Need Help w/ Care Map - Cardiomyopathy

tnt1985 · Feb 20, 2012

You are definitely on the right track! First, remember that cardiomyopathy is a disorder involving the structure and function of the myocardium. There are also different types of cardiomyopathy: dilated, hypertrophic, and restrictive. Clinical presentations can vary depending on the type of cardiomyopathy. It may help you to look back at the patient's past medical history to determine the cause of cardiomyopathy (i.e. idipathic; infection; toxins; pregnancy; etc.). Here are some examples of nursing diagnoses for cardiomyopathy:

* Decreased cardiac output related to decreased contractility. (Your patient's EF is 35 to 40% which signifies there is a decrease in contractility). - Dilated

* Fluid volume excess related to maladaptive compensatory mechanism resulting from decreased cardiac output. (Does your patient have dependent edema? Your patient will also most likely have decreased cardiac output due to a decrease in EF).

* Activity intolerance related to decreased tissue oxygenation.

* Deficient knowledge related to disease process, therapy, and recommended lifestyle changes. (Does the patient have a history of smoking or drinking?)

* Interrupted family processes related to change in health status and potential life-threatening situation.

* Decreased cardiac output related to pump failure. - Hypertrophic

* Decreased cardiac output related to inability of the heart to stretch and fill. - Restrictive

* Activity intolerance related to pump failure.

* Anxiety related to health alteration and recommended lifestyle changes.

Hope this helps! When I was in nursing school I found a nursing diagnosis book to be helpful. Keep up the good work!

nurseprnRN, BSN, RN · Feb 20, 2012

I've come a bit late to this party, so I haven't had a chance to say, "we don't do your homework for you," and since you have shown some of your own work, it's easier to lead you down the thought-path to more answers.

first, and biggest point: you do not you cannot make a nursing diagnosis based on a medical diagnosis. you make your nursing diagnosis based on the data you assess. some of this might include medical diagnosis or data points that the physician used to make the medical diagnosis, but there is no such chart of nursing diagnoses that you can pull up from a given medical diagnosis. you have to make your own based on the data on this patient. if for example I admit someone with diabetes, I can be reasonably sure I'll see a number of things, like, oh, altered sensation, decreased tissue perfusion, knowledge deficits, and more. but I don't put them in my nursing plan of care until I have made accurate nursing diagnoses-- they might not apply and there are bound to be others. what would you think if you sat in your physician's office and s/he came into the room, having done no exam and sent no labs, and announced, "you have leukemia. now let's get some labs to see." not cool, huh. data first, diagnosis second.

"decreased cardiac output r/t altered heart rate and rhythm aeb atrial fibrilation, anteroseptal infarction, marked st abnormality, left axis deviation, hr of 128, shortness of breath, ef of 30-40%, hypokinesis of the apex, and weakened pulses.

if I've said it once, I've said it a thousand times: the terms "related to" and "as evidenced by" should be banned from student work (and from faculty mouths) for at least two years. that's because they are confusing. what your nursing diagnosis statement should communicate is something along the lines of, "I have decided that my patient has x that is caused by y. I know this because I see data points a, b, c... ." in your example above, what you're saying is that you have diagnosed that your patient has decreased cardiac output caused by altered heart rate and rhythm, and you know that because he has (all that other stuff). that sort of doesn't hold together.

first, think about what is going on here. he has a decreased co because his heart isn't pumping well, right? you might not know yet whether it's because he has crummy contractility or what, but changes in rate and rhythm in and of themselves do not cause low cardiac output.

he has decreased cardiac output (x) because (y1) his lv isn't getting a nice packet of blood dumped into it before it contracts in systole (he has atrial fibrillation) and because (y2) his myocardium is weak (he has an infarction). you know this because you can see/measure/find in the chart these things that support your conclusions above: (a), he has af, (b) he has an ejection fraction of only 30-40%, © he has hypokinesis, (d), he has a weak pulse. does that make sense?

let's look at the next one.

ineffective breathing pattern because he has ? aeb use of accessory muscles, shortness of breath, rr of 48, insert abnormal spo2 or abgs values here, af.

"I think my patient's breathing is ineffective because he has (hint: a honking big wet chest caused by his heart failure and a lot of secretions ?smoker, pneumonia, anything else?)...... . I know this because I see/measure/read in the labs ... "

ineffective airway clearance r/t presence of secretions? aeb diminished breath sounds of the left side, crackles on the right side, productive cough, thick sputum, severe aspirations on mbss.

I don't know what mbss means, must be a local abbreviation, but this makes sense, now, doesn't it? you have decided that his airways aren't able to do their job well because they're full of secretions, and you know this because you hear them in his chest and see what junk he coughs up.

impaired verbal communication r/t decreased cognitive functioning aeb drowsiness, difficulty speaking, disorientation to person, place, time. now you're cooking. wtg.

