643
Chapter 30 Coordinating Care for Patients With Cardiac Disorders
V1
V4
I
aVR
V2
V5
II
aVL
aVF
V3
V6
III
IV
ST elevation PR depression
FIGURE 30.6 Electrocardiogram illustrating ST elevation and PR depression associated with pericarditis.
of pericardial tamponade include dyspnea, tachycardia, pulsus paradoxus, JVD, an enlarged heart, and muffled heart tones. Pulsus paradoxus is an abnormal drop in systolic blood pressure during inspiration. Beck’s triad is the classic finding of hypotension, muffled heart sounds, and JVD but is only present in 10% to 40% of cases of tamponade. Emergent pericardiocentesis is indicated in this clinical presentation. Surgical management of peri- cardial effusions and cardiac tamponade may include a pericardial window or pericardiectomy, in which a win- dow or fistula is created to drain excess fluid from the pericardial space. Recurrent pericarditis and constrictive pericarditis are also complications. Nursing Management Assessment and Analysis The major clinical manifestation 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. Nursing Diagnoses/Problem List z Chest pain related to swelling and inflammation secondary to pericarditis z Risk for decreased cardiac output related to cardiac structure compression Nursing Interventions ■ Assessments z Vital signs 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.
z Pain Chest pain that is relieved by sitting up and leaning forward distinguishes pericarditis pain from the pain associated with MI. z Auscultate heart sounds. A friction rub is a common finding in pericarditis. Muffled heart tones may indicate pericardial effusion or cardiac tamponade. z ECG ST elevation or PR depression in all or most leads can be associated with pericarditis. ■ Actions z Keep the head of the bed elevated. Pericardial effusion exerts pressure on surrounding organs, resulting in orthopnea (shortness of breath when lying down) and dyspnea. Raising the head of the bed relieves shortness of breath. Pain is also relieved by sitting in the upright position. z Administer NSAIDs, colchicine, and other medications as prescribed. Pain relating to pericarditis is associated with inflammation, so control is largely managed with anti-inflammatories. Steroids are added if necessary. z Provide emotional support. Anxiety can occur because of the fear that the pain is from a heart attack. ■ Teaching z Avoid strenuous activities until symptoms resolve or laboratory values return to normal. Heart rate should be kept to 100 beats per minute (bpm) or less. Activity restrictions may reduce the risk of sudden cardiac death and recurrence of inflammation. z Distinguish between the pain of pericarditis and heart attack. Ensures patient will seek emergency help appropriately.
Powered by FlippingBook