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Nursing 172 > Week 8: Chp 30: Pericarditis > Flashcards

Week 8: Chp 30: Pericarditis Flashcards

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1
Q

What is pericarditis?

A

inflammation of the pericardium

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2
Q

Epidemiology

A
  • not related to ischemia
  • 80% of cases are idiopathic (unknown etiology) or are presumed to occur after viral infection
  • acute pericarditis is common following MI
  • low mortality rate
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3
Q

How can pericarditis be categorized?

A

-infectious (viral, bacterial, fungal, parasitic)
-noninfectious (autoimmune, neoplastic, metabolic, trauma, and drug related)
idiopathic
>acute, chronic, or recurrent

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4
Q

Pathophysiology of Pericarditis

A

When the pericardium becomes inflamed

  • the heart is surrounded by two-layered pericardium, which protects the heart, reduces friction with surrounding structure, and helps to determine chamber size and pressure
  • the tough, fibrous outer wall is the parietal pericardium
  • the inner is the visceral pericardium, or epicardium
  • the space between the pericardium and the epicardium contains 20 to 60 mL of pericardial fluid; the fluid acts as a lubricant to prevent friction between the 2 layers
  • When the pericardium becomes inflamed, it is termed pericarditis
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5
Q

The heart is surrounded by what?

A

a two-layered pericardium

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6
Q

What does the pericardium do?

A

protect the heart, reduces friction with surrounding structures, and helps determine chamber size and pressure

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7
Q

What are the two-layers of the pericardium?

A
  • Parietal pericardium: the tough, fibrous outer wall

- Visceral pericardium/ epicardium: inner wall

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8
Q

What is between the parietal pericardium and visceral pericardium/epicardium?

A

pericardial fluid; acts as a lubricant to prevent friction between the two layers

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9
Q

Clinical Manifestations

A
  • pleuritic chest pain (most common); tends to be relieved by sitting up and leaning forward
  • auscultation of friction rub (scratchy sound heard with each heartbeat)
  • new or worsening pericardial effusion
  • ECG changes: diffuse ST-segment elevations or PR depressions
  • fever
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10
Q

Tests For Diagnosis

A
  • ECG
  • Chest x-rays
  • echocardiogram (transthoracic or transesophageal)
  • cardiac CT scan
  • MRI
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11
Q

Diagnosis: Electrocardiogram (hallmark changes)

A

hallmark ECG changes include widespread ST-segment elevation or PR segment depression

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12
Q

Diagnosis: Chest x-ray

A

the finding of cardiomegaly (enlarged heart) and clear lung fields may indicate pericardial effusion (fluid build up in the pericardial sac) and might be supportive of pericarditis

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13
Q

Pericardial Effusion

A

fluid buildup in the pericardial sac

  • may be found on a chest x-ray
  • might be supportive of pericarditis
  • might also be evident on an echocardiogram, CT scan, or MRI
  • complication of pericarditis
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14
Q

Laboratory Tests

A
  • Serial cardiac biomarkers to rule out MI
  • positive blood cultures
  • a CBC with a high WBC count
  • positive inflammatory markers such a C-reactive protein or
  • sedimentation rates may indicate presence of infection or inflammation, leading to the diagnosis of pericarditis when combined with the clinical manifestations
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15
Q

Medication Goals

A

alleviate pain and stop the inflammatory process

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16
Q

Medications Used

A
  • Aspirin and other NSAIDSs are indicated
  • Colchicine may be used as an additional anti-inflammatory with acetylsalicylic acid (ASA) or NSAIDs
  • If pain or inflammation is not relieved by ASA or NSAID, corticosteroids may b used
  • antimicrobial therapy might be used if bacterial pericarditis
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17
Q

Complications

A
  • pericardial effusion (accumulation of fluid in the pericardial space exceeding the typical 20 to 60 mL)
  • pericardial fluid may accumulate slowly (ie. neoplastic), allowing pericardium to stretch to accommodate the increased volume; clinical symptoms progress; rapidly growing effusions overwhelm the stretching capacity of the pericardium, resulting in acute decompensation; if not treated emergently, the increased fluid volume within the pericardial space can exert pressure on the heart resulting in cardiac tamponade
  • Cardiac tamponade
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18
Q

Pericardial effusion is diagnosed by

A

chest x-ray, echocardiography, and ECG

19
Q

Depending on the volume of excess fluid and clinical presentations what may be indicated?

