This is an NCLEX review for pericarditis. Patients who have pericarditis are experiencing inflammation of the pericardium layer of the heart.
When taking care of a patient with pericarditis, it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, the types of pericarditis, treatments, nursing interventions, and patient education.
Don’t forget to take the pericarditis quiz.
In this NCLEX review for pericarditis, you will learn the following:
- Definition of pericarditis
- Causes of pericarditis
- Types of pericarditis
- Signs and Symptoms of pericarditis
- Nursing Interventions (treatments, patient education etc.)
NCLEX Lecture on Pericarditis
Pericarditis NCLEX Review
Definition: Inflammation of the pericardium layer of the heart.
What is the pericardium layer? It is a double layered sac filled with serous fluid that surrounds the heart which:
- helps provide a protective layer around the heart
- anchors the heart to the mediastinum
- protects the heart from infection
- keeps the heart from over expanding if fluid overload happens
- lubricates the heart while it beats
The layers are:
- Fibrous pericardium
- Serous pericardium which has two layers
- Parietal pericardium
- Serous fluid is between the parietal and visceral layer
- Visceral pericardium (also called the epicardium)
- Parietal pericardium
Causes of Pericarditis
- Illness: viral, bacterial infection
- Trauma: heart attack, heart surgery, physical injury
- Autoimmune: body causes it (ex: Lupus)
- Unknown: idiopathic
Types of Pericarditis
Acute: pericarditis that last for less than 6 weeks (most common)
Chronic: happens overtime and lasts a long time…about 6 months.
- Can lead to constrictive pericarditis: where thick tissue forms around the pericardium and this compresses the heart (the heart can’t expand to fill with blood properly). The compression causes the heart not to fill properly and this leads to heart failure.
- Also, chronic pericarditis can lead to a pericardial effusion (too much fluid around the heart) ..hence cardiac tamponade.
- Can have both: Effusion-Constrictive Pericarditis
Complications of Pericarditis
- Cardiac Tamponade: pericardial effusion causes fluid to build up around the heart and compresses it.
- Constrictive pericarditis: recurrent pericarditis causes thickening of the pericardium that leads to heart failure.
Signs and Symptoms of Pericarditis
*Friction rub pericardial (sounds like a grating, scratching sound), Fever
Radiating substernal pain to left shoulder, neck or back
*Increased pain when in supine position (leaning forward relieves pain)
*Chest pain that is stabbing (will feel like a heart attack)
Trouble breathing when lying down (supine position)
*Inspiration or coughing makes pain worse
Overall feels very sick and weak
Noticeable ST segment elevation
*most common signs and symptoms
Nursing Interventions for Pericarditis
Mild cases: just needs rest and it will go away on its own.
- Assess patient’s pain (very painful)
- Keep patient in high Fowler’s position (avoid supine) because this relieves pain
- Monitor for Cardiac Tamponade (fluid compressing the heart):
- Pulsus paradoxus (during the inspiratory phase that is a 10 or greater mmHg drop in the systolic blood pressure)
- Jugular venous distention with clear lungs
- Heart sounds are muffled (fluid buildup on the heart
Administer medications as prescribed by physician:
- Aspirin OR
- NSAIDS (nonsteroidal anti-inflammatory medications) Ibuprofen…watch for GI bleeding..take with a full glass of water
- Colchicine: decreases the inflammation (used in gout) don’t take with grapefruit juice because this increases toxicity (nausea vomiting, abdominal pain, (can take it with or without food)
- Corticosteriods: used if patient not responding to other treatments…Prednisone..decreases the inflammation
- IV antibiotics for infection
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