AADARSH NURSING COLLEGE DHAR

SUBJECT : MEDICAL SURGICAL NURSING

TOPIC : CASE PRESENTATION ON
CARDIOMYOPATHY
DATE : 02/07/2021

SUBMITTED TO: SUBMITTED BY

MR. JITENDRA Jitendra bhargav
ASSISTANT PROFESSOR
1 [Link]
st
(A) BIODATA OF THE PATIENT:
1. Patient’s Name : - Manishaben Pragneshbhai Patel
2. Age/ sex : - 67yrs/female
3. Marital status : - Married
4. Education :- Illiterate
5. Occupation : - Housewife
6. Religion: - Hindu
7. Address : - Tapi
8. Diagnosis : - Cardiomyopathy
9. Ward : -Medical intensive care unit
[Link] No.: - 16
11. IP No. : - 45795
12. Date ofadmission : -
13. Attending physician : - Dr. Rabi Mall
14. Informants : - Patient (self) & her Husband
15. Height : 164cm
16. Weight : 60 Kg.
17. Health Habit :
Tobacco chewing : No
Smocking : Yes
Alcohol Consumption : No
Vegetarian : Yes
Non-vegetarian : No
 (B) CHIEF COMPLAINTS:
Manishaben Patel was Shortness of Breath for 2 days Pedal Edema for 1
month.

(C) HISTORY OF PRESENT ILLNESS:

As stated by the patient party, patient was apparently well 2 days back
when she started having shortness of breath on exertion. she also had pedal
edema for one month and made her difficult to mobilize. so she was taken to
the emergency department of hospital.
She was diagnosed as known case of DCM 2 year back. She was having
her medicine regularly. She was admitted to the general ward of SGNHC on
2068/11/15. then she was transfer to Medical Intensive Care Unit for Increased
Shortness of breath and admitted there no any skin change, bowel and bladder
are normal, she had no history of any abnormality of the menstrual cycles.
Symptom Onset charecter Duration Aggrevatin allevatin
gfactor gfactor
Shortness of 2 days Sharp pain Continues Notknown Notknown
breath
Padal edema 2month Mild Continuous Notknown Notknown
 (D) HISTORY OF PAST ILLNESS:
Disease Childhood illness Disease condition Adulthood
condition
illness
Yes No Yes No
Measeal Hypertensi
s onHeart
Mumps disease
Whooping Tuberculosi
coughPolio sDiabetes II
Rheumatic Filariasis
fever Malaria
Tuberculosis Cancer
Malnutrition Asthma
Operation Accidents
Others Others(hypothyrodism,
renal impairment)
. (E) Family History:
Age Relationship Illness in Family
[Link]. Name of Family
Members in With patient Members Education
Year
1 Pragneshbhai 67 Husband COPD Secondary
Patel education
2 Manishaben 72 Self cardiomyopathy 5th pass
Patel
3 Nijaben Patel 45 Daughter No 10th pass
4 Khyatiben Patel 42 Daughter No 12thpass
5 Mohan Patel 39 Son No [Link]
(F) Health facility near Home:
Manishben residing at Tapi and at Tapi there was a two private
dispensary in the Village. Dispensary is very near from his house. There are
other private doctors in his area where he is residing. The primary health
centre is also available in his Village. Transport facility is available in the form
of Government bus services as well as private vehicles are also available for
transportation.
(G) Housing:
Manishaben has his own pakka house in village. The house is having
one hall and one room, 1 kitchen and facilities of toilet and bathroom are
also available in house. There are also facilities of electricity and drinking water
from the panchayat.