MJ_14 · Feb 21, 2012

Haha! Thanks guys! GrnTea, I agree about the r/t, AEB usage! It can be very confusing. As for the "MBSS", that's a Modified Barium Swallow Study to assess for aspirations. Thanks for the help, it will most definitely be used! :w00t:

Esme12, ASN, BSN, RN · Feb 21, 2012

where I used to work they called it a "cookie swallow"........the mbss is to access the ability of the patient to swallow and if they are aspirating or pocketing food.

OK....first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms. let me try to help you. there are many nurses here and many who came before me to this site but one nurse stands out.....daytonite(rip)

maslow's hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization - e.g. morality, creativity, problem solving.
esteem - e.g. confidence, self-esteem, achievement, respect.
belongingness - e.g. love, friendship, intimacy, family.
safety - e.g. security of environment, employment, resources, health, property.
physiological - e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow's theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs ("d-needs") in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. abraham lincoln, thomas jefferson, albert einstein, eleanor roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient's strengths, limitations, and need for nursing interventions.

care plan basics:
every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the nanda taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. you need to have access to these books when you are working on care plans. there are currently 188 nursing diagnoses that nanda has defined and given related factors and defining characteristics for. what you need to do is get this information to help you in writing care plans so you diagnose your patients correctly.

don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. these will become their symptoms, or what nanda calls defining characteristics.

here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

now, listen up, because what I am telling you next is very important information and is probably going to change your whole attitude about care plans and the nursing process. . .a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

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care plan reality: the foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. what is happening to them could be a medical disease, a physical condition, a failure to be able to perform adls (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. therefore, one of your primary aims as a problem solver is to collect as much data as you can get your hands on. the more the better. you have to be a detective and always be on the alert and lookout for clues. at all times. and that is within the spirit of step #1 of this whole nursing process.

assessment is an important skill. it will take you a long time to become proficient in assessing patients. assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. history can reveal import clues. it takes time and experience to know what questions to ask to elicit good answers. part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. but, there will be times that this won't be known. just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

a nursing diagnosis standing by itself means nothing. the meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient. in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are.

what I would suggest you do is to work the nursing process from step #1. take a look at the information you collected on the patient during your physical assessment and review of their medical record. start making a list of abnormal data which will now become a list of their symptoms. don't forget to include an assessment of their ability to perform adls (because that's what we nurses shine at). the adls are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you. what is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient. did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list. this is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

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care plan reality: what you are calling a nursing diagnosis (ex: activity intolerance) is actually a shorthand label for the patient problem. the patient problem is more accurately described in the definition of this nursing diagnosis (every nanda nursing diagnosis has a definition).

one more thing . . .

care plan reality: nursing diagnoses, nursing interventions and goals are all based upon the patient's symptoms, or defining characteristics. they are all linked together with each other to form a nice related circle of cause and effect.

you really shouldn't focus too much time on the nursing diagnoses. most of your focus should really be on gathering together the symptoms the patient has because the entire care plan is based upon them. the nursing diagnosis is only one small part of the care plan and to focus so much time and energy on it takes away from the remainder of the work that needs to be done on the care plan.

you may also like these resources...... I strongly suggest you budget for a good care plan book as you will need it...alot! I hope this helps.

https://nursingcrib.com/nursing-care-plan/

https://www.delmarlearning.com/companions/content/0766822257/apps/appa.pdf

Esme12, ASN, BSN, RN · Feb 21, 2012

My patient's current condition that I'm using for my skeleton map is cardiomyopathy. It was noted that he has severe hypokinesis of the apex, an EF of 30-40 %, an elevated HR, etc. I have to come up with 5 diagnoses related to his condition. Here's what I've come up with.
Decreased cardiac output r/t altered heart rate and rhythm AEB atrial fibrillation, anteroseptal infarction, marked ST abnormality, left axis deviation, HR of 128, shortness of breath, EF of 30-40%, hypokinesis of the apex, and weakened pulses.
Ineffective breathing pattern r/t ? AEB use of accessory muscles, shortness of breath, RR of 48.
Ineffective airway clearance r/t presence of secretions? AEB diminished breath sounds of the left side, crackles on the right side, productive cough, thick sputum, severe aspirations on MBSS.
Impaired verbal communication r/t decreased cognitive functioning AEB drowsiness, difficulty speaking, orientation to person, place, time.
Am I on the right track here? For some reason, I'm struggling. These obviously need work and I still need one more, but suggestions are appreciated!

Do you have a NANDA care plan book? they are essential.

Now what is cardiomyopathy.

Nursing Care Plan | NCP Cardiomyopathy - Memoir of a Schizo

Cardiomyopathy, which literally means "heart muscle disease", is the deterioration of the function of the myocardium (the actual heart muscle) for any reason. People with cardiomyopathy are often at risk of arrhythmia or sudden cardiac death or both.

So your decrease in cardiac output would be evidenced by.....think symptoms, pathophysiology not medical diagnosis as Great said.

Ineffective airway clearence...why. Remember patients symptoms, lung sounds.

TNT1985 gave you great diagnosis. Good luck

Need Help w/ Care Map - Cardiomyopathy

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