Primary Nursing Diagnosis

Decreased cardiac output related to a reduced mechanical function of the heart muscle or valvular dysfunction

OUTCOMES. Cardiac pump: Effectiveness; Circulation status; Tissue perfusion: Abdominal organs and peripheral; Vital sign status; Electrolyte and acid base balance; Endurance; Energy conservation; Fluid balance

INTERVENTIONS. Cardiac care; Circulatory care: Mechanical assist device; Fluid/electrolyte management; Medication administration; Medication management: Oxygen therapy; Vital signs monitoring

U PLANNING AND IMPLEMENTATION Collaborative

The primary goal of treatment of myocarditis is to eliminate the underlying cause. Patients admitted to the hospital are placed in a coronary care unit where their cardiac status can be observed via cardiac monitor. Oxygenation and rest are prescribed in order to prevent dysrhyth-mias and further damage to the myocardium. Apply intermittent compression boots, as prescribed, to prevent the complications of thrombophlebitis.

Congestive heart failure responds to routine management, including digitalization and diuresis, although patients with myocarditis appear to be particularly sensitive to digitalis. Observe for signs of digitalis toxicity such as anorexia, nausea, vomiting, blurred vision, and cardiac dys-rhythmias. Patients with a low cardiac output state, which is commonly associated with severe congestive heart failure, require serial monitoring of cardiac filling pressures; a flow-directed pulmonary artery catheter has the capability of measuring cardiac output. With severe heart failure, dobutamine appears valuable because of its inotropic effects with limited vasoconstrictor and arrhythmogenic properties. Intractable congestive cardiac failure or shock, or both, in a patient with acute myocarditis may indicate the need for temporary partial or total cardiopul-monary bypass and eventual cardiac transplantation.

Pharmacologic Highlights

Medication or

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