16.12: Pericarditis IV: Nursing Management

Pericarditis, an inflammation of the pericardium, necessitates diligent nursing management to ensure effective patient care and recovery. The initial step in managing pericarditis is a comprehensive patient medical assessment.

The patient reports chest pain aggravated by breathing, coughing, and swallowing, which worsens when lying supine. The pain often improves when sitting up and leaning forward. Additional symptoms may include fever, malaise, and, in severe cases, signs of heart failure. Objective findings include:

• An increased temperature and white blood cell count.
• Signs of heart failure.
• Possible ST-elevation on an electrocardiogram.
• Decreased oxygen saturation (SpO2).

Physical Examination

During the physical examination, the nurse should be vigilant for specific signs of pericarditis. Auscultation may reveal a characteristic pericardial friction rub, indicative of pericardial inflammation. Additionally, signs and symptoms of cardiac tamponade, such as muffled heart sounds, narrow pulse pressure, pulsus paradoxus, jugular venous distention (JVD) with clear lungs, and decreased cardiac output, should be observed. Additional symptoms to check include fever and malaise.

Nursing Diagnoses

Based on the assessment, nurses can formulate several pertinent diagnoses:

1. Acute pain related to the inflammatory process of bacterial pericarditis, as evidenced by a chest pain score of 10 out of 10, guarding signs, and shortness of breath.
2. Ineffective breathing pattern related to hyperventilation, evidenced by dyspnea and pain aggravated by the supine position and inspiration.

Nursing Interventions

Effective nursing interventions are vital for managing pericarditis.

• Bed rest is recommended to reduce cardiac workload. The head of the bed should be elevated to 45 degrees to facilitate breathing. An overbed table allows the patient to lean forward, alleviating discomfort and pain.
• Education plays a pivotal role in management. It encompasses advice on a balanced diet, regular exercise, adequate rest, and avoiding alcohol, all of which can mitigate symptoms and promote recovery.
• Administer prescribed pain medication with food or milk to prevent gastrointestinal upset, a common side effect.
• Ensure patients brush their teeth twice daily to maintain good oral hygiene, which supports overall cardiovascular health.
• Nurses caring for patients with pericarditis must be alert to the signs and symptoms of cardiac tamponade and monitor the patient for heart failure. Patients with hemodynamic instability or pulmonary congestion should be treated as if they had heart failure.

The nurse must continuously assess the patient's interventions, adjusting the care plan as necessary.