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35 Cards in this Set

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What is acute pericarditis?
aninflammation or alteration of the pericardium, the membranous sac that encloses the heart...
may be:
fibrous
serous
hemorrhagic
purulent
neoplastic
Acute pericarditis is most commonly associated with?
malignant neoplasms
idiopathic causes
infective organisms
(bacteria, viruses, fungi)
postmyocardial infarction
(MI) syndrome (Dresslers
syndrome)
postpericardiotomy syndrome
systemic connective tissue disease
renal failure
The cause of pericarditis determines its?
presentation
Acute viral pericarditis commonly follows a?
respiratory infection and is more common in men between 20 and 50 years of age
What is Dressler's syndrome?
occurs from 1 to 12 weeks after infarction...
postmyocardial infarction syndrome characterized by pleuritic chest pain, pericarditis,
fever,
leukocytosis
What is postpericardiotomy syndrome?
fever
pericardial friction rub
chest pain

occurs several days or weeks after cardiac surgery...syndrome appears to be an autoimmune response to damaged cardiac cells...congestive heart failure may ensue..occurs in 10% to 40% of clients after cardiac surgery
What is chronic constrictive pericarditis?
occurs when chronic pericardial inflammation causes a fibrous thickening of the pericardium

caused by:
tuberculosis
radiation therapy
trauma
renal failure
metastatic cancer

pericardium becomes rigid, preventing adequate filling of the ventricles and eventually resulting in cardiac failure
Assessment finds for pericarditis include?
substernal precordial pain that radiates to left side of neck, shoulder, or back
How is the pain described?
grating
oppressive
aggravated by brething (mainly on inspiration)
coughing
swallowing
pain is worse when patient is
in supine position and may
be relieved by sitting up
and leaning forward
Chest discomfort should be evaluated carefully to differentiate?
pericarditis from acute MI
What kind of lung sound can be heard with the diaphragm of the stethoscope positioned at the left lower sternal border?

scratchy, high-pitched sound...it is produced when the inflamed, roughened pericardial layers create friction as their surfaces rub together
pericardial friction rub....what does a pericardial friction rub sounds like?
What are the symptoms of chronic constrictive pericarditis?
symptoms of right-sided
heart failure
elevated systemic venous
pressure with jugular
distention
hepatic engorgement
dependent edema
exertional fatigue
dyspnea
What is found on echocardiography or CT scan in the pericardium?
thickening

may also be used to determine pericardial effusion
Patients with an acute pericarditis may have? (2)
elevated white blood cell
count
fever

blood culture and sensitivity may be analyzed in the lab...the electrocardiogram usually shows ST-T spiking with the onset of inflammation, which returns to baseline with treatment

atrial fibrillation is also
common
What med is usually prescribed for the pain of pericarditis while patient is being hospitalized?
NSAIDs...this med may be given for 48 to 96 hours...if not relieved and patient DOES NOT have bacterial pericarditis, then start corticosteroid therapy
The most therapeutic position to place patient in is?
sitting upright and leaning slightly forward...if the pain is not relieved within 24 to 48 hours, the nurse notifies primary care provider
There are various causes of pericarditis, so there are a variety of therapies. Bacterial pericarditis (acute) usually requires?
antibiotics
pericardial drainage....
the usual clinical course of acute pericarditis is short term (2 to 6 weeks), but episodes may recur
Chronic pericarditis caused by malignant disease may be treated with radiation or chemotherapy, whereas uremic pericarditis is treated by?
hemodialysis
The definitive treatment for chronic constrictive pericarditis is surgical incision of the pericardium which is termed?
pericardiectomy
What is a significant complication to pericarditis?
pericardial effusion
How does pericardial effusion occur?
when the space between the parietal and visceral layers of the pricardium fills with liquid
What does pericardial effusion put the client at risk for?
cardiac tamponade or
excessive fluid within
pericardial cavity
What does cardiac tamponade do?

jugular venous distention
paradoxical pulse (systolic
blood pressure 10 mm Hg
higher or more on expira-
tion than on inspiration
decreased cardac output
muffled heart sounds
circulatory collapse
restricts diastolic ventricular filling and cardiac output drops...what are the symptoms?
Define acute cardiac tamponade?
may occur when small volumes (20 to 50 mL) of fluid accumulate rapidly in the pericardium
How many mL can the pericardium hold providing it fills slowly due to cardiac tamponade?
several hundred milliliters...report suspicion of this immediately to physician
CARDIAC TAMPONADE IS AN?
EMERGENCY!!!
One of the first things the doctor will do is start?
increased fluid volume administration to manage decreasing cardiac output...a CXR or echocardiogram to confirm the diagnosis will be ordered as well...unfortunately, these tsts are not always helpful because the fluid volume around the heart may be too small to visualize
Hemodynamic monitoring in a specialized CCU usually demonstrates?
compression of the heart, with all pressures (right atrial, pulmonary artery, wedge) being similar and elevated (plateau pressures)
What is a pericardiocentesis?
relieves pressure on heart...uses a needle to withdraw fluid...blood pressure should decrease as fluid is withdrawn...monitor all pressures as procedure is being done...closely monitor patient in case tamponade returns...be prepared to provide adequate fluid volumes to increase CO...be prepared to prepare client for emergency sternotomy if tamponade recurs
Following pericardiocentesis, what if patient experiences a recurrence of tamponade or recurrent effusions or adhesions from chronic pericarditis?
a portion or all of the pericardium may need to be removed to allow adequate ventricular filling and contraction...surgeon may create a pericardial window or in severe cases remove toughened encasing pericardium (pericardiectomy)
Where is pericardial pain typically found?

inspiration
substernal...is it worse on inspiration or expiration?
Does pericardial pain increase or decrease when client leans forward?
decreases
What kind of meds may be prescribed?
anti-inflammatory (NSAIDs)
What 2 agents should be avoided because they might increase the possibility of tamponade?
aspirin
anticoagulants
What kind of blood pressure is a sign of tamponade?

systolic pressure...deflate the cuff gradually, and note when sounds are first audible on ?

inspiration...subtract inspiratory pressure from the expiratory pressure to determine the amount of pulsus paradoxus (greater than 10 mm Hg is an indication of tamponade)...
what are other signs of tamponade?
paradoxical (pulsus paradoxus)

and here's how pulsus paradoxus is auscultated:
palpate the blood pressure and inflate the cuff above the?

expiration...Identify when sounds are also audible on?

jugular venous distention with clear lungs, muffled heart sounds, decreased cardiac output...notify dr if tamponade suspected