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Acute Pericarditis

Etiology
1. Infections
  1. -Viral -Bacterial -Fungal
2. Metabolic
  1. -Uremia -Myxedema -Acute MI -Neoplasm -Trauma -Radiation
3. Autoimmune
  1. -Rheumatic fever -Drug reaction -Rheumatological diseases -Lupus -Dressler's syndrome -Delayed post myocardial pericardial injury
Pathophysiology & Epidemiology
1. Cardiovascular disorder caused by inflammation of the pericardial sac (pericardium)
2. -85% of cases are viral or idiopathic - Accounts for 5% of emergency department visits for chest pain
Diagnosis
1. Sudden onset of sharp/stabbing chest pain
2. pericardial rub on auscultation
3. ECG
  1. -ST segment elevation -PR segment depression -T wave flattening and inversion
4. Chest X-ray
  1. Pleural effusion
5. CT Scan/ MRI
  1. Visualization of pericardium
6. Labs
  1. Markers for inflammation: -CRP -ESR -WBC
  2. BUN, Creatinine
7. Echocardiogram
8. Pericardiocentisis
High risk Patients/ Medical History
1. -Fever (>38C) -Immunosuppression -Pulsus Paradoxus -Lyme Disease -Toxoplasmosis -Anticoagulant treatment
Complications
1. Recurrence of acute pericarditis
2. Pericardial effusion
3. Cardiac tamponade
4. Constructive pericarditis
Clinical Manifestations
1. Persistent chest pain
  1. Aggravated by deep inspiration & lying supine
  2. Radiating pain to neck, arms, & trapezius muscle
2. Dyspnea
3. Pericardial friction rub
4. Fever
5. Fatigue
6. Abdominal & Leg edema
Nursing Interventions
1. Pain Relief
  1. Sitting or leaning forward
    1. Elevate head of bed (High Fowler)
  2. Bed Rest
  3. assess pain around the clock
2. Decrease pt anxiety & fear
3. Monitor for s/s of tamponade
4. Pericardiocentsis
  1. Monitor catheter drainage
Treatment
1. Pericardiocentisis
  1. if pericardial effusion & tamponade developed
2. Pericardiectomy
  1. if recurrent & last resort
3. Pharmacology
  1. Antibiotics
  2. NSAIDS
    1. Ibuprofen
  3. Colchicine
    1. to prevent reoccurance
  4. Aspirin
  5. Corticosteriods
    1. Prednisone
4. Underlying disease
Assessment
1. V/S: BP, RR, P, Temp, O2
2. Pain Level
  1. Chest Pain (PQRSTU)
3. Chest Auscultation
  1. Rub
4. Observe limbs for edema
5. Physical Exam
Patient Education
1. Elevate head of bed
2. Healthy diet
  1. Decrease Sodium
  2. Take meds with food
3. No smoking
4. Elevate legs
5. Manage stress & anxiety
6. Follow ups w/ doctor

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Acute Pericarditis

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