Pericarditis is an inflammatory condition affecting the pericardium, the thin fibrous sac surrounding the heart. The pericarditis nursing diagnosis focuses on identifying and managing pericarditis symptoms, preventing complications, and promoting patient recovery.
Causes (Related to)
Pericarditis can develop from various factors that influence its severity and progression:
- Viral infections (most common cause)
- Bacterial infections
- Autoimmune conditions
- Medical conditions such as:
- Recent heart attack
- Cancer
- Kidney failure
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Other factors including:
- Recent cardiac surgery
- Chest trauma
- Certain medications
- Radiation therapy
Signs and Symptoms (As evidenced by)
Pericarditis presents with characteristic signs and symptoms that nurses must recognize for accurate diagnosis and treatment.
Subjective: (Patient reports)
- Sharp, stabbing chest pain that worsens with breathing
- Pain that improves when sitting up and leaning forward
- Anxiety and restlessness
- Fatigue
- Weakness
- Palpitations
- Shortness of breath
Objective: (Nurse assesses)
- Pericardial friction rub on auscultation
- ECG changes showing ST-segment elevation
- Tachycardia
- Low-grade fever
- Decreased heart sounds
- Signs of cardiac tamponade in severe cases
- Elevated jugular venous pressure
Expected Outcomes
The following outcomes indicate successful management of pericarditis:
- The patient will report decreased chest pain
- The patient will maintain stable vital signs
- The patient will demonstrate improved activity tolerance
- The patient will verbalize understanding of the condition and treatment
- The patient will maintain adequate cardiac output
- The patient will avoid complications
- The patient will adhere to the prescribed medication regimen
Nursing Assessment
Monitor Cardiovascular Status
- Assess heart sounds and rhythm
- Monitor vital signs
- Check for signs of cardiac tamponade
- Evaluate peripheral circulation
- Document chest pain characteristics
Assess Pain Levels
- Monitor pain intensity
- Note pain triggers
- Document pain relief measures
- Assess response to medications
- Evaluate position changes’ effect on pain
Monitor Activity Tolerance
- Assess energy levels
- Document activity limitations
- Monitor vital signs with activity
- Note exertion-related symptoms
- Evaluate rest periods
Check for Complications
- Monitor for signs of cardiac tamponade
- Assess for arrhythmias
- Watch for signs of constrictive pericarditis
- Check for fever and infection signs
- Monitor for medication side effects
Evaluate Understanding
- Assess knowledge of the condition
- Review medication compliance
- Check lifestyle modification understanding
- Document follow-up care comprehension
- Evaluate support system
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to inflammation of the pericardium as evidenced by reported sharp chest pain and guarding behavior.
Related Factors:
- Pericardial inflammation
- Cardiac muscle strain
- Movement and breathing
- Anxiety and stress
Nursing Interventions and Rationales:
- Assess pain characteristics
Rationale: Establishes baseline and monitors treatment effectiveness - Position the patient semi-fowler or upright
Rationale: Reduces cardiac workload and minimizes pain - Administer prescribed medications
Rationale: Controls inflammation and pain
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved comfort
- The patient will maintain optimal positioning
Nursing Care Plan 2: Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to inflammatory process affecting cardiac function as evidenced by tachycardia and decreased exercise tolerance.
Related Factors:
- Pericardial inflammation
- Fluid accumulation
- Altered contractility
- Hemodynamic changes
Nursing Interventions and Rationales:
- Monitor vital signs and hemodynamics
Rationale: Identifies early signs of cardiac compromise - Assess for signs of tamponade
Rationale: Enables early detection of life-threatening complications - Maintain activity restrictions
Rationale: Reduces cardiac workload
Desired Outcomes:
- The patient will maintain stable hemodynamics
- The patient will demonstrate adequate tissue perfusion
- The patient will avoid complications
Nursing Care Plan 3: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to decreased cardiac output as evidenced by fatigue and dyspnea with minimal exertion.
Related Factors:
- Cardiac inflammation
- Reduced stroke volume
- Increased metabolic demand
- Pain with movement
Nursing Interventions and Rationales:
- Plan graduated activity progression
Rationale: Prevents overexertion while maintaining function - Monitor response to activity
Rationale: Ensures safe activity levels - Provide adequate rest periods
Rationale: Allows for energy conservation
Desired Outcomes:
- The patient will demonstrate improved activity tolerance.
- The patient will maintain an energy balance
- The patient will perform ADLs without undue fatigue
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to acute illness and uncertain prognosis as evidenced by expressed concerns and increased heart rate.
Related Factors:
- Acute illness
- Pain
- Fear of complications
- Limited understanding of the condition
Nursing Interventions and Rationales:
- Provide clear information
Rationale: Reduces fear of the unknown - Teach coping strategies
Rationale: Helps manage stress response - Encourage expression of concerns
Rationale: Allows for emotional support
Desired Outcomes:
- The patient will demonstrate reduced anxiety
- The patient will use effective coping strategies
- The patient will verbalize understanding of the condition
Nursing Care Plan 5: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to inflammatory process and compromised cardiac function as evidenced by vulnerability to pathogenic organisms.
Related Factors:
- Inflammatory condition
- Compromised immune function
- Invasive procedures
- Medication effects
Nursing Interventions and Rationales:
- Monitor for infection signs
Rationale: Enables early detection and treatment - Maintain a strict aseptic technique
Rationale: Prevents introduction of pathogens - Educate about infection prevention
Rationale: Promotes self-care and prevention
Desired Outcomes:
- The patient will remain free from infection
- The patient will demonstrate infection prevention measures
- The patient will identify early infection signs
References
- Ben Gaied M, Krähenbühl J, Rey F, Genné D. La péricardite aiguë [Acute pericarditis]. Rev Med Suisse. 2015 Oct 7;11(489):1835-8. French. PMID: 26638513.
- Cremer PC, Klein AL, Imazio M. Diagnosis, Risk Stratification, and Treatment of Pericarditis: A Review. JAMA. 2024 Oct 1;332(13):1090-1100. doi: 10.1001/jama.2024.12935. PMID: 39235771.
- Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA. 2015 Oct 13;314(14):1498-506. doi: 10.1001/jama.2015.12763. Erratum in: JAMA. 2015 Nov 10;314(18):1978. doi: 10.1001/jama.2015.14847. Erratum in: JAMA. 2016 Jan 5;315(1):90. doi: 10.1001/jama.2015.16998. Dosage error in article text. PMID: 26461998.
- Kytö V, Matti Niemelä M. Acute pericarditis. Duodecim. 2017;133(4):391-6. PMID: 29205986.
- Tonini M, Melo DT, Fernandes F. Acute pericarditis. Rev Assoc Med Bras (1992). 2015 Mar-Apr;61(2):184-90. doi: 10.1590/1806-9282.61.02.184. PMID: 26107370.
