(^26) Medical-Surgical Nursing Demystified
- Monitor intake and output of fluids—look for adequate renal perfusion.
Without sufficient cardiac function, the patient will not have enough blood
flow to the kidneys to get adequate filtration. - Explain to the patient:
- Which symptoms to be aware of and when to call the doctor.
- Take rest periods.
- Call the physician if there are signs of fluid overload—weight increase,
shortness of breath, fatigue, dependent edema. - Record weight each day and call the physician, nurse practitioner, or
physician assistant if there is an increase of 3 lbs (1.4 kg). - Change to a low-sodium, low-fat diet.
Cardiomyopathy
WHAT WENT WRONG?
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:- Dilated cardiomyopathy (common): The heart muscle thins and enlarges,
which leads to congestive heart failure. Progressive hypertrophy and dilata-
tion result in problems with pumping action of ventricles. - Hypertrophic cardiomyopathy: The ventricular heart muscle thickens, result-
ing in outflow obstruction or restriction. There is some blood flow present. - Restrictive cardiomyopathy (rare): The heart muscle becomes stiff and re-
stricts blood from filling ventricles, usually as a result of amyloidosis, radi-
ation, or myocardial fibrosis after open-heart surgery.
PROGNOSIS
Prognosis is variable. Sudden cardiac death is a possible outcome in dilated or
hypertrophic cardiomyopathy; arrhythmia is often a precursor to sudden death.8