Dilated cardiomyopathy, commonly referred to as DCM, is a condition whereby the heart’s ability to pump blood is reduced due to weakened muscles. It is caused by a weakened, or enlarged, left ventricle. In some cases of the condition the heart does not relax as it should, hence it does not get filled with blood as it should. Many people with DCM do not show obvious signs or symptoms and live normal day-to-day lives, except for a few minor symptoms. Others may develop symptoms that progressively become conspicuous with the worsening of the heart condition. The symptoms, which may appear at any age, include the swelling of the lower limbs, weight gain, shortness of breath, fatigue, palpitations, fainting, lightheadedness or dizziness, chest pains or pressure and sudden death. There are a number of subscriptions for management of this condition. DCM can be defined as idiopathic when its appearance is isolated to a single family member, or sporadic and without a known cause. On the other hand, it is defined as familial if it occurs in more than one related members from the same family (Davis & Edwards, 2014).

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1. Section I
Summary of the Scenario
A 40-year old man who has a history of dilated cardiomyopathy (DCM) comes in for a visit seeking care for “shortness of breath, which has worsened in the last 3-5 days, and swollen lower limbs”. He also reported regular feeling of tiredness and fatigue. The patient who attended a wedding the previous weekend has since had his weight up 5 pounds. The man is on various subscription drugs for treating heart failure. The drugs include Lasix, Coreg and Lisinopril. The patient attended a wedding in the past one week and the weight has gone up 5 pounds.

2. Section II
Focused Assessment
Subjective:
The 40-year old man has a history of DCM. In evaluating the condition, the patient’s history must be assessed in relation to the following risk factors and/or comorbidities: hypertension, alcohol use, myopathy, valvular heart disease, thyroid disease, substance abuse history, rheumatic fever and collagen vascular disease, history of chemotherapy, dyslipidemia, diabetes and pheochromocytoma. For the patient, a careful assessment of his medical history, including asymptomatic first-degree relatives is required. Special focus should be on arrhythmias, syncope, presyncope and other heart failure symptoms (Mestroni et.al., 2012). Genetic evaluations for the disease include asymptomatic at-risk first degree relatives known to carry DCM-causing mutation(s) must be screened at intervals (for cardiomyopathy). Screening of at-risk first relatives in whom mutation for the disease has not been found, or who have not been subjected to genetic testing, before has to be done.

Objective
Genetic evaluation can be complex. It is important to quantify the clinical assessment of cardiac failure. Breathlessness or shortness of breath was reported by the patient. It is a sign of failure of the left ventricle. Shortness of breath (known as dyspnea) may manifest itself with increasing severity of orthopnea, dyspnea at rest, exertional dyspnea, paroxysmal nocturnal dyspnea and acute pulmonary edema. This condition can, however, sometimes be harmless when it is as a result of nasal congestion or exercise (Mestroni et.al., 2012). Swelling of the lower limbs particularly the ankles is a sign of weakened left ventricle. During physical examination, signs of volume overload and heart failure are checked with specific attention on tachycardia, Tachypnea, hypertension and/or hypotension. Include other important observations and findings like hypoxia signs (clubbing and cyanosis), enlarged liver, pulmonary edema, peripheral edema and jugular venous distension (JVD).

3. Section III
Health Promotion Strategies Taught to the Client
There are a number of health promotion strategies that should be taught to the patient with shortness of breath and swollen ankles. These signs are manifestations of dilated cardiomyopathy. The following strategies must therefore be taught to the client:
• Be active physically. The results of activeness can be seen in improved status of health and decreased symptoms of depression. There are no safety concerns from regular exercise.
• Limit alcohol. Heavy alcohol consumption must be discouraged in the patient. The man should not take more than drinks per day. If the DCM condition is alcohol-related, then the patient must stop the habit completely.
• Eat wisely. The patient with DCM requires studies/knowledge on the ideal sodium restriction levels. This helps improve control of blood pressure. Dietary sodium that is recommended is 2-3g per day. This is based on consensus.
• Manage stress and maintain a healthy weight.
• Strive for a healthy weight. Obesity increases the risk of death in DCM. It is important to manage weight in order to control diabetes and such-like weight-related conditions. Weigh-in regularly to keep track of changes in weight.
• Be involved in your own health. Self-management/self-care is a crucial aspect of DCM care. It includes following recommendations for exercise, managing medications, adhering to dietary recommendations such as salt intake, alcohol and fluid intake, monitoring symptoms on daily basis, monitoring the state of emotions. Self-care challenges include depression and anxiety and low literacy. Promoters of self-care on the other hand include: social support, behavioral change, skill development and systems of care.
• Go for recommended screening tests and immunization (Davies & Edwards, 2014). The recommended ones for the patient include a yearly influenza immunization and pneumococcal immunization. The latter is administered once at diagnosis and then repeated at the age of 65.
• Be tobacco free. It is important that if the patient uses tobacco, he/she quits. Use of tobacco increases the risk of DCM and mortality from the condition. Nicotine can worsen hemodynamics as it has vasoconstrictor activity. There are tobacco-cessation aids available.

Moreover, there are specific considerations to make. There are developmental and cultural considerations that must be made (Jarvis, 2016). The patient probably lives with members of his family and/or other people with different cultures. Different people have different cultures, behaviors and beliefs. As a result of interaction with other people, culture is dynamic and changes constantly. It is therefore imperative to put into considerations the cultural set up of the patient. To know this, the client should be asked about his health practices, beliefs and values.

    References
  • Davies, B. & Edwards, N. (2014). RNs measure effectiveness of best practice guidelines.
    Registered Nurse Journal, 16(1), 21-23.
  • Jarvis, C. (2016). Physical examination & health assessment. St. Louis, Mo: Elsevier.
  • Mestroni L, Maisch B, McKenna WJ, Schwartz K, Charron P, Rocco C, Tesson F, Richter A,
    Wilke A, Komajda M. Guidelines for the study of familial dilated cardiomyopathies. Eur Heart J. 2012;20:93–102. doi: 10.1053/euhj.2011.1145.