Pericarditis NCLEX

Pericardial effusion

- build up of fluid in pericardium - causes cough, dyspnea, tachypnea, hiccups, hoarseness - distant, muffled heart sounds

A nurse in a clinic is caring for a client who has been on long term NSAID therapy to treat pericarditis. Which of the following lab findings should the nurse report to the provider? A. Platelets 100,000/mm3 B. Serum glucose 110 mg/dL C. Serum creative 0.7 mg/dL D. Amino alanine transferase (ALT) 30 IU/L

A Long-term NSAID therapy can lower platelets. This finding is outside expected range and should be reported. The rest are within normal range

A pt is admitted to the hospital with possible acute pericarditis. The nurse should plan to teach the pt about the purpose of a. blood cultures. b. echocardiography. c. cardiac catheterization. d. 24-hour Holter monitor.

ANS: B Echocardiograms are useful in detecting the presence of the pericardial effusions associated with pericarditis. Blood cultures are not indicated unless the patient has evidence of sepsis. Cardiac catheterization and 24-hour Holter monitor are not diagnostic procedures for pericarditis

To assess the pt with pericarditis for evidence of a pericardial friction rub, the nurse should a. listen for a rumbling, low-pitched, systolic murmur over the left anterior chest. b. auscultate with the diaphragm of the stethoscope on the lower left sternal border. c. ask the patient to cough during auscultation to distinguish the sound from a pleural friction rub. d. feel the precordial area with the palm of the hand to detect vibrations with cardiac contraction.

ANS: B Pericardial friction rubs are best heard with the diaphragm at the lower left sternal border. The nurse should ask the patient to hold his or her breath during auscultation to distinguish the sounds from a pleural friction rub. Friction rubs are not typically low pitched or rumbling and are not confined to systole. Rubs are not assessed by palpation

Which action by the nurse will determine if the therapies ordered for a patient with chronic constrictive pericarditis are most effective? a. Assess for the presence of a paradoxical pulse. b. Monitor for changes in the patient's sedimentation rate. c. Assess for the presence of jugular venous distention (JVD). d. Check the ECG for ST segment changes.

ANS: C Because the most common finding on physical examination for a patient with chronic constrictive pericarditis is jugular venous distention, a decrease in JVD indicates Improvement. Paradoxical pulse, ST segment ECG changes, and changes in sedimentation rates occur with acute pericarditis but are not expected in chronic constrictive pericarditis

Which assessment finding obtained by the nurse when assessing a patient with acute pericarditis should be reported immediately to the health care provider? a. Pulsus paradoxus 8 mm Hg b. Blood pressure (BP) of 168/94 mm Hg c. Jugular venous distention (JVD) to jaw level d. Level 6 (0 to 10 scale) chest pain with a deep breath

ANS: C The JVD indicates that the pt may have developed cardiac tamponade and may need rapid intervention to maintain adequate cardiac output. Hypertension would not be associated with complications of pericarditis, and the BP is not high enough to indicate that there is any immediate need to call the health care provider. A pulsus paradoxus of 8 mm Hg is normal. Level 6/10 chest pain should be treated but is not unusual with pericarditis

A pt recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10scale) chest pain with deep breathing. Which prescribed PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV b. IV morphine sulfate 4 mg c. Oral ibuprofen (Motrin) 600 mg d. Oral acetaminophen (Tylenol) 650 mg

ANS: C The pain associated with pericarditis is caused by inflammation, so nonsteroidal antiinflammatory drugs (e.g., ibuprofen) are most effective. Opioid analgesics and acetaminophen are not very effective for the pain associated with pericarditis

A nurse is assessing a client who has pericarditis. Which of the following manifestations should the nurse expect? a. Bradycardia with ST-segment depression b. Relief of chest pain with deep inspiration C. Dyspnea with hiccups d. Chest pain that increases when sitting up

ANS: C Will experience dyspnea, hiccups, and nonproductive cough. Thes manifestations can indicate heart failure from pericardial compression due to constrictive pericarditis o r cardiac tamponade A: Pericarditis is usually seen on ECG as ST-T spiking and tachycardia B. Chest pain associated with pericarditis will increase with deep inspiration due to greater pressure of pericardial sac D. Will decrease when client sits upright or leans forward

The nurse has identified a nursing diagnosis of acute pain related to inflammatory process for a pt with acute pericarditis. An appropriate intervention by the nurse for this problem is to a. teach the pt to take deep, slow breaths to control the pain. b. force fluids to 3000 mL/day to decrease fever and inflammation. c. provide a fresh ice bag every hour for the pt to place on the chest. d. place the patient in Fowler's position, leaning forward on the overbed table.

