Restrictive Cardiomyopathy: Assessment and Care (Nursing)

00:02 Now, symptoms, you can also see there'll be a systolic heart murmur and an S3 Gallop.

00:06 We've kind of got a graphic picture for you.

00:08 But I recommend that you listen to actual heart tones to help you understand what this would actually sound like.

00:14 [heart tone sound] Remember, we said right sided heart failure, you can end up with hepatomegaly.

00:27 How that works is, it's all backing up to the right side.

00:31 And what's right down here is your liver.

00:33 So, that's an easy way to remember it is this backing up on the right side of the body is going to involve the liver. Can live with hepatocmegaly.

00:41 because all those extra blood and fluid that's backed up, and you end up with that peripheral edema as a sign of right sided failure.

00:49 Think about the pictures of the left ventricular wall being like stiff and fibrotic.

00:54 Looking like that brick wall, you already know that if the left ventricle is going to have things back up, it's going to back up that left atrium into the lungs and so you can assess your patient for signs of pulmonary edema.

01:08 Easy way to do that is by listening with your stethoscopes.

01:13 You can auscultation crackles.

01:15 If you hear crackles, there is pulmonary edema.

01:18 Now, labs that you would look at are things that tell you how is the heart functioning? And elevated BNP means that heart is being overstretched and overworked. That is a bad sign.

01:29 You can look at an ECG. You might see tachycardia at rest, because you're really working hard. You could see atrial fibrillation.

01:37 That's one of the most common dysrhythmias or you might see an atrial ventricular block.

01:42 Why? things are just not able to move through the heart.

01:46 The electrical impulses.

01:47 You've had changes to the wall into the tissue, and that can make it more difficult for that electrical impulse to flow smoothly through the heart.

01:56 If you have the opportunity to have a patient with cardiomyopathy, you always want to take a look at their echocardiogram report.

02:04 Let's take a look at you actually see changes from this test.

02:08 So, if you look at the results, what you would expect with somebody with restrictive cardiomyopathy is the left ventricle would be normal in size.

02:16 But it's going to have a bit of a thickened wall.

02:18 It's also going to have a dilated right ventricle.

02:22 That's all that stuff backing up and dilated atria, because that left ventricle is causing things to back up.

02:31 You're going to end up with dilating the other chambers of the heart.

02:37 So, we've talked about the cues that you should recognize.

02:40 We've kind of analyzed them put them together.

02:42 So, we've come to the point where you're prioritized the hypothesis that you think this patient clearly has restrictive cardiomyopathy.

02:49 What are the things we can do to help this patient? Well, like other forms of cardiomyopathy, we want to treat the symptoms.

02:57 We want to decrease pulmonary and systemic venous congestion, because that will aid the patient and being able to be more comfortable and to be able to breathe. So, what our goals are? Is we're going to decrease pulmonary and systemic venous congestion, right? That extra fluid making up.

03:13 We want to decrease venous pressure, and we want to slow the heart rate down so we can control the filling time.

03:22 Remember, they have diastolic dysfunction.

03:24 So if we can slow that heart rate down will allow more time for that chamber to fill.

03:30 So, beta-blockers are an obvious choice. right? They can help us increase the ejection fraction, because they will directly decrease the rate of the heart, and it's going to help us increase filling time.

03:41 Calcium channel blockers can do the same thing.

03:44 Specific calcium channel blockers that decrease the rate of the heart.

03:48 They control the heart rate, and that will also help us increase the filling time.

03:53 Diuretics will help us with fluid volume overload and pulling out any extra fluid.

03:59 ACE inhibitors can also be used in selective cases.

04:02 And that will be decided by the clinical healthcare team led by a physician, nurse practitioner, or PA.

04:09 Warfarin is a really old school drug.

04:12 But the purpose of doing that is this patient is at an increased risk for developing clots.

04:18 So, you want to put a patient or consider having the patient on warfarin, so you minimize the risk of them developing a clot.

04:25 Particularly if they have a dysrhythmia like atrial fibrillation.

04:29 Now, we can also put a pacemaker or an implanted cardioverter defibrillator into the patient, just like we talked about in previous cardiomyopathy treatments.

04:38 Heart transplant, as we have discussed is the end stage treatment for this type of cardiomyopathy.

04:46 We've talked about some pretty significant treatments that would need to be ordered by a healthcare provider.

04:50 But there are lots of things that you can do as the nurse caring for this client.

04:56 You can do individualized teaching based on their manifestations.

05:00 What are the biggest problems for this patient? Get creative.

05:03 Don't just hand them the sheet that comes from the hospital.

05:06 Think about the things that are important to the patient, what they want to do.

05:10 Help them determine what they want to save their energy for, if they're really having a severe exacerbation.

05:16 Now, you want to watch them very closely for signs of fluid overload.

05:20 And you want to teach them how to do the same thing.

05:23 Help them to monitor how severe their dyspnea is, if they notice changes in their weight.

05:28 There's all the signs and symptoms you can treat that they can do at home.

05:32 So they know when to alert their healthcare provider that they're starting to get into a little bit of trouble.

05:37 Now, this client might need supplemental oxygen.

05:40 So you can work with the assessment of that, and getting that order through the healthcare provider.

05:45 And if they're in a hospital, working with discharge services to make sure that arrives at their home.

05:50 Everyone needs to stay as active as as safely possible for them no matter what disease process they're experiencing.

05:58 So, listen to the client. Figure out what they enjoy doing, take a look at their symptoms and make a collaborative decision with the client at the center and all the healthcare team members as to what are the signs and symptoms that would indicate this is appropriate activity for the client, or it's starting to get them into trouble.

06:18 Now, like anyone else, we also want them to avoid stress, avoid alcohol, particularly excessive alcohol and completely avoid tobacco, if possible.

06:26 Because as you educate the patient on the importance of all of these plans, don't make it your plan.

06:33 Make sure that they understand these are lifestyle changes that they have the right to choose to implement.

06:40 No one likes to be told what to do.

06:42 And some of the things we're going to have to adjust our lifestyle are going to be very difficult.

06:46 So be patient, just walk with the patient one step at a time as they make healthier choices, day by day.

06:54 So, providing emotional support kind of is a weird, kind of a touchy issue, right? While they're in the hospital, that's an appropriate position for the nurse to do at the bedside.

07:04 But you don't want to be their source of emotional support.

07:08 You want to help them to develop strong support systems, whether you're reaching out for resources or support groups, but help them develop the kind of support systems that can be with them after they're discharged from the hospital and out in the community.

07:23 So that's it. That's an overview of restrictive cardiomyopathy.

07:28 Remember, even though is the least common type of cardiomyopathy, it's a big deal and impact on a patient's daily life.

07:37 You can help them make the best choices to enjoy their quality of life.

07:41 So, thanks for watching this video series with us today and join me in the next video.