Management of Acute Pericarditis

Acute Pericarditis is an inflammation of the pericardium characterized by chest pain, pericardial friction rub, and serial electrocardiographic (ECG) changes. The surrounding surface of the heart can have problems when it will be filled up with fluid, which is true in the case of pericarditis. When the fluid accumulated in the surrounding space of the heart, it will definitely affect the hemodynamic status of the heart. This status is called cardiac tamponade.

Pericarditis is an acute or chronic inflammation of the pericardium, the membranous sac enveloping the heart.

It may be caused by the following:

  1. Viral, bacteria, fungal infection
  2. Pericardial injury such as myocardial infarction or heart surgery
  3. Disorders of the connective tissues and allergies
  4. Neoplasm
  5. Uremia
  6. Exposure to high doses of radiation in the chest area
  7. Aortic aneurysm with pericardial leakage

Signs and Symptoms:

  1. A sharp and sudden pain over the pericardial area can be elicited with associated radiation to the neck and left scapular region.
  2. A patient will have  difficulty in breathing or the pain will increase whenever he or she inhales air. The comfortable position for this patient will probably be a leaning position.
  3. In order to for the heart to compensate with the blood supply, it pumps harder and faster resulting to tachycardia.
  4. Since the heart is surrounded by a fluid, there will be dullness upon percussion.
  5. In some instances, the apical pulse cannot be heard upon auscultation due to fluid accumulation.

Diagnostic Procedures:

  1. A complete blood count may reveal normal levels of white blood cells that mean there is no infection involved as well as the erythrocyte sedimentation rate.
  2. In the ECG, there will ST-segment elevation, T wave inversion and diminished QRS with effusion.
  3. 2D echocardiogram may also detect free space echo on the ventricular which confirms the diagnosis of pericarditis.

Nursing Management:

  1. The primary problem here will be the response of the patient. Pain relief must be done by assessing the pain first and block the pain receptors through pain medications. Morphine is used to remove the pain in the first phase of occurrence. At the later part, NSAIDS can also be used.
  2. Placing the patient in the most comfortable position must also be observed. The upright and leaning position can relieve the pain as the gravity aids in preventing the fluid to tighten the surface of the heart as it contracts.
  3. Monitor for the signs and symptoms. A case of an acute pericarditis can lead to cardiac tamponade when there is hypotension, muffled cardiac sound.
  4. In some cases, a pericardiocentesis might be ordered in order to take out the accumulated fluid. This must do aseptically.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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