Nursing Care Plan (NCP) for Pericarditis

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Outline

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

  • Assess Heart and Lung Sounds
  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.
  • Assess and Address Oral Hygiene
  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.
  • Administer IV Antibiotics
  If the source is bacterial, IV antibiotics will be required to treat the infection. Be sure to obtain blood cultures before 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.
  • Perform 3-5 lead ECG monitoring and/or 12-lead ECG
  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.
  • Assess and Manage Pain
  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.
  • Assess for s/s Cardiac Tamponade
  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.
  • Prepare patient for emergent pericardiocentesis
  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.
  • Educate patient on s/s infection
  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.
  • Educate the patient to inform other providers before procedures
    • May need prophylactic antibiotics
    • No dental procedures for at least 6 months
  Because the patient is at high risk for recurrence and complications, they must notify other providers of their history of pericarditis. They may require prophylactic antibiotics before any invasive procedures, and they should avoid dental procedures for at least 6 months after their hospitalization.

Writing a Nursing Care Plan (NCP) for Pericarditis

A Nursing Care Plan (NCP) for Pericarditis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Today we are going to be talking about pericarditis. Pericarditis is the inflammation of the pericardium, the area around the heart. Pericarditis could be caused by either an infectious source, so which could be viral, bacterial, or fungal, or it can be caused by an MI. Some of the things we want to think about as nurses when we are taking care of these patients are we want to think about performing a 12 lead EKG. We want to do a good assessment, listening to the heart sounds, and we want to manage their pain. This thing is very painful, our desired outcome. We want to treat the cause and remove the source of infection. If it’s caused by an infection while preserving the cardiac output and preventing any other major or minor complications. 

So, you have inflammation inside of your pericardium. So, what are some things that you think we’d need to, uh, look out for? What do you think the patient’s going to tell us? Well, first number one is chest pain. These patients are in pain, so it’s aggravated by breathing, coughing, and swallowing. So it’s not normal chest pain. When you’re gonna think about, um, like when you have a heart attack, it’s going to be exacerbated by coughing and breathing. We also want to think about pain. That’s worse when they’re supine. So when they’re lying flat on their back, that pain is worse. That’s why you oftentimes see those pericarditis patients leaning forward to get relief. And also you’ll see some symptoms of heart failure, you know, fluid overload, shortness of breath, those types of things, some signs that we’ll see as a nurse, some objective signs that we’ll see increased temperature fever. We’re going to see increased white blood cells. That’s going to be on the labs again, signs of heart failure. We may see some ST elevation on the EKG that we perform. We’re going to see decreased o2 SATs. 

We’re going to see signs and symptoms of cardiac tamponade. So that’s actually very, uh, specialized, um, condition, the cardiac tamponade, not, and not just run over those really quickly. The fact that some of the cardiac tamponade not, ER, muffled heart sounds narrow, pulse pressure, uh, juggler, venous distension, and also a decreased cardiac output. So nursing intervention, obviously with ad PI, we want to focus on assessing the person. We want to assess the heart, assess the lungs. You may hear something, what we call pericardial friction rub. And that’s just a heart sound that we’re going to hear when we’re auscultating, you may hear muffled heart sounds, or you may hear extra sounds because of all the extra pressure from the inflammation. 

We also want to perform that, uh, that EKG. So, we want to take a look at the heart from an electrical standpoint. Pericarditis is known for causing any type of arrhythmias and ST elevation has fluid builds up so, we want to focus on that as well. We want to manage the pain because the pain is out of this world for these patients, okay. Patients are going to have significant chest pain that is worse when breathing, and also when they’re supine. Remember old carts, we want to assess the character. We want to assess the location. What makes it better? What makes it worse? We want to do a good pain assessment and administer any type of pain medication or anti-inflammatories as necessary. And that’s order again. We want to check for cardiac tamponade. We want to assess Beck’s triad. And that is the JVD the juggler vein distension, decreased BP, and muffled heart sounds. That is Beck’s Triad. We want to prepare the patient for an emergent pericardiocentesis. I know that’s a long word, but all we’re saying is we want to go in and drain some of the fluid that’s around the heart, and that’s, um, will allow the heart to beat more freely and it will improve cardiac output rapidly as soon as the procedure’s done. We want to educate the patient on the signs and symptoms of infection. So we want to make sure that the patient has no dental work, uh, for at least six months because the patient is at high risk for a reoccurrence. We want to make sure that they notify providers, that they don’t have a history of pericarditis. Very important. The next thing I want to show you is what the EKG looks like when a patient presents with pericarditis. 

So as you see here, there is ST Elevation here, here, here, this ST elevation all over. And the thing that makes this unique is because with a heart attack or am I, you will see ST elevation, but typically in one lead pericarditis, because of the inflammatory process, the EKG is going to show inflammation and multiple leads. So that’s something that will help rule out whether it’s a heart attack or MI. Some key points, pathophysiology. Pericarditis is an inflammation of the heart is caused by the bacterial virus, or am I the subjective things that we want to focus on? Chest pain, pain that is worse with supine, some symptoms of heart failure, the things that we want to assess for as nurses, or we want to assess for fever. There may be some ST elevation on that EKG. And also they’re going to have some decreased o2 Sats. 

We want to do a good cardiac assessment, 12 lead EKG. We want to take a listen. We want to auscultate, and we want to keep track of those vital signs. We may see or hear those muffled heart tones or pericardial friction rubs. When we listen, pain management is, is very important. We want to do frequent pain assessments, at least every two hours. And we want to administer, uh, anti-inflammatories uh, with the frequency as ordered by the doctor. I know that this was a lot of information, but I know you guys are going to do so well on it. We love you guys go out and be your best self today. And as always happy nursing.

 

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