(H) Physical Assessment:

 History: CHF, bronchial asthma, heart block, cardiogenic shock,
hypersensitivity to carvedilol, pregnancy, lactation, hepatic
impairment, peripheral vascular disease, thyrotoxicosis, diabetes,
anesthesia or major surgery
 Physical: Baseline weight, skin condition, neurologic status, P, BP,
ECG, respiratory status, LFTs, renal and thyroid function tests,
blood and urine glucose
Warning :
 Do not discontinue drug abruptly after chronic therapy
(hypersensitivity to catecholamines may have developed, causing
exacerbation of angina, MI, and ventricular arrhythmias); taper
 drug gradually over 2 wk with monitoring.
 Consult with physician about withdrawing drug if patient is to
undergo surgery (withdrawal is controversial).
 Give with food to decrease orthostatic hypotension and adverse
effects.
 Monitor for orthostatic hypotension and provide safety precautions.
 Monitor patients with diabetes closely; drug may mask
hypoglycemia or worsen hyperglycemia.
 Monitor patient for any sign of liver dysfunction (pruritus, dark urine
or stools, anorexia, jaundice, pain); arrange for LFTs and
discontinue drug if tests indicate liver injury. Do not restart
carvedilol.
OBJECTIVE DATA:
Assessment of Cardiovascular system:
 Heart rate: 138 beats/min.
 Rhythm : Regular
 Apical Pulse: 138beats/min.
 Jugular vein : Not distention:
 Heart sound: S1, S2 Present, No murmur.
Respiratory System:
 Respiration rate: 30 breaths /min.
 Breathe sound: Creps present
 Dyspnea: present.
 Pulmonary effusion: No.
 Cough: Present with whitish expectorant and copious.
Abdomen:
 Hepatomegaly: No. Abdomen is soft and no mass palpate
 No tenderness
 Hernia site Normal
  Skin:
Color of mucous membrane: Cyanotic
 Peripheral Cyanosis: yes Clubbing: yes
 Ecchymosed : No
Urinary system:
 Urine output: 1600 ml/24hrs.
Extremities:
 Edema: Present on feet
 Color and Temperature of Skin: Warm and moist.

DRUG SHEET:
DRUG & ACTION USES CONTRAINDICATI SIDE EFFECT
DOSE ON
Pyridoxine ADULTS: Pyridoxine Standard CNS:
Category: PO/IM/IV 100 to deficiency, including considerations Neuropathy;
Vitamin 200 mg/day for inadequate diet, drug unstable gait;
3 wk; follow with -induced causes (eg, drowsiness;
25 to 100 isoniazid, somnolence.
mg/day. hydralazine, oral EENT: Perioral
Neuropathy contraceptives) or numbness.
ADULTS: inborn errors of OTHER:
PO/IM/IV 50 to metabolism Numbness of
200 mg/day. feet;
Vitamin B6 decreased
Dependency sensation to
Syndrome touch,
ADULTS: temperature or
 PO/IM/IV 600 vibration;
mg, followed by paresthesia;
30 mg/day for low serum folic
life. Dependency acid levels;
has been noted burning/stingin
in adults g atIM
administered injection site;
200 mg/day. photoallergic
PYRIDOXINE- reaction;
DEPENDENT ataxia.
INFANTS: IM/IV
10 to 100 mg,
followed by 2
to 100 mg/day.
Metabolic
Disorders
ADULTS:
PO/IM/IV 100 to
500 mg/day
Carvedilol Competitively  Hypertension,  Contraindicate  CNS:
Drug blocks alpha-, alone or with d with Dizziness,
classes beta-, and beta2 other oral decompensate vertigo,
Alpha- and -adrenergic drugs, d CHF, tinnitus,
beta- receptors and especially bronchial fatigue,
adrenergic has some diuretics asthma, heart emotional
blocker, sympathomimeti  Treatment of block, depression,
Antihypert c activity at mild to severe cardiogenic paresthesia
ensive beta2- CHF of shock, s, sleep
receptors. Both ischemic or hypersensitivity disturbanc
alpha and beta cardiomyopathi to carvedilol, e
blocking actions c origin with pregnancy,  CV:
contribute to the digitalis, lactation. Bradycardi
BP-lowering diuretics, ACE  Use cautiously a,
effect; beta inhibitors with hepatic orthostatic
blockade  Left ventricular impairment, hypertensi
prevents the dysfunction peripheral on, CHF,
reflex (LVD) after MI vascular cardiac
tachycardia  Unlabeled uses: disease, arrhythmia
seen with most Angina (25–50 thyrotoxicosis, s,
alpha- blocking mg bid) diabetes, pulmonary
drugs and anesthesia, edema,
decreases major surgery. hypotensio
plasma renin n
activity.  GI: Gastric
Significantly pain,
reduces plasma flatulence,
renin activity. constipatio
n, diarrhea,
hepatic
failure
 Respirator
y: Rhinitis,
pharyngitis,
dyspnea
 Other:
Fatigue,
back pain,
infections
 INVESTIGATION (DIAGNOSTIC EVALUATION)
[Link]. Biochemical test Patient’s Report Normal Value
1. Hemoglobin 12.1% 14-16gm%
2. WBCcount 9000/cumm3 4000-11000/cumm
3. Neutrophil 68% 40-75%
4. Lymphocyte 26% 20-50%
5. Monocyte 00 2-10%
6. Esinophil 06 1-6%
7. Basinophil 00 <1%
8. Platlet 31600 150000-450000
9. ALT 38.0IU/L 5.0-35.0IU/L
10. AST/GOT 34 5.0-40.0IU/L
11. Sugar 96 mg/dl 65 – 140 mg/dl
12. Urea 33mg/dl 10-45mg/dl
13. Creatinine 184umol/l 40-110umol/l
14. Sodium 137mEq/l 3.6-5.5mEq/l
15. Potassium 3.8mEq/l 135-145mEq/l
 DISEASE CONDITION ON CARDIOMYOPATHY:
DEFINATION:
“Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart
muscle that makes it harder for your heart to pump blood to the rest of your
body. Cardiomyopathy can lead to heart failure.”

