Nursing Care Plan for Pericarditis

Pathophysiology

Pericarditis is inflammation of the pericardium – the outer layer of the heart and pericardial sac. Fluid and inflammation build up around the heart inside the pericardial sac, putting pressure on the heart and making it harder for the heart to fully relax and contract. It can cause heart failure or cardiac tamponade.

Etiology

Pericarditis is caused by an infectious source, either viral, bacterial, or fungal. Fungal is the least common, while the Coxsackie virus is a common source.

Desired Outcome

To treat the cause and remove the source of infection while preserving cardiac output and preventing any major (or minor) complications.

Pericarditis Nursing Care Plan

Subjective Data:

  • Chest Pain
    • Aggravated by breathing, coughing, swallowing
    • Worse when supine
  • Symptoms of Heart Failure

Objective Data:

  • ↑ Temperature
  • ↑ WBC
  • Signs of Heart Failure
  • ST Elevation possible
  • ↓ SpO2
  • S/S Cardiac Tamponade
    • Muffled heart sounds
    • Narrow Pulse Pressure
    • Pulsus Paradoxus
    • JVD with clear lungs
    • ↓ Cardiac Output

Nursing Interventions and Rationales

  1. Assess Heart and Lung Sounds

  2. May hear a pericardial friction rub, muffled heart sounds, or extra sounds because of the pressure being placed on the heart. It’s possible, but unlikely that you will hear fluid in the lungs – in cardiac tamponade the lungs will be clear.

  3. Assess and Address Oral Hygiene

  4. There is a significant connection between oral health and pericarditis. Bacteria can travel to the heart easily from the oral cavity. Patients should brush their teeth twice daily to prevent complications.

  5. Administer IV Antibiotics

  6. If the source is bacterial, IV antibiotics will be required to treat the infection. Be sure to obtain  blood cultures prior to initiating antibiotics.

    If the source is viral – providers may order anti-inflammatory medication since antibiotics aren’t effective. If the virus is known and susceptible, an antiviral medication could be used.

  7. Perform 3-5 lead ECG monitoring and/or 12-lead ECG

  8. Pericarditis could cause arrhythmias or ST elevation as the fluid puts pressure on the heart.  

    Cardiac tamponade is a risk – in which case we’ll see the QRS amplitude decrease with inspiration.

  9. Assess and Manage Pain

  10. Patients will have significant chest pain that is worse with breathing or when supine. Perform OLDCARTS pain assessment and administer pain medication as ordered.

    Positioning the patient in High-Fowler’s position can also relieve pressure on the heart and be more comfortable for the patient.

  11. Assess for s/s Cardiac Tamponade

  12. Assess for Beck’s Triad – JVD, ↓ BP, muffled heart sounds. May also see Pulsus Paradoxus and narrowing pulse pressures.

    This is a medical emergency and needs to be treated as such.

  13. Prepare patient for emergent pericardiocentesis

  14. A physician will insert a large, long needle into the pericardial sac, using ultrasound as a guide, to drain off the fluid that is collecting around the heart.  This will allow the heart to beat more freely and should improve cardiac output rapidly.

  15. Educate patient on s/s infection

  16. Pericarditis is an infectious process, therefore infection control is imperative. They need to be taught hand hygiene as well as other infection precautions. They should also be taught s/s of infection to report to their provider.

  17. Educate patient to inform other providers before procedures

    • May need prophylactic antibiotics
    • No dental procedures for at least 6 months
  18. Because the patient is at high risk for recurrence and complications, it’s important that they notify other providers of their history of pericarditis. They may require prophylactic antibiotics prior to any invasive procedures and they should avoid dental procedures for at least 6 months after their hospitalization.


References

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