what arer the nursing interventions for myocarditis?
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Treatment is supportive, aimed at promptly recognizing and treating cardiac arrhythmias, preserving myocardial function, and preventing heart failure and other complications, such as dilated cardiomyopathy. Supportive care includes bed rest and avoiding strenuous exercise until the ECG returns to normal. Diuretics, angiotensin-converting enzyme inhibitors, and sodium restriction are indicated if heart failure develops.
If an underlying autoimmune disease is a factor, the patient may receive steroids or immune globulin to reduce inflammation. Anticoagulation therapy may be indicated to treat cardiovascular problems, such as an MI or a thrombus. Depending on the underlying cause of his myocarditis, he also may receive antibiotics or antiviral medications, although this hasn't proven beneficial in most cases.
Monitor for worsening symptoms, the patient may require vigorous diuresis, mechanical ventilation, and a pacemaker. If severe cardiomyopathy develops, treatment options include a left-ventricular assist device and heart transplant.
If the underlying cause of myocarditis is Lyme disease or another bacterial infection, the patient will receive antibiotics as indicated. Monitor for arrhythmia development, especially in the acute phase.
Provide supplemental oxygen, limiting myocardial oxygen demand, and enhancing circulatory support and cardiac output if needed. Patients who develop heart failure may be treated with angiotensin-converting enzyme (ACE) inhibitors, diuretics, and sodium restriction. Anticoagulation may be indicated to reduce the risk of thrombosis and pulmonary embolism. In more severe cases of myocarditis, the patient may need inotropic support with such intravenous drugs as dobutamine.
Myocarditis appears to make patients sensitive to digoxin. If your patient is taking digoxin, monitor him for toxicity. Intravenous immunoglobulin may be given to enhance the immune system and limit the disease. In severe cases, the patient may need heart transplantation.
During the acute phase of myocarditis, keep the patient on bed rest because activity increases myocardial oxygen demand. Teach him about his medications and when he can resume activities and exercise.
Depending on the presence and extent of myocardial damage, the patient may fully recover or be left with chronic heart failure. Before discharge, explain any activity limitations or diet restrictions and teach him how to recognize the signs and symptoms of heart failure. Tell him to contact his cardiologist or dial 911 immediately if symptoms worsen.
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Myocarditis is an uncommon disorder caused by viral infections such as coxsackie virus, adenovirus, and echovirus. It may also occur during or after various viral, bacterial, or parasitic infections (such as polio, influenza, or rubella).
Treatment includes evaluation and treatment of underlying cause. This may require use of antibiotics, reduced level of activity, and low-salt diet. Steroids and other medications may be used to reduce inflammation. Diuretic medicines are also given to remove body water via the urine.
If the heart muscle is very weak, standard medicines to treat heart failure are also used. Abnormal heart rhythm may require the use of additional medications, a pacemaker or even a defibrillator. If a blood clot is present in the heart chamber, blood thinning medicine is given as well.
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