CAUSES:
 Often the cause of the cardiomyopathy is unknown. In
some people, however, it's the result of another
condition (acquired) or passed on from a parent
(inherited).
 Certain health conditions or behaviors that can lead to
acquired cardiomyopathy include:
Long-term high blood pressure


Heart tissue damage from a heart attack


 Long-term rapid heart rate
 Heart valve problems
 COVID-19 infection
 Certain infections, especially those that cause
inflammation of the heart
 Metabolic disorders, such as obesity, thyroid disease or
diabetes
 Lack of essential vitamins or minerals in your diet, such
as thiamin (vitamin B-1)
 Pregnancy complications
 Iron buildup in your heart muscle (hemochromatosis)
 The growth of tiny lumps of inflammatory cells
(granulomas) in any part of your body, including your
heart and lungs (sarcoidosis)
 The buildup of abnormal proteins in the organs
(amyloidosis)
 Connective tissue disorders
 Drinking too much alcohol over many years
 Use of cocaine, amphetamines or anabolic steroids
 Use of some chemotherapy drugs and radiation to treat
cancer
TYPES OF CARDIOMYOPATHY INCLUDE:
DILATED CARDIOMYOPATHY:
 In this type of cardiomyopathy, the pumping ability of
your heart's main pumping chamber — the left
ventricle — becomes enlarged (dilated) and can't
effectively pump blood out of the heart
 Although this type can affect people of all ages, it
occurs most often in middle-aged people and is more
likely to affect men. The most common cause is
coronary artery disease or heart attack. However, it
can also be caused by genetic defects.

Hypertrophic cardiomyopathy.
 This type involves abnormal thickening of your heart
muscle, which makes it harder for the heart to work. It
mostly affects the muscle of your heart's main pumping
chamber (left ventricle).
 Hypertrophic cardiomyopathy can develop at any age,
but the condition tends to be more severe if it occurs
during childhood. Most people with this type of
cardiomyopathy have a family history of the disease.
Some genetic mutations have been linked to
 hypertrophic cardiomyopathy.
Restrictive cardiomyopathy.
 In this type, the heart muscle becomes stiff and less
flexible, so it can't expand and fill with blood between
heartbeats. This least common type of cardiomyopathy
can occur at any age, but it most often affects older
people.
 Restrictive cardiomyopathy can occur for no known
reason (idiopathic), or it can by caused by a disease
elsewhere in the body that affects the heart, such as
amyloidosis.

Arrhythmogenic right ventricular dysplasia.

