DCM

LEARNING OBJECTIVE

DEFINITION
It is the condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently.

ETIOLOGY
Cardio toxic agents
Metabolic disorders Ischemia

Ventricular trombus
Muscular dystrophy Hypertension Neo plastic tumors

PATHOPHYSIOLOGY
Diffuse inflammation
Rapid regeneration of myocardial fibers Ventricular dilation Mitral and tricuspid regurgitation

Decreased cardiac output Increase ventricular wall stress Further dilation Myocardial dysfunction

CLINICAL MANIFESTATIONS
Chest pain
Dyspnea Palpitations

Irregular heart rhythms

Dizziness Fatigue Orthopnea Cardiomegaly Swelling of the lower extremities

DIAGNOSTIC STUDIES
History and Physical examination
Ecg Chest x ray

Serum laboratory tests

Echocardiogram Stress test Nuclear imaging studies Cardiac catheterization and pericardiocentesis Myocardial biopsy

NURSING MANAGEMENT
Cardiac rehabilitation
Reducing cardiac overload Maintaining optimum oxygenation

Prevent complications
Nutritional therapy Educate the family how to perform CPR

COLLABORATIVE MANAGEMENT
Treatment of underlying causes
Pharmacological management nitrates beta adrenergic blockers antidysrhythmics ace inhibitors diuretics anticoagulants

Ventricular assist device Cardiac resynchronization therapy Implantable cardioverter defibrillator Cardiac transplant Surgical correction

NURSING CARE PLAN

NURSING DIAGNOSIS Acute pain related to myocardial ischemia as evidenced by severe chest pain GOAL To relief of pain INTERVENTIONS Assess the patient and evaluate chest pain Oxygen therapy to increase oxygenation of myocardial tissue Administer medication to relieve pain Monitor cardiac rhythm and hemodynamic parameters

NURSING DIAGNOSIS Activity intolerance related to fatigue secondary to decreased cardiac output and poor tissue perfusion as evidenced by fatigue and dyspnea

GOAL Achieve activity that balances physical activity with energy conserving activities

INTERVENTIONS Monitor patient responds to medications prior to activity Arrange exercise and rest periods to avoid fatigue and cardiac work load Assist the patient to understand the requirement for restricted activity

NURSING DIAGNOSIS Ineffective therapeutic regimen management related to lack of knowledge risk factors and disease process

GOAL Educate regarding risk f actors ,disease process and rehabilitation activities

I NTERVENTIONS Evaluate the patient current level of knowledge regarding disease condition Explain the pathophysiology of disease and how it relates to anatomy and physiology to individualize the information Discuss the life style changed that may require to prevent complications