Pericarditis

PERICARDITIS

Pericarditis is an inflammation of the pericardium.

1. Acute pericarditis: may be dry or may cause excessive fluid accumulation in the pericardial space.

2 Chronic pericarditis: fibrous thivkening of the visceral and parietal pericardium; thickening inhibits cardiac filling during systole.

Assessment

1. Risk factors/iology

   1. Acute.

      1. Infection.

      2. Myocardial Injury.

      3. Hypersensitivity (collagen diseases, systematic lupus erythematosus, drug reactions).

      4. Renal failure.

2. Clinical Manifestations.

   1. Acute.

      1. Precordial pain.

      2. Pericardial friction rub caused by myocardium rubbing against inflamed pericardium.

      3. Pain increases with respiration; sitting may relieve pain.

   2. Chronic: symptoms are characteristic of gradually occurring CHF; chest pain is not a prominent symptom.

3. Diagnostics (acute and chronic).

   1. ECG changes.

   2. increased WBCs.

   3. History of precipitating causes.

   4. CT scan.

Complications.

1. Pericardial effusion resulting in cardiac tamponade.

_{PA and lateral close-ups show thick pericardial calcification around
apex of heart from patient with history of tuberculous pericarditis}

Treatment

1. Acute episode.

   1. Treat underlying problem.

   2. Bed rest.

   3. Antiinflammatory medications.

   4. If pleural effusion and tamponade occur, then pericardiocentesis (aspiration of fluid from the pericardial sac) is performed.

Nursing Intervention

• GOAL: To maintain homeostasis and promote comfort.

1. Assess characteristics of pain; administer appropriate analgesics.

2. Upright position, with client leaning forward, may relieve the pain.

3. Decrease anxiety, because client often associates problem with an MI; assist client to distinguish the difference.

4. Observe for symptoms of cardiac tamponade.
   -Paradoxical blood pressure: precipitous decrease in systolic blood pressure on inspiration.
   -CVP increased; presence of jugular venous distention.
   

-Heart sounds are muffled or distant.
-Narrowing pulse pressure.

5. In a client with chronic pericarditis, evaluate for symptoms of CHF and initiate nursing intervention.