 In this rare type of cardiomyopathy, the muscle in the
lower right heart chamber (right ventricle) is replaced by
scar tissue, which can lead to heart rhythm problems. It's
often caused by genetic mutations.
Unclassified cardiomyopathy.
 Other types of cardiomyopathy fall into this category.
Symptoms:
 There might be no signs or symptoms in the early stages
of cardiomyopathy. But as the condition advances, signs
and symptoms usually appear, including:
Breathlessness with activity or even at rest
Swelling of the legs, ankles and feet
Bloating of the abdomen due to fluid buildup
Cough while lying down
Difficulty lying flat to sleep
Fatigue
Heartbeats that feel rapid, pounding or fluttering
Chest discomfort or pressure
Dizziness, light-headedness and fainting

MANAGEMENT:
Based on patient history, physical assessment
findings, and diagnostic study results, the cardiologist
considers the following treatment options.
 An implantable cardioverter defibrillator (ICD) is
indicated for patients at highest risk for SCD.2,29
 Beta-blockers such as atenolol can help minimize
dysrhythmias as well as reduce heart rate, thereby
increasing diastolic time to allow for better filling of the
ventricles.2,14 A slower heart rate will also decrease
myocardial oxygen demand, which helps alleviate chest
pain caused by poor coronary perfusion. Controlling
heart rate is important because increased heart rate can
worsen LVOT obstruction and decrease cardiac
output.14,30
 No dihydropyridine calcium channel blockers such as
verapamil and diltiazem can help improve ventricular
filling and may help reduce angina, DOE, and
dysrhythmias.
NURSING DIAGNOSIS:
1. Decreased cardiac output related to altered
myocardial contractility as evidenced by hypotension.
2. Acute chest pain related to decreased cardiac
contractility as evidenced by patient’s verbal note.
3. Ineffective tissue perfusion related to decreased
cardiac output as evidenced by generalized weakness
and difficulty in breathing.
4. Activity intolerance related to imbalance between
oxygen supply and demand as evidenced by
weakness.
5. Excess fluid volume related to reduced glomerular
filtration rate secondary to decreased cardiac output
as evidenced by decreased urine output.
6. Risk for impaired gas exchange related to alveolar-
capillary membrane changes.
7. Risk for impaired skin integrity as evidenced by
decreased tissue perfussion.
8. Ineffective coping (relatives) related to cognitive
perceptual changes as evidenced by difficulty asking
for help.
9. Deficient knowledge related to lack of understanding
as evidenced by questioning.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Decreased To maintain  To auscultate  Assessed the Partial
data cardiac or control apical pulse, heart rate of the changes in
Patient said, output dysrhythmias. assess heart rate patient the laboratory
“I’m not feeling related to and rhythm. HR: 68 beats/min findings.
well.” altered
Objective data myocardial  To monitor blood  Monitored BP:
Hypotension contractility pressure 94/62 mm of Hg
as
evidenced  To monitor the  Monitored urine
by urine output. output 500-600
hypotension ml.
 To administer IV
solutions as  Administered IV
indicated by the solutions as
doctor avoiding indicated by the
saline solutions doctor and
avoided saline
 To administer solutions
drugs as
prescribed by the  Administered
doctore. drugs as
prescribed by the
doctor.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Acute chest To  To assess  Assessed the Patient
data pain related demonstrate patient’s pain for extent of pain by reported
Patients said, to activities and intensity using a using pain rating reduced
“I have chest decreased behaviours pain rating scale. scale that is 6. chest pain.
pain.” cardiac that will  To provide
Objective data contractility prevent the comfort  Provided comfort
Patient’s as recurrence measures. measures for non-
verbal note of evidenced of pain. pharmacological
having chest by patient’s pain management.
pain verbal note.  To establish a  Established a quiet
quiet environment. environment to
reduce the energy
demand on the
 To elevate head of patient.
the bed.  Elevated head end
of the bed which
improved chest
expansion and
 To administer oxygenation.
analgesics as  Administered
prescribed by the analgesics as
physician. prescribed by the
physician.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Ineffective To  To assess cardiac  Assessed the Patient’s
data tissue demonstrate and circulatory status cardiac and circulation
Patient said, “I perfusion behaviours to circulatory status. improved
feel lethargic.” related to improve Presence of partially.
Objective data decreased circulation.  To monitor vital signs hypotension.
Generalized cardiac especially pulse and  Monitored vital signs
weakness and output as blood pressure. BP: 94/62 mm of HG
difficulty in evidenced  To provide oxygen HR: 68 beats/min
breathing by and monitor oxygen  Provided oxygen as
generalized via pulse oximetry. it increases the
weakness amount of available
and difficulty oxygen to
in breathing myocardium and
 To teach patient decreasing
relaxation techniques myocardial ischemia
and how to use them and pain.
to reduce stress.  Taught non-
 To instruct patient on pharmacological
eating small frequent measures such as
feedings. relaxation.
 Instructed patient to
eat small frequent
feedings to prevent
 heartburn and
indigestion.

