular walls of the heart become inflamed. Myocarditis typically results in poor heart function. There are many causes of myocarditis including infections, medications, chemicals, radiation, and certain diseases that cause inflammation in many different organs of the body. In most children, myocarditis is triggered by an infection, usually viral, involving the heart. There are no known risk factors for developing myocarditis. The severity of disease seems to be dependent upon many factors such as age, sex, and the genetic make-up of the immune system. Treatment for myocarditis is evolving as the disease process is better understood. Many children experience a complete recovery, but some may develop serious heart failure and require chronic care by a cardiologist.

Mechanism of Myocarditis
The inflammatory process begins when the body's immune cells (the cells that fight infection) actually penetrate the heart tissue. These immune cells become activated and produce chemicals that can cause damage to the heart muscle cells. There is thickening and swelling of the heart muscle. All four chambers of the heart may be affected and become enlarged. Damaged muscle cells may heal over time or there may be cell death followed by scar formation. If this process is extensive and a large portion of the heart is involved, the ability of the heart to pump blood is impaired. As a result, the important organs and tissues in the body are deprived of oxygen and nutrients and cannot eliminate waste products. This is often referred to as congestive heart failure. It is not unusual for someone that has severe myocarditis to suffer from other problems such as liver or kidney failure, as well.