Unit 2 and 3 Chapter 32 Pericarditis, Cardiac Tamponade

Question 1

What is Pericarditis?

Answer 1

is an inflammation or alteration of the pericardium (the membranous sac that encloses the heart). The problem may be fibrous,serous, hemorrhagic, purulent, or neoplastic. Acute pericarditis is most commonly associated with:

Question 2

What can cause Pericarditis?

Answer 2

• Infective organisms (bacteria, viruses, or fungi) (usually respiratory)
• Post–myocardial infarction (MI) syndrome (Dressler syndrome)
• Postpericardiotomy syndrome
• Acute exacerbations of systemic connective tissue disease (Marfan Syndrome)

Question 3

What are the s/s of Pericarditis

Answer 3

-pericardial friction rub; This scratchy, high- pitched sound is produced when the inflamed, roughened pericardial
-pain in supine position
-pain in include substernal precordial pain that radiates to the left side of the neck, the shoulder, or the back
-wbc elevation
-fever
-a fibrillation
-st elevation on EKG on ALL 12 leads

Question 4

What is the medical tx for afib

Answer 4

-Warfarin

normal w/o use;0.9-1.2
with use -2-3

Question 5

What is the medication of use to reverse the effect of warfarin if the PT 65

Answer 5

Vitamin K

Question 6

What does the treatment plan consist of for a person dx with Pericarditis

Answer 6

-NSAIDs-to reduce inflammation , pai mngmt works in 48 hours
-assist the client position to provide comfort
-DO NOT administer aspirin or anticoags can induce tamponade
-corticorsteroids

Question 7

What should you monitor for when taking steroids
A. hyperglycemia
B.hypoglycemia
C. WBC 7,000
D. hypertention

Answer 7

A. hyperglycemia

Question 8

Which of the following positions relieves the pericardial pain that is associated pericarditis
A.supine
B.prone.
C.trensdelenburg
D.leaning forward or tripod

Answer 8

D.leaning forward or tripod

The pain is worse when the patient is in the supine position and may be relieved by sitting up and leaning forward.

Question 9

What are the different types of Pericarditis?

Answer 9

-Bacterial pericarditis
-Chronic pericarditis
-Uremic pericarditis
-Chronic constrictive pericarditis

Question 10

Tx for bacterial pericarditis?

Answer 10

bacterial pericarditis (acute) usually requires antibiotics and pericardial drainage. The usual clinical course of acute pericarditis is short term (2 to 6 weeks), but episodes may recur.

Question 11

Tx for Chronic Pericarditis

Answer 11

Chronic pericarditis caused by malignant disease may be treated with radiation or chemotherapy,

Question 12

Tx for Uremic Pericarditis

Answer 12

uremic pericarditis is treated by hemodialysis

Question 13

Tx for Chronic constrictive pericarditis i

Answer 13

surgical excision of the pericardium (pericardiectomy)

Question 14

What are the two complications that can occur with Pericarditis

Answer 14

• Pericardial effusion
  -Cardiac tamponde
  ^MEDICAL EMERGENCY

Question 15

What is Pericardial Effusion?

Answer 15

Pericardial effusion occurs when the space between the parietal and visceral layers of the pericardium fills with fluid.

Question 16

What does Pericardial Effusion put your patient at risk for?

A. crackles in the lungs
B. splinter hemmroges
C. pink frothy sputum
D. Cardiac Tamponde

Answer 16

D. Cardiac Tamponde

This complication puts the patient at risk for cardiac tamponade, or excessive fluid within the pericardial cavity.

Question 17

What is Cardiac Tampnde

Answer 17

Excessive fluid in the pericardium space or cavity

Question 18

Is Cardiac Tamponde a medical emergency?
A. Yes
B. No

Answer 18

A. Yes

Question 19

What are the S/s of Cardiac Tamponde?

Answer 19

Jugular vein distention
Clear lungs
Muffles heart tones
pulses paradoxes
-decreased cardiac output
(4-8ML per min is normal)
-Tachycardia
-Hypotention
-decrease O2 sat
-Decrease CO

Question 20

What is Pulsus paradoxes

Answer 20

Pulsus paradoxus ( BP more than 10 mm HG higher on expiration
than inspiration

Example you Bp is 120/80 on expiration

on Inspiartion your BP in 99/59

Question 21

What is the tx for Cardiac tamonde

Answer 21

Oxygen
*Volume expansion with fluid admin
* Bed rest with leg elevation
* Dobutamine (increase pump without increasing
SVR)
* Avoid using PEEP with MV (decreases venous
return)
Pericardiocentisis
Percutaneous Surgical window

Question 22

What is the medical intervention for Decreased CO for a patient with Cardiac Tamponde ?

Answer 22

The health care provider may initially manage the decreased CO with increased fluid volume administration while awaiting an echocardiogram or x-ray to confirm the diagnosis.

Question 23

What is Pericardiocentis used to treeat? and what is it?

Answer 23

To treat Cardiac Tamponde**

The health care provider may elect to perform a pericardiocentesis to remove fluid and relieve the pressure on the heart

Question 24

Which of the following is expected outcome after Pericardiocentesis?

A. Negative Jugular vein distention
B. decreased CO
C. present muffled heart tones
D. systolic bp more 20mm on expiration

Answer 24

A. Negative Jugular vein distention

After Pericardiocentesis:

The pressures should return to normal as the fluid compressing the heart is removed, and the signs and symptoms of tamponade should resolve.

Question 25

Nursing Considerations Post op Pericardiocentesis?

Answer 25

ASSESS FOR CARDIAC TAMPONDE IT MAY REOCCUR

• After the pericardiocentesis, closely monitor the patient for the recurrence of tamponade.
• Pericardiocentesis alone often does not resolve acute tamponade.
• Be prepared to provide adequate fluid volumes to increase CO and to prepare the patient for surgical intervention if tamponade recurs.

Question 26

If Cardiac Tompnde reoccurs frequently what may be the procedure of choice?

Answer 26

Pericardectomy

If the patient has a recurrence of tamponade or recurrent effusions or adhesions from chronic pericarditis, a portion or all of the pericardium may need to be removed to allow adequate ventricular filling and contraction.

Question 27

What is the function of the Pericarial Window?

Answer 27

The surgeon may create a pericardial window, which involves removing a portion of the pericardium to permit excessive pericardial fluid to drain into the pleural space. In more severe cases, removal of the toughened encasing pericardium (pericardiectomy) may be necessary.