ASSESSMENT NURSING
DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION
Subjective Ineffective To verbalize  To assess extent of  Assessed the Effective
data coping acceptance altered perception extent of altered coping was
Patient’s (relatives) of patient’s and determine perception, gained.
relative asked, related to condition. functional determining factors
“why are cognitive independence. aid in developing
these regimen perceptual plan of care for the
performed?” changes as  To determine patient.
Objective data evidenced by stressors.  Determined
Difficulty difficulty stressors to
asking for help asking for identify specific
help needs and provides
opportunity to offer
information and
 To provide begin problem
psychological solving.
support.  Provided
psychological
support to increase
sense of
confidence in
 To identify previous compliance to
methods of dealing therapeutic
with life problems. regimen.
 Identified previous
methods of dealing
which is effective
and mobilize
resources.
ASSESSMENT NURSING GOAL PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Activity To achieve  To check vital signs  Assessed vital Demonstrated
data intolerance measurable before and signs before and improved
Patient said, “I related to increase in immediately after after activity to rule activity
feel weak.” imbalance activity activity. out orthostatic tolerance.
Objective data between tolerance. hypotension.
weakness oxygen
supply and  To document  Documented
demand as cardiopulmonary cardiopulmonary
evidenced response to activity. response to
by compromised
weakness myocardium.
 To provide  Provided
assistance with self- assistance with self
care activities. -care activity.
 To assist patient
with range of motion  Assisted patient
exercise. with range of
motion exercise.
ASSESSMENT NURSING
DIAGNOSIS GOAL PLANNING IMPLEMENTATION EVALUATION
Subjective Excess fluid To  To monitor urine Monitored urine Patient’s urine
data volume demonstrate output. output of the output was
Patient said, “I related to stabilized fluid  To monitor and patient. moderately
have reduced reduced volume with calculate 24-hour  Monitored and increased.
urinary glomerular balanced intake and output calculated 24-hour
output.” filtration rate intake and (I&O) balance. intake and output
Objective data secondary to output. (I&O) balance. The
Decreased decreased output of patient is
urine output cardiac  To weigh the 500-600ml.
output as patient daily.  Weighed the
evidenced by patient daily
decreased To assess for Wt: 69 kg
urine output 
distended neck and  Assessed for
peripheral vessels. distended neck and
 To change position peripheral vessels.
frequently.  Elevated position of
the patient to
promote circulation
and prevent
prolonged
immobility.
DAILY PROGRESS REPORT:
ADMISSION DAY
Vital signs
Respiration: 22/minTemperature: 37.2 °C
Pulse: 86/min BP: 100/70 mm of Hg
• Patient diagnosis of Cardiomyopathy with Rt sided
pleural effusion was admitted in medical from medical
OPD.
• Patient came by walking. Vitals within normal range.
• Patient is conscious and well oriented to time place
and person.
• Plan for diagnostic tapping today.
• Report CBC ,Hb, ESR is to be collected.
DAY – 1
1st day of admission
Vital signs
Respiration: 20/min Temperature: 36.8° C
Pulse: 64/min BP: 100/60 mm of Hg
 • Patient’s general condition is fair. Vitals within
normal range.
• Tolerating normal diet. Normal bowel and bladder
habit.
• Patient is started ATT drugs. No any specific
complain from patient side..
• Patient’s general condition is improving.
• Saturation maintained at room air tolerating normal
diet.
• Normal bowel and bladder habit. No soakage from
tapping site.
• Patients complains of slight chest pain.
Vital signs
Respiration: 20/min Temperature: 36.8° C
Pulse: 64/min BP: 100/60 mm of Hg
• Patient’s general condition is improve.
• Vitals within normal range.
• Tolerating normal diet.
• Normal bowel and bladder habit.
• Patient give instruction about ATT drug
• No any specific complain from patient side.
DAY – 2
2nd of admission
Vital signs
Respiration: 18/minTemperature: 98.8° f
Pulse: 68/min BP: 100/60 mm of Hg
• Patient improve the condition today.
• Assist patient for morning care.
• Attend morning round.
• Ambulate the patient.
3rd day of admission
Vital signs
Respiration: 18/minTemperature: 98.8° f
Pulse: 68/min BP: 100/60 mm of Hg
• Patient improve the condition and plan of discharge.
• Discharge patient today
• Provide health education
• At the time of hospitalization, the following teaching
 was given to client and his visitor about health
promotion including