ANS: D Sitting upright and leaning forward frequently will decrease the pain associated with pericarditis. Forcing fluids will not decrease the inflammation or pain. Taking deep breaths will tend to increase pericardial pain. Ice does not decrease this type of inflammation and pain.

Non infectious causes of pericarditis

Acute MI Cancers: lung, breast, leukemia, Hodgkins Aortic aneurysm Radiation Renal Failure Trauma

Which of the following are NOT typical signs and symptoms of pericarditis? (SATA) A. Fever B. Increased pain when leaning forward C. ST segment depression D. Pericardial friction rub E. Radiating substernal pain felt in the left shoulder F. Breathing in relieves the pain

B, C, F

Infectious causes of pericarditis

Bacterial (pneumococci, staph, strep) Fungal (candida) Viral (mumps, hep) Lyme disease

You are providing care to a pt experiencing chest pain when coughing or breathing in. The pt has pericarditis. The physician has ordered the pt to take Ibuprofen for treatment. How will you administer this medication? A. strictly without food B. with a full glass of juice C. with a full glass of water D. with or without food

C

You are providing care to a pt with pericarditis. Which of the following is NOT a proper nursing intervention for this pt? A. Monitor the pt for complications of cardiac tamponade B. Administer Ibuprofen as scheduled. C. Place the pt in supine position to relieve pain. D. Monitor the pt for pulsus paradoxus and muffled heart sounds.

C

You are providing discharge teaching to a pt being discharged home after hospitalization with pericarditis. The physician has ordered the patient to take Colchicine. Which of the following statements indicate the patient did NOT understand your education about how to take this medication? A. "I will make sure I take this medication with food." B. "I will notify the doctor immediately if I start experiencing nausea, vomiting, or stomach pain while taking this medication." C. "I like to take my medications in the morning with grapefruit juice." D. "This medication is also used to treat patients with gout."

C

The nurse is evaluating the condition of a client after Pericardiocentesis performed to treat cardiac tamponade. Which observation would indicate that the procedure was effective? A. Muffled heart sounds B. Client reports dyspnea C. A rise in blood pressure D. JVD

C Following pericardiocentesis, the client usually experiences immediate relief. heart sounds are no longer muffles or distant and blood pressure increases. Distended neck veins are a sign of increased venous pressure, which occurs with cardiac tamponade

A nurse is assessing the heart sounds of a client who has developed chest pain that worsens with inspiration. The nurse auscultates a high-pitched scratching sound during both systole and diastole with the diagram of the stethoscope positioned at the left sternal border. Which of the following heart sounds should the nurse doc? A. Audible click B. Murmur C. Third heart sound D. Pericardial friction rub

D

A pt with severe pericarditis has developed a large pericardial effusion. The pt is symptomatic. The physician orders what type of procedure to help treat this condition? A. Pericardiectomy B. Heart catheterization C. Thoracotomy D. Pericardiocentesis

D

On physical assessment of a pt with pericarditis, you may hear what type of heart sound? A. S3 or S4 B. mitral murmur C. pleural friction rub D. pericardial friction rub

D

A nurse is caring for a pt who has pericarditis. Which of the following findings should the nurse expect? a. Petechiae b. Murmur c. Rash D. Friction rub

D A friction rub can be heard during auscultation The others are findings of endocarditis

cardiac tamponade

Develops as pericardial effusion volume increase and compresses heart - chest pain, confused, anxious, restless - decreased CO, muffled heart sounds, narrowed pulse pressure, tachycardia - JVD - pulsus paradoxus (if >10mmHg cardiac tamponade is present)

Diagnostics for pericarditis

EKG Echocardiogram (determine presence of pericardial effusion and cardiac tamponade) Doppler imaging CT scan MRI Chest Xray

Complications of pericarditis

Pericardial effusion Cardiac tamponade

hallmark finding of pericarditis

Pericardial friction rub (scratching, grating, high pitched) - ask patient to hold breath while using stethoscope to LL sternal border

Hypersensitive or Autoimmune cause of pericarditis

Rheumatic fever

Treatment for pericarditis

Treatment of underlying disease Bed rest Drug therapy: NSAIDs, corticosteroids Pericardiocentesis (for tamponade) Pericardial window (for tamponade or ongoing pericardial effusion) cut "window" for fluid to drain

pericarditis

inflammation of the pericardium, often with fluid accumulation (sac that surrounds heart) - anchors heart - provides lubrication to decrease friction between contractions - prevent excess dilation during diastole