Dilated Cardiomyopathy: Manifestations (Nursing)

00:00 Now let's look at what it looks like are the clinical manifestations.

00:04 That means, what are the symptoms? What are the cues that you should be looking for? Now, this is the clinical judgment measurement model that the NCLEX is based on.

00:14 This is meant to help you think like a nurse and make safe clinical judgments.

00:20 Layer 3 is where you really want to zero in.

00:22 Recognize cues, analyze cues, prioritize hypothesis, generate solution, take actions and evaluate outcomes.

00:29 Those may sound like kind of boring, educationally objective kind of words, but they're actually an excellent framework for you to study.

00:37 When you're thinking about problems with the heart, what are the types of cues you should be looking for? How do you analyze those and put them together and prioritize the hypothesis? Then what solutions or ideas for treatment would you generate? Then you do those things and you evaluate if they have worked well or not.

00:56 So, that's how the measurement model is used in your practice, and where they will draw test questions from on your NCLEX exam.

01:04 So, back to that picture of the heart.

01:06 We've got that sliced off left hand side, so you can see what it looks like.

01:12 We've got a location of our mitral valve there, so you know where it is. This is a normal heart.

01:18 We're starting back from there and this is dilated cardiomyopathy.

01:22 This picture really helps you see why it's called dilated cardiomyopathy. That ventricle is also dilated.

01:29 And if it's overstretched, it's not going to pump as efficiently.

01:33 Remember that left ventricle is what pushes blood out to the rest of the body.

01:39 So, if it's been overworked, and overstretched, now, it's at the point where it cannot, it's not strong enough anymore, to push blood out efficiently or adequately to the rest of the body.

01:51 Then we also have issues with valves.

01:53 Alright, the valves don't close very well.

01:55 Well, why is that such a big deal? Think about the purpose of a valve.

02:02 It opens and closes in systole and diastole, to keep blood moving through the heart in an organized manner, from the right side to the lungs, to the lungs back to the left side out to the rest of the body.

02:14 If the valves don't close all the way there inefficient blood is going to back up to in appropriate places.

02:21 And that's why it's really important when the valves are impacted, this will cause difficulties and symptoms for your patient.

02:29 You see if that valve doesn't fully close, you see that instead of blood going from the left ventricle, all out through the aorta, some of it is going to back up into the left atrium.

02:40 That's where the mitral valve is on the left side of the heart.

02:43 So now, we don't just have a left ventricle that's dilated.

02:46 Now look at that left atrium is also becoming dilated and big.

02:51 Now, the worst case scenario with the left side of the heart not pumping efficiently, is that fluid is going to back up, right? Like we saw it back up into the left atrium, then it's going to back up into the lungs, and you're going to end up with pulmonary edema.

03:07 Now, this makes it very difficult for a patient to breathe.

03:11 It makes it difficult for them to exchange oxygen for CO2.

03:15 So pulmonary edema is very serious.

03:17 You can see it on an X-ray, you can hear it with your stethoscope.

03:21 You'll hear crackles as long sounds.

03:23 Remember to always listen to the back in the basis.

03:27 That's where it usually develops first, particularly if the patient is lying down or is in bed.

03:31 So, what's the worst thing? Some people in heart failure, like the have swollen ankles, Thats no fun. Sometimes they don't feel really good physically about eating.

03:40 That's no fun, but they're not going to cause immediate damage.

03:45 Someone in pulmonary edema is going to have immediate impact on their overall body systems because their tissues are not going to get the oxygen that they need to function.

03:55 So, we're going to show you this visually. You see it? There you go. Kind of filling up the lungs for you to think visually, that when that left ventricle is not strong enough, it can lead to pulmonary edema.

04:08 Now, pause the video, and I want you to write out why.

04:10 How does a left ventricle that's weakened end up causing pulmonary edema? Then restart the video and we'll move on to the next point.

04:27 Hey, welcome back.

04:30 I hopefully you took the opportunity to do that because those little stop quick study breaks will really help this sink into your brain so you can retrieve it when you need it.

04:40 So, what do you think it feels like to have pulmonary edema? Well, we have the ugly word right there. Dyspnea.

04:47 -Pnea means breathing or air. Dys- means difficulty.

04:53 So, this is difficulty with breathing.

04:56 And you know why? Right? Because we have a client whose lungs are are filled with extra fluid because the left ventricle couldn't push enough blood around.

05:05 So, patient has this and have severe pulmonary edema.

05:10 They have what's called Orthopnea.

05:12 They cannot lay down or lay flat, because they'll feel like they are drowning.

05:17 So, people who are in significant fluid volume overload will always want to be straight up.

05:22 Otherwise, it feels like they are drowning.

05:25 So, orthopnea is kind of an extreme shortness of breath when laying down, particularly when pulmonary edema is involved.

05:32 They might have chest pain. Now why? Why would I look for this cue? Why would I be looking for chest pain with somebody with cardiomyopathy? Remember, this heart is weakened.

05:44 And anytime a heart has to work harder than the amount of oxygen they're receiving they can start to have chest pain.

05:52 Now, it can start as ischemia.

05:54 But you know that ischemia tells you, "Hey, I'm not getting enough oxygen." Ischemia can turn into infarcted tissue, if it progresses.

06:03 So, you're picturing in your mind, what does it look like with somebody who has cardiomyopathy? Well, externally, they're going to have difficulty breathing when they're fluid volume overload.

06:14 And we know internally, that's because of pulmonary edema.

06:18 They're going to have chest pain, and they're going to tell you, "Ah, feel like it was crushing pain on my chest." We know internally, that's because the heart is being worked harder than the oxygen, it's being supplied and that's why they're having chest pain.

06:32 Now, because they're having these symptoms or short of breath, or having chest pain, they might also feel very dizzy.

06:39 That's a sign that their brain is not being perfused enough.

06:42 When your brain is not being profuse enough, you might not only just feel dizzy, but they're going to get really irritable because their brain is telling them, "Whoa, this is not good.

06:50 Unless we do something we're going to die." Now, some people can even develop syncopal episodes.

06:56 That's not as common, but the dizziness and agitation, yeah.

07:00 If you feel like you can't breathe, you're going to get real agitated, because it's that sense of fear or impending doom.

07:08 Another place you can look is at the jugular vein.

07:11 Now, if the jugular vein is distended, meaning it's sticking out of the neck.

07:16 When you assess that appropriately, that's another sign that your fluid volume overloaded.

07:21 That's why everything backing up, right, left atrium, can't push it out.

07:26 So, left ventricle cannot push out to the rest of the body pushes back up through the left atrium to the lungs.

07:32 It's backing up on the right side of the heart, all the way out through to the jugular vein.

07:37 Now, it's going all throughout the body.

07:39 But this is just one visible sign on the outside of what is going on on the inside.

07:45 Remember the peripheral edema we talked about? Yeah, it's going to continue to keep backing up, backing up, and you're going to have extra fluid in the feet, particularly if the patient is sitting up or the legs are lower than the heart.