NURSING PROCESS: THE PATIENT WITH PERICARDITIS
primary symptom of the patient with pericarditis is pain, which is assessed by
observing and evaluating the patient in var-ious positions. While observing the
patient, the nurse tries to dis-cover whether the pain is influenced by
respiratory movements, with or without the actual passage of air; by flexion,
extension, or rotation of the spine, including the neck; by movements of the
shoulders and arms; by coughing; or by swallowing. Recognizing the events that
precipitate or intensify pain may help establish a diagnosis and differentiate
the pain of pericarditis from the pain of myocardial infarction.
pericardial friction rub occurs when the pericardial surfaces lose their
lubricating fluid because of inflammation. The rub is audible on auscultation
and is synchronous with the heartbeat. However, it may be elusive and difficult
there is difficulty in distinguishing a pericardial friction rub from a pleural
friction rub, patients are asked to hold their breath; a pericardial friction
rub will continue.
patient’s temperature is monitored frequently. Pericardi-tis may cause an
abrupt onset of fever in a patient who has been afebrile.
on the assessment data, the major nursing diagnosis of the patient may include:
Acute pain related to inflammation
of the pericardium
on the assessment data, potential complications that may develop include:
patient’s major goals may include relief of pain and absence of complications.
of pain is achieved by having the patient rest. Because sit-ting upright and
leaning forward is the posture that tends to re-lieve pain, chair rest may be
more comfortable. It is important to instruct the patient to restrict activity
until the pain subsides. As the chest pain and friction rub abate, activities
of daily living mayresume gradually. If the patient is receiving medications
such as analgesics, antibiotics, or corticosteroids for the pericarditis, his
or her responses are monitored and recorded. If chest pain and friction rub
recur, bed or chair rest resumes.
the patient does not respond to medicalmanagement, fluid may accumulate between
the pericardial lin-ings or in the sac. This condition is called pericardial effusion . Fluid in the
pericardial sac can constrict the myo-cardium and interrupt its ability to
pump. Cardiac output de-clines with each contraction. Failure to identify and
treat this problem can lead to the development of cardiac tamponade and the
possibility of sudden death.
signs and symptoms of cardiac tam-ponade begin with falling arterial pressure.
Usually, the systolic pressure falls while the diastolic pressure remains
stable; hence, the pulse pressure narrows. Heart sounds may progress from
sounding distant to being imperceptible. Neck vein distention and other signs
of rising central venous pressure are observed. These signs and symptoms occur
because, as the fluid-filled peri-cardial sac compresses the myocardium, blood
continues to return to the heart from the periphery but cannot flow into the
heart to be pumped back into the circulation.
such situations, the nurse notifies the physician immediately and prepares to
assist with pericardiocentesis . The nurse stays with the patient and continues
to assess and record signs and symptoms while intervening to decrease the
patient outcomes may include:
Is free of pain
Performs activities of daily living
without pain, fatigue, or shortness of breath
Temperature returns to normal range
Exhibits no pericardial friction rub
Absence of complications
Sustains blood pressure in normal
Has heart sounds that are strong and
can be auscultated
Shows absence of neck vein