Medical-Ms38-Pericarditis

Front 1

What is acute pericarditis?

Back 1

aninflammation or alteration of the pericardium, the membranous sac that encloses the heart...
may be:
fibrous
serous
hemorrhagic
purulent
neoplastic

Front 2

Acute pericarditis is most commonly associated with?

Back 2

malignant neoplasms
idiopathic causes
infective organisms
(bacteria, viruses, fungi)
postmyocardial infarction
(MI) syndrome (Dresslers
syndrome)
postpericardiotomy syndrome
systemic connective tissue disease
renal failure

Front 3

The cause of pericarditis determines its?

Back 3

presentation

Front 4

Acute viral pericarditis commonly follows a?

Back 4

respiratory infection and is more common in men between 20 and 50 years of age

Front 5

What is Dressler's syndrome?

Back 5

occurs from 1 to 12 weeks after infarction...
postmyocardial infarction syndrome characterized by pleuritic chest pain, pericarditis,
fever,
leukocytosis

Front 6

What is postpericardiotomy syndrome?

Back 6

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

Front 7

What is chronic constrictive pericarditis?

Back 7

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

Front 8

Assessment finds for pericarditis include?

Back 8

substernal precordial pain that radiates to left side of neck, shoulder, or back

Front 9

How is the pain described?

Back 9

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

Front 10

Chest discomfort should be evaluated carefully to differentiate?

Back 10

pericarditis from acute MI

Front 11

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

Back 11

pericardial friction rub....what does a pericardial friction rub sounds like?

Front 12

What are the symptoms of chronic constrictive pericarditis?

Back 12

symptoms of right-sided
heart failure
elevated systemic venous
pressure with jugular
distention
hepatic engorgement
dependent edema
exertional fatigue
dyspnea

Front 13

What is found on echocardiography or CT scan in the pericardium?

Back 13

thickening

may also be used to determine pericardial effusion

Front 14

Patients with an acute pericarditis may have? (2)

Back 14

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

Front 15

What med is usually prescribed for the pain of pericarditis while patient is being hospitalized?

Back 15

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

Front 16

The most therapeutic position to place patient in is?

Back 16

sitting upright and leaning slightly forward...if the pain is not relieved within 24 to 48 hours, the nurse notifies primary care provider

Front 17

There are various causes of pericarditis, so there are a variety of therapies. Bacterial pericarditis (acute) usually requires?

Back 17

antibiotics
pericardial drainage....
the usual clinical course of acute pericarditis is short term (2 to 6 weeks), but episodes may recur

Front 18

Chronic pericarditis caused by malignant disease may be treated with radiation or chemotherapy, whereas uremic pericarditis is treated by?

Back 18

hemodialysis

Front 19

The definitive treatment for chronic constrictive pericarditis is surgical incision of the pericardium which is termed?

Back 19

pericardiectomy

Front 20

What is a significant complication to pericarditis?

Back 20

pericardial effusion

Front 21

How does pericardial effusion occur?

Back 21

when the space between the parietal and visceral layers of the pricardium fills with liquid

Front 22

What does pericardial effusion put the client at risk for?

Back 22

cardiac tamponade or
excessive fluid within
pericardial cavity

Front 23

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

Back 23

restricts diastolic ventricular filling and cardiac output drops...what are the symptoms?

Front 24

Define acute cardiac tamponade?

Back 24

may occur when small volumes (20 to 50 mL) of fluid accumulate rapidly in the pericardium

Front 25

How many mL can the pericardium hold providing it fills slowly due to cardiac tamponade?

Back 25

several hundred milliliters...report suspicion of this immediately to physician

Front 26

CARDIAC TAMPONADE IS AN?

Back 26

EMERGENCY!!!

Front 27

One of the first things the doctor will do is start?

Back 27

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

Front 28

Hemodynamic monitoring in a specialized CCU usually demonstrates?

Back 28

compression of the heart, with all pressures (right atrial, pulmonary artery, wedge) being similar and elevated (plateau pressures)

Front 29

What is a pericardiocentesis?

Back 29

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

Front 30

Following pericardiocentesis, what if patient experiences a recurrence of tamponade or recurrent effusions or adhesions from chronic pericarditis?

Back 30

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)

Front 31

Where is pericardial pain typically found?

inspiration

Back 31

substernal...is it worse on inspiration or expiration?

Front 32

Does pericardial pain increase or decrease when client leans forward?

Back 32

decreases

Front 33

What kind of meds may be prescribed?

Back 33

anti-inflammatory (NSAIDs)

Front 34

What 2 agents should be avoided because they might increase the possibility of tamponade?

Back 34

aspirin
anticoagulants

Front 35

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?

Back 35

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