1. Personal hygiene:
• The following informal teaching related to personal
hygiene was provided:
• Trimming nail and keeping it clean.
• Washing hand before and after having food and after
defecation.
• Also frequent hand washing is necessary for infection
prevention.
• Oral hygiene and hair care is also necessary.
• wearing neat and clean dress.

2) Nutritious food:
• Encouraged for balanced diet and provided informal
teaching on its importance and sources.
3) Rest and sleep:
• Provided informal teaching regarding importance of
enough rest and sleep for patient’s recovery.
4) Infection prevention:
• Encouraged the client’s family to adopt infection
 control measures such as:
• Keeping environment clean
• Hand washing
• Washing raw vegetables and fruits properly before
consuming it.
• Drinking safe water after purifying it, taught them
about SODIS method of water purification.
• Care of the operative wound and its infection
prevention
DISCHARGE TEACHING
DISCHARGE MEDICINE:
• Tab Aspirin 75mg OD continue
• Tab Enalpril 5mg OD continue
• Carvedilol 3.125mg BD continue

At the time of discharge I was present there.

• Patient was informed about the follow up on
2068/12/15
• Patient was advised to have the prescribed medication
on proper time and dose after discharge.
• Patient was informed about the side effect of the drugs
and importance of continuation of ATT drug.
• Patient advice to be far from smoke, dust. Close the
mouth while coughing, sneezing etc
SPECIAL GAGETS USED IN MY PATIENT:
Sphygmomanometer Stethoscope
ECG monitoring X-ray machine Pulse oxymeter.
U.S G machine.

This case study gives following opportunity and knowledge

such as
• Identified the complete health need of older adult and give
nursing care
• Provide comprehensive nursing care to the adult patient.
• Assist in different type of diagnosis procedure of the
patient
• Analyze the concept and approach to nursing practice
according to trend and technology
• Identified the factors influencing nursing practice.
• Develop competency in handling various gadgets.
• Identified the plan, implement and evaluate the educational
need of the patient and patient family.
BIBLIOGRAPHY:
1. Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing Lippincott 12theditionvol-1 p-776
2. Black J.M &Hawks J.H. “Medical Surgical Nursing
Clinical Management For PositiveOutcome”, division
of Reed Elsevier India pvt ltd 8th edition ,vol -2 pgno
1392
3. Lippincott,
“ 8th Edition“manual of nursing
,Jaypee brother [Link] of the adult
4. Devidson’s “principle and practice of mrdicine” 20th
[Link] .641
5. Smeltzer. C. Suzanne, Bare. G. Brenda, “Brunner
and Suddarth’s Textbook of Medical Surgical
Nursing”, 12th edition (2010), Wolters Kluwer India
Pvt. Ltd, Page no: 574-575
6. Kumar. Parveen, Clark. Michael, “Clinical
Medicine”, 6th edition (2005), ElsevierLimited,
7. Boon. A. Nicholas, Colledge. R. Nicki,
“Davidson’s Principles and Practice ofMedicine”,
20th edition (20), Elsevier Limited
8. Mosby’s “Nursing Drug Reference” , 23rd Edition, 2010
9. Cardiomyopathy [Link]