Uncompressed cardiomyopathy: case report and proposal for systematization of nursing care

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ORIGINAL ARTICLE

SCALIA, Luiza da Cruz [1], BRASILEIRO, Marislei Espíndula [2]

SCALIA, Luiza da Cruz. BRASILEIRO, Marislei Espíndula. Uncompressed cardiomyopathy: case report and proposal for systematization of nursing care. Revista Científica Multidisciplinar Núcleo do Conhecimento. 04 year, Ed. 10, Vol. 13, pp. 53-62. October 2019. ISSN: 2448-0959

SUMMARY

Uncompressed cardiomyopathy (MCN) is a type of malformation related to genetic factors that can result in severe hemodynamic changes. We report the case of a patient who was initially diagnosed with arrhythmia and was treated with amiodarone. Approximately 2 years after initial diagnosis, the presence of NCM through an mri was confirmed, and the diagnosis of arrhythmia was ruled out. Drug treatment was then modified to beta-blocker, angiotensin conversion enzyme inhibitor (ACEI) and cumarinic. Emphasis on cardiovascular and respiratory components was emphasized in nursing diagnoses. Results and implementations were proposed that could improve physical and family comfort.

Keywords: Uncompressed cardiomyopathy, systematization of nursing care.

1. INTRODUCTION

Uncompressed cardiomyopathy (NCM) is a rare disease, which is probably still developed in embryo formation due to genetic factors, in which myocardial trabeculations are formed with recesses between them and muscle density in two different parts. The disease, when symptomatic, can cause dyspnea, heart failure, chest pain and chronic atrial fibrillation (ROSA et al, 2011). According to Martins et al (2018) the incidence of the disease in the population is 0.014 to 1.3%, affecting individuals of any sex and age group.

MNC, often worsens with cases of systole and diastole insufficiency, and may result in congestive heart failure (FRIEDMANN, 2017). Considering that an intensive care unit (ICU) is a sector where critical patients who require continuous monitoring and specialized care are inserted, it is necessary to consider the possibility of treatment of NCM in an ICU, depending on the stage of the disease.

To care for these patients, nurses use the Systematization of Nursing Care (SAE), which organizes professional work regarding the method, personnel and instruments, making it possible to operationalize the Nursing Process. (COFEN, 2009)

Also according to COFEN Resolution 358/2009, the Nursing Process (PE) is a methodical instrument of work of the nursing professional in which care is divided into 5 deliberate, systematic stages and that relate to each other. They are: collection of nursing data (history), nursing diagnosis, nursing planning, implementation and nursing evaluation. The PE should be effected in all public or private institutions where nursing care occurs.

The interest in presenting the present work is to provide greater knowledge about the disease and facilitate the practice of nursing care, contributing to a better performance of nurse professionals. It is believed that this Proposal of NcS will singularly direct customer service, and will be guided by MNC.

2. GOAL

The objective of this work is to propose a complete application of SAE for the patient mentioned in the case report of uncompressed cardiomyopathy.

3. METHOD

The selected method consisted of a case report accessed through advanced search on the Virtual Health Library (VHL) platform, using the following descriptors: case report and heart disease. The filters used were: full text (available), type of study (case report), language (Portuguese) and year of publication (from 2013 onwards). This case report was selected because it is a current study and because it approaches a rare disease, thus enabling a special increase in knowledge.

Reports are the detailed description of clinical cases, containing important characteristics on the patient’s signs, symptoms and other characteristics and reporting the therapeutic procedures used, as well as the case denolace. They have clear indication in situations of rare diseases, for which both diagnosis and therapy are not clearly established in the scientific literature. (OLIVEIRA, VELARDE, SÁ, 2015, p. 236)

Thus, the report below was accessed at an e-mail address. [3]

4. CASE REPORT

This is a 34-year-old female patient who, approximately 10 years ago, presented repeated episodes of tachycardia associated with precordialgia, receiving a diagnosis of arrhythmia and being treated with amiodarone.

Nine years ago, she became pregnant and with 16 weeks of gestation she presented tachycardia associated with presyncope, with physical examination within normal limits. In this period i was not using antiarrhythmic. Admitted to the emergency care service of Gynecology and Obstetrics, she was hospitalized and evaluated by Cardiology, receiving hospital discharge after a few days with prescription of metoprolol 25 mg.

