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35 Cards in this Set
- Front
- Back
What is acute pericarditis?
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aninflammation or alteration of the pericardium, the membranous sac that encloses the heart...
may be: fibrous serous hemorrhagic purulent neoplastic |
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Acute pericarditis is most commonly associated with?
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malignant neoplasms
idiopathic causes infective organisms (bacteria, viruses, fungi) postmyocardial infarction (MI) syndrome (Dresslers syndrome) postpericardiotomy syndrome systemic connective tissue disease renal failure |
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The cause of pericarditis determines its?
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presentation
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Acute viral pericarditis commonly follows a?
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respiratory infection and is more common in men between 20 and 50 years of age
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What is Dressler's syndrome?
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occurs from 1 to 12 weeks after infarction...
postmyocardial infarction syndrome characterized by pleuritic chest pain, pericarditis, fever, leukocytosis |
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What is postpericardiotomy syndrome?
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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 |
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What is chronic constrictive pericarditis?
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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 |
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Assessment finds for pericarditis include?
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substernal precordial pain that radiates to left side of neck, shoulder, or back
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How is the pain described?
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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 |
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Chest discomfort should be evaluated carefully to differentiate?
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pericarditis from acute MI
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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?
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What are the symptoms of chronic constrictive pericarditis?
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symptoms of right-sided
heart failure elevated systemic venous pressure with jugular distention hepatic engorgement dependent edema exertional fatigue dyspnea |
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What is found on echocardiography or CT scan in the pericardium?
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thickening
may also be used to determine pericardial effusion |
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Patients with an acute pericarditis may have? (2)
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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 |
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What med is usually prescribed for the pain of pericarditis while patient is being hospitalized?
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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
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The most therapeutic position to place patient in is?
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sitting upright and leaning slightly forward...if the pain is not relieved within 24 to 48 hours, the nurse notifies primary care provider
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There are various causes of pericarditis, so there are a variety of therapies. Bacterial pericarditis (acute) usually requires?
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antibiotics
pericardial drainage.... the usual clinical course of acute pericarditis is short term (2 to 6 weeks), but episodes may recur |
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Chronic pericarditis caused by malignant disease may be treated with radiation or chemotherapy, whereas uremic pericarditis is treated by?
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hemodialysis
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The definitive treatment for chronic constrictive pericarditis is surgical incision of the pericardium which is termed?
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pericardiectomy
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What is a significant complication to pericarditis?
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pericardial effusion
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How does pericardial effusion occur?
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when the space between the parietal and visceral layers of the pricardium fills with liquid
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What does pericardial effusion put the client at risk for?
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cardiac tamponade or
excessive fluid within pericardial cavity |
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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?
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Define acute cardiac tamponade?
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may occur when small volumes (20 to 50 mL) of fluid accumulate rapidly in the pericardium
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How many mL can the pericardium hold providing it fills slowly due to cardiac tamponade?
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several hundred milliliters...report suspicion of this immediately to physician
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CARDIAC TAMPONADE IS AN?
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EMERGENCY!!!
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One of the first things the doctor will do is start?
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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
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Hemodynamic monitoring in a specialized CCU usually demonstrates?
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compression of the heart, with all pressures (right atrial, pulmonary artery, wedge) being similar and elevated (plateau pressures)
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What is a pericardiocentesis?
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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
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Following pericardiocentesis, what if patient experiences a recurrence of tamponade or recurrent effusions or adhesions from chronic pericarditis?
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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)
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Where is pericardial pain typically found?
inspiration |
substernal...is it worse on inspiration or expiration?
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Does pericardial pain increase or decrease when client leans forward?
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decreases
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What kind of meds may be prescribed?
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anti-inflammatory (NSAIDs)
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What 2 agents should be avoided because they might increase the possibility of tamponade?
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aspirin
anticoagulants |
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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 |