Special report: Nursing diagnoses and interventions for a child with dilated cardiomyopathy requiring intra-aortic balloon pump support--case report.

OBJECTIVE: The study aims to identify the nursing diagnoses and interventions for a child requiring intra-aortic balloon pump support. METHODS: This was a case study of a 7-year-old child. The nursing diagnoses and interventions were obtained by three cardiology and pediatric specialist nurses, familiar with NANDA-International and Nursing Intervention Classification taxonomies. RESULTS: Many nursing diagnoses and interventions were identified, but the main diagnosis for this patient was decreased cardiac output. CONCLUSIONS: The nursing care for a child with an intra-aortic balloon requires well-qualified professionals, prepared to handle the diagnoses and interventions identified in this study. PRACTICAL IMPLICATIONS: The use of a standard language system is essential to guide professionals in the caring process, providing essential elements to optimize interpretations.

Monitorização eletrocardiográfica ambulatorial por 24-horas em cães com cardiomiopatia dilatada idiopática / Twenty-four-hour ambulatory electrocardiographic monitoring in dogs with idiopathic dilated cardiomyopathy

Caracterizou-se monitorização eletrocardiográfica ambulatorial por 24 horas (ou monitorização Holter) em cães com cardiomiopatia dilatada idiopática, visando principalmente à detecção de arritmias ventriculares não detectadas pela eletrocardiografia convencional (de repouso). Para tanto, avaliaram-se 40 pacientes com diagnóstico de cardiomiopatia dilatada idiopática, por meio de exame físico e mensuração indireta da pressão arterial, além de exames eletrocardiográfico, ecocardiográfico, radiográfico de tórax e da monitorização Holter. Extra-sístoles ventriculares foram detectadas, por monitorização Holter, em 97,5 por cento dos animais e taquicardia ventricular, em 45 por cento. Não houve correlação entre o número de extra-sístoles ventriculares e a fração de encurtamento. Considerando as manifestações clínicas, apenas houve associação entre presença de taquicardia ventricular e histórico de síncopes. Conclui-se que a incidência de arritmias ventriculares em cães com cardiomiopatia dilatada idiopática é bastante alta, sendo a taquicardia ventricular relativamente freqüente, ocorrendo mais sob a forma não sustentada

This study aimed to characterize 24-hour ambulatory electrocardiographic monitoring (Holter monitoring) in dogs with idiopathic dilated cardiomyopathy. Physical examination and indirect (Doppler) blood pressure measurement, and also electrocardiography, thoracic radiography, echocardiography, and 24-hour ambulatory electrocardiographic exams were performed in 40 dogs with idiopathic dilated cardiomyopathy. Ventricular extrasystoles were detected in 97.5 percent of the animals, and ventricular tachycardia in 45 percent. No correlation between the number of ventricular extrasystoles and the shortening fraction was observed. Concerning the clinical symptoms, there was only association between the presence of ventricular tachycardia and past report of syncope. It was concluded that the incidence of ventricular arrhythmias is high in dogs with dilated cardiomyopathy, being ventricular tachycardia, mostly non-sustained, relatively frequent

Symptoms and management options in cardiomyopathy.

Cardiomyopathy is the most common cause of sudden cardiac death in young people, including trained athletes (Maron et al, 1996). Often the tragedy of sudden death is the first indication of its presence within a family. This article describes the four types of cardiomyopathy, diagnosis, treatment and management options, and discusses ways in which the new National Service Framework for Coronary Heart Disease (Department of Health, 2005) will help in planning and implementing services.

Unconventional applications in pacemaker therapy.

Since its inception, the principal application of permanent pacing has been for the correction of symptomatic bradycardia. During the past 3 decades, pacemaker therapy indications have evolved, through scientific research and through advances in technology, beyond conduction system disorders and sinus node dysfunction. This article presents recent progress in the application of permanent pacing in hypertrophic obstructive cardiomyopathy, dilated cardiomyopathy, paroxysmal atrial fibrillation, neurocardiogenic syncope, and in long-QT syndrome. In each clinical entity, certain pacing parameters are crucial for achieving the therapeutic goal. Advanced practice clinicians will encounter these patients in practice and are urged to recognize the therapeutic goal and optimal function of the device.

Listening for the patient's story. The psychosocial story of a patient with end-stage heart disease.

1. The way patients make sense of their lives can be heard in the stories they tell. 2. Nurses should address the patient's experience as well as the patient's disease. 3. Listening carefully to patients gives nurses valuable tools for intervening in their lives. 4. Medical illnesses extend far beyond the biological processes.

Cocaine-induced cardiovascular dysfunction: a case study.

This article focuses on the authors' experience with a 25-year-old female patient exhibiting cocaine-induced cardiovascular dysfunction. A care plan is provided that emphasizes the patient's need for assistance with individual coping.

Psychosocial adjustment of patients and spouses to severe cardiomyopathy.

Severe cardiomyopathy (SCM) imposes considerable psychosocial stress on families; however, little is known about the effect of SCM from the point of view of the marital couple. In this study, adjustment to SCM of 90 patients and their spouses was compared. Patients reported more vocational, domestic, and sexual problems than spouses. Spouses reported more problems in health care orientation, family relationships, and psychological distress than patients. The findings indicate that severe cardiomyopathy impacts on the psychosocial integrity of both partners. Therefore, one should plan interventions to support spouses as well as patients. Because problems of spouses and patients may differ, both partners should be assessed to appropriately target interventions.

Evaluating oxygen delivery and oxygen utilization with mixed venous oxygen saturation monitoring: a case study approach.

Three cases studies are presented to demonstrate clinical application of mixed venous oxygen saturation (SvO2) monitoring in critical care nursing practice. Examples of critically ill patients are used to demonstrate how SvO2 monitoring can be used in clinical practice to reflect an imbalance between oxygen delivery and oxygen utilization. In the first case, the patient had a problem with oxygen delivery. Continuous SvO2 data aided nurses in guiding, adjusting, and assessing therapy. The second case demonstrates how SvO2 monitoring can provide an early sign of a life-threatening complication. The final case is one in which the patient had a problem with oxygen utilization. In all the cases, continuous SvO2 data provided important information about the balance between oxygen delivery and oxygen utilization.

Advances in the treatment of dilated cardiomyopathy.

The nursing care of the patient with dilated cardiomyopathy focuses on (1) improving right and left heart function, i.e., titrating vasoactive drugs to maintain acceptable cardiac index with minimum side effects (and/or monitoring the operation of a left ventricular assist device when left heart function is refractory to vasoactive drugs), (2) reducing cardiac filling pressures with diuretics, vasodilators, and/or restriction of dietary sodium, oral and IV fluids, (3) maintaining optimum oxygenation, (4) preventing complications associated with either the disease or treatment, and (5) assisting the patient/family to maintain hope during the often lengthy and crisis-filled wait for a donor heart. The critical care nurse is challenged, often for weeks or months at a time, by the complexity of this patient's physical and emotional needs and functions in a collaborative role with the entire health team in an attempt to maintain both cardiovascular and psychological stability until a donor heart is available.

Peripartum cardiomyopathy.

Peripartum cardiomyopathy is a rare and devastating disease of unknown etiology that manifests between the last trimester of pregnancy and five postpartum months. This disease often is confused with many other illnesses, and even with hemodynamic changes in normal pregnancy. Pathophysiology, signs, and symptoms of this unique cardiomyopathy are presented and case studies offered. Since outcome of this disease is directly related to duration of the illness, nurses must be aware of the symptoms and investigate them immediately. The nurse must support the patient and involve the family and social services in the patient's recovery.