In routine consultation, after delivery, the patient complained of precordialgia that persisted for 18 months, presyncope, dyspnea and sweating; abnormalities were not observed. At that moment, mnc mnc was suspected, being requested echodopplercardiogram, whose conclusion was as follows: contractile function of the preserved left ventricle and mitral and aortic insufficiencies of discrete grade. In the following months, in consultation for reassessment, the patient complained again of chest pain associated with dyspnea. Then, bisoprolol was prescribed 5 mg, keeping amiodarone 200 mg; also, she was referred for cardiac magnetic resonance imaging in order to confirm NCM and remove possible dysplasia from the right ventricle.

Six months later, the hypothesis of right ventricle dysplasia was ruled out and the existence of NCM was confirmed. In view of the diagnosis of NCM, the patient initiated follow-up through imaging tests (echocardiogram and 24-hour Holter system annually, associated with recurrent cardiac magnetic resonance imaging (CMR) and the following pharmacological therapy: beta-blocker (carvedilol 6.25 mg, replacing bisoprolol by persistence of symptomatology), angiotensin conversion enzyme inhibitor (ACEI) (enalapril 10 mg) and cumarínico (warfarin 5 mg), used daily. Antiarrhythmic (amiodarone 200 mg) was suspended due to abnormalities in thyroid function.

According to the echocardiogram, there was progression of the disease with worsening of the ejection fraction, mild contractile dysfunction of the left ventricle associated with low-key pulmonary arterial hypertension and tricuspid valve insufficiency, in addition to insufficiencies pre-existing mitral and aortic. However, pulmonary hypertension was not observed in the last examination and there was a slight improvement in the ejection fraction (EF=48%).

The most recent cardiac magnetic resonance presented discrete dilation of the left ventricle, preserved biventricular systolic function, increased myocardial trabeculation of the left ventricle, predominantly lateral basal and diffuse middle Apical.

5. PROPOSAL FOR SYSTEMATIZATION OF NURSING CARE

Nursing diagnoses – NANDAPlanning – Expected Results – NOCNursing interventions – NIC
Impaired gas exchange characterized by dyspnea associated with imbalance in the perfusion ventilation ratio.The patient will present improvement in respiratory status.
  • Monitor frequency, rhythm, depth, effort in breathing and O2 saturation.
  • Institute oxygen therapy at 2l/min in case of dyspnea and/or SpO2< 96%.></ 96%.>
Decreased cardiac output related to tachycardia, dyspnea and decreased ejection fraction, associated with alteration in contractility.The patient will present increased efficacy of the cardiac pump and improves cardiopulmonary status
  • Evaluate chest pain regarding location, intensity and precipitating factors.
  • Monitor patient tolerance to activity.
  • Guide the patient on the importance of immediately informing any discomfort in the chest.
  • Avoid situations that cause intense emotions.
Ineffective respiratory pattern characterized by pain-related dyspnea.The patient will present improvement in ventilation.
  • Monitor the occurrence of dyspnea and events that improve or worsen.
Risk of unstable blood pressure associated with hypothyroidism/hyperthyroidism.The patient will maintain blood pressure within physiological parameters.
  • Teach the patient and the family to monitor respiratory rate and blood pressure.
Risk of impaired maternity associated with physical illness.The patient will receive family support during treatment.
  • Teach health care and nursing plans to the family.
  • Determine the patient’s emotional, physical, psychosocial and spiritual support needs and initiate measures to satisfy them if necessary.
Chronic pain defined by self-report of pain characteristics associated with genetic disorder.The patient will experience a decrease in the level of pain associated with sleep quality.
  • Implement comfort measures such as massage and positioning.
  • Help eliminate stressful situations before bedtime.
  • Adapt environment to promote sleep.
Impaired comfort defined by feeling of discomfort associated with symptoms related to disease.The patient will present a decrease in the level of discomfort.
  • Give immediate attention to the calls, always keeping the bell at hand’s reach.
  • Create a calm and supportive environment.
  • Provide relevant and useful educational resources on the treatment of the disease.
Risk of dysfunctional gastrointestinal motility associated with pharmaceutical agent.The patient will present reduced gastrointestinal motility dysfunction.
  • Guide the patient to record color, volume, frequency, consistency of feces.
Risk of decreased cardiac tissue perfusion associated with hypertension.The patient will maintain vital signs within the appropriate parameters.
  • Monitor and record blood pressure, heart rate, temperature, respiratory pattern and 4/4-hour O2 saturation.
  • Identify possible causes of changes in vital signs.
  • Monitor heart leaflets and record changes.
Risk of deficient fluid volume associated with pharmaceutical agent.The patient will maintain adequate fluid volume.
  • Guide soft toothbrush use for oral care.
  • Guide the patient and family members on signs of bleeding and appropriate actions.
  • Guide the patient to avoid aspirin or other anticoagulants.

