Pericarditis

1. Definition and related terms
1. in pericarditis, an infection (from a bacterium, a fungus, Systemic Lupus Erythematosus (SLE), etc.) inflames the pericardium.
2. there may or may not be pericardial effusion or constrictive pericarditis.
3. dressler's Syndrome, also called postmyocardial infarction syndrome, is a combination of pericarditis, pericardial effusion and constrictive pericarditis. It occurs several weeks to months after a myocardial infarction. Etiology unclear.

2. Epidemiology
1. may be acute or chronic and may occur at any age.
2. pericarditis occurs in up to 15% of persons with a transmural infarction.
3. Findings  
1. sharp chest pain often relieved by leaning forward
2. pericardial friction rub
3. dyspnea
4. fever, sweating, chills
5. dysrhythmias
6. pulsus paradoxus
7. client cannot lie flat without pain or dyspnea

4. Management
1. antibiotics to treat underlying infection
2. corticosteroids: usually reserved for clients with pericarditis due to SLE, or clients who do not respond to NSAID
3. NSAIDS/Asprin for pain and inflammation
4. oxygen: to prevent tissue hypoxia
5. surgical
1. emergency pericardiocentesis if cardiac tamponade develops
2. for recurrent constrictive pericarditis, partial pericardiectomy (pericardial window) or total pericardiectomy
5. Nursing interventions
1. manage pain and anxiety
2. the cardio-care six 

THE CARDIO-CARE SIX: A,B,C,D,E,F

1. ADL: Help the client with activities of daily living.
2. Bed rest
3. Commode at bedside (it stresses the heart less than using a bedpan does).
4. Diversions: offer diversions that don't stress the heart.
5. Elevate head of bed, or sit client up.
6. Feelings: Let clients express concern; reassure when activity will resume

3. maintain a pericardiocentesis set at the bedside in case of cardiac tamponade.
4. assess respiratory, cardiovascular, and renal status often.
5. observe for findings of infiltration or inflammation at the venipuncture site, a possible complication of long-term IV administration. Rotate the IV sites often.
6. client and family teaching - teach the cardio five 

TEACH THE CARDIO FIVE: TDDDS

1. Tests and treatments: explain them in simple, culturally sensitive ways.
2. Drugs, their side effects, and how long client will take them.
3. Diet: good nutrition and restrictions (such as low sodium).
4. Disease, its treatment, and what signs to report promptly: the 'watch-fors'.
5. Smoker? Teach and encourage 'stop smoking'.

6. Diagnostic studies
1. EKG changes, arrythmias
2. echocardiography to determine pericardial efusion or cardiac tamponade
3. history and physical exam