A

pericardiocetesis

20
Q

Pericardiocentesis

A

this may be indicated depending on the volume and clinical manifestations from excess fluid
-ultrasound guides needle insertion through the chest wall to aspirate the excess fluid

21
Q

Complication: Cardiac Tamponade

A

the excessive fluid in the pericardial sac compresses the cardiac structures and dramatically decreases cardiac output

  • common signs: dyspnea, tachycardia, pulsus paradoxus, JVD, an enlarged heart, and muffled heart tones
  • Beck’s triad is the classic finding of hypotension, muffled heart sounds, and JVD (emergent pericardiocentesis)
22
Q

Pulsus Paradoxus

A

abnormal drop in systolic BP during inspiration

23
Q

Surgical Management of pericardial effusions and cardiac tamponade

A

-pericardial window; in which a window or fistula is created to drain excess fluid from the pericardial space

24
Q

Nursing Management: Assessment and Analysis

A
  • the major clinical manifestations of pericarditis is pain due to friction between the inflamed layers of the heart that occurs with movement
  • Excessive accumulation of fluid, or pericardial effusion, can result in acute decompensation due to the increased pressure around the heart limiting ventricular filling and contraction, resulting in decreased cardiac output
25
Q

The major clinical manifestations of pericarditis is pain due to what?

A

friction between the inflamed layers of the heart that occurs with movement

26
Q

Excessive accumulation of fluid, or pericardial effusion, can result in acute decompensation due to what?

A

the increased pressure around the heart limiting ventricular filling and contraction, resulting in decreased CO

27
Q

Nursing Diagnosis

A
  • chest pain r/t swelling and inflammation secondary to pericarditis
  • risk for decreased cardiac output r/t cardiac structure compression
28
Q

Nursing Interventions: Assessment

A
  • vital signs
  • pain
  • auscultate heart sounds
  • ECG
29
Q

Assessment: Vital Signs

A

hypotension, tachycardia, tachypnea, and pulsus paradoxus are indicative of cardiac tamponade, which is due to an excessive or sudden buildup of pericardial effusion
-fever is indicative of an ongoing infection

30
Q

Assessment: Pain

A

chest pain that is relieved by sitting up and leaning forward distinguishes pericarditis pain from the pain associated with an MI

31
Q

Assessment: Auscultate Heart Sounds

A

a friction rub is a common finding of pericarditis

-muffled heart tones may indicate pericardial effusion or cardiac tamponade

32
Q

Assessment: ECG

A

-ST-elevation or PR depression in all or most leads can be associated with pericarditis

33
Q

Friction rub

A

scratchy sound heard with each heart beat

  • a result of the friction between the inflamed layers of the pericardium when the heart moves within the pericardial sac
  • best heard over the left sternal border at the end of expiration with the patient leaning forward
  • it produced a high-pitched, scratchy noise and is muffled when excess fluid is present
34
Q

How is the chest pain relieved?

A

by sitting up and leaning forward

35
Q

Nursing Interventions: Actions

A
  • keep the head of the bed elevated
  • administer NSAIDs or ASA and colchicine medications as prescribed
  • provide emotional support
36
Q

Nursing Action: Keep the head of the bed elevated

A

pericardial effusion exerts pressure on the surrounding organs resulting in orthopnea (SOB when lying down) and dyspnea

  • raising the head of the bed relieves SOB
  • pain is also relieved by sitting in the upright position
37
Q

Nursing Actions: Administer NSAIDs or ASA and colchicine medications as prescribed

A

pain relating to pericarditis is associated with inflammation, so control is largely managed with anti-inflammatories
-steroids are added if necessary

38
Q

Nursing Actions: Provide emotional support

A

anxiety can occur because of the fear that the pain is from a heart attack

39
Q

Teaching

A
  • avoid strenuous activity until symptoms resolve or laboratory values return to normal
  • distinguish between the pain of pericarditis and heart attack
40
Q

Teaching: Avoid strenuous activity until symptoms resolve or lab values return to normal

A

activity restrictions may reduce the risk of sudden cardiac death, which is rare but has been reported

41
Q

Teaching: distinguish between the pain of pericarditis vs heart attack

A

ensures patient will seek help appropriately

42
Q

Primary goal of care

A

pain relief

-early recognition and management of pericardial effusions are also important factors in the care of these patients

43
Q

Well-Managed patient

A
  • free from pain, SOB and indicators of cardiac tamponade
  • Ensuring the patient and family is knowledgeable about the signs and treatment of the disease as well as indicators of pericardial effusion is necessary to avoid the negative consequences associated with cardiac tamponade

Nursing 172 (120 decks)

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