Source: the authors

6. FINAL CONSIDERATIONS

At the end of the study it was possible to realize that when we are faced with a cardiac patient, a detailed physical examination and anamnesis by the nursing team is necessary, considering that it will be from this information that will be established the necessary intervention. The attention and understanding of the collected data are extremely important, because in a heart disease, nonspecific signs and symptoms are likely to arise, and the ability to association between them is indispensable.

The objective of the present study was achieved, which was to elaborate a proposal of SAE for the clinical case reported, aiming at scientifically based nursing care that involves the patient and his/her family members holistically. It is expected to put the suggestion of SAE into practice in the future.

7. REFERENCES

ARAGÃO, J. et al. O perfil epidemiológico dos pacientes cardiopatias congênitas submetidos a cirurgia no Hospital do Coração. João Pessoa: Revista Brasileira de Ciências de Saúde, 2013. Disponível em: <http://periodicos.ufpb.br/ojs2/index.php/rbcs/article/view/13221>

BRASIL, Resolução COFEN-358/2009. Sistematização da Assistência de Enfermagem e a implementação do Processo de Enfermagem em ambientes, públicos ou privados, em que ocorre o cuidado profissional de Enfermagem. Disponível em: <http://www.cofen.gov.br/resoluo-cofen-3582009_4384.html>

BULECHEK, G. M; BUTCHER, H. K; DOCHTERMAN, J. M. NIC: Classificação das intervenções de enfermagem. Tradução de Soraya Imon de Oliveira et al. 5 ed. Rio de Janeiro: Elsevier, 2010.

FRIEDMANN, Antonio. Cardiomiopatia não compactada. São Paulo. 2018. Disponível em: <http://docs.bvsalud.org/biblioref/2018/04/882160/rdt_v23n1_15-18.pdf >

MARTINS, T; ARAKAKI, R; BONINI, R. Miocardiopatia não compactada: um relato de caso na região de Presidente Prudente. São Paulo: Revista da Sociedade de Cardiologia do Estado de São Paulo, 2017. Disponível em: <http://socesp.org.br/revista/edicao-atual/miocardiopatia-nao-compactada-um-relato-de-caso-na-regiao-de-presidente-prudente/67/63/>

MAGALHÃES, M. et al. Ventrículo esquerdo não compactado: causa rara de transplante cardíaco. Portugal: Revista Portuguesa de Cardiologia, 2016. Disponível em: <http://www.revportcardiol.org/pt-pdf-S0870255115002334>

MOORHEAD, S. et al. NOC: Classificação dos resultados de enfermagem. Tradução de Regina Machado Garcez et al. 4 ed. Rio de Janeiro: Elsevier, 2010.

NANDA INTERNATIONAL. Diagnósticos de enfermagem da NANDA-I: definições e classificação 2018-2020. Tradução de Regina Machado Garcez. Porto Alegre: Artmed, 2018.

OLIVEIRA, M; VELARDE, G; SÁ, R. Entendendo a pesquisa clínica V: relatos e séries de casos. Rio de Janeiro: Revista Femina – Febrasgo, 2015. Disponível em: <http://files.bvs.br/upload/S/0100-7254/2015/v43n5/a5320.pdf >

ROSA, L. et al. Miocardiopatia não compactada – uma visão atual. São Paulo: ABC Cardiol Journal, 2011. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0066-782X2011000900021>

3. http://socesp.org.br/revista/edicao-atual/miocardiopatia-nao-compactada-um-relato-de-caso-na-regiao-de-presidente-prudente/67/63/.

[1] Specializing in Adult ICU from the Pontifical Catholic University of Goiás; Graduated in Nursing from the Pontifical Catholic University of Goiás.

[2] PhD in Health Sciences from the Federal University of Goiás; PhD in Religion Sciences from the Pontifical Catholic University of Goiás; Master’s degree in nursing from the Federal University of Minas Gerais; Specialized in Educational Planning from Salgado de Oliveira University; Graduated in Nursing from the Federal University of Goiás.

Submitted: October, 2019.

Approved: October, 2019.

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