Pericarditis Nursing Diagnosis and Nursing Care Plan

Pericarditis Nursing Care Plans Diagnosis and Interventions

Pericarditis NCLEX Review and Nursing Care Plans

Pericarditis is a condition that refers to the inflammation of the pericardium typically accompanied by the accumulation of fluid in the pericardial sac.

The pericardium is a double layered sac that surrounds the heart. It normally contains about 15-50mls of serous fluid; however, more fluid may accumulate when it gets inflamed.

Pericarditis can be classified as acute, subacute, or chronic.

Acute pericarditis has a sudden onset, and it resolves within 3 weeks. It may settle completely and recur in the future.

Subacute pericarditis lasts about 4-6 weeks but not exceeding 3 months and with continuous presence of symptoms.

Chronic pericarditis develops slowly and can last up to more than 3 months.

Pericarditis is known to be the most common cause of chest pain and is also the leading form of pericardial conditions.

Pericarditis may be caused by several reasons; however, majority of cases are idiopathic.

Signs and Symptoms of Pericarditis

The signs and symptoms of pericarditis depend on the severity of pleural effusion or fluid build up in the pericardial sac.

In some cases, symptoms may not manifest despite a large volume of fluid accumulation if the disease developed slowly.

Signs and symptoms of pericarditis include the following:

Chest pain – chest pain is a common symptom associated with pericarditis. It may be described as sharp and stabbing pain although some reported dull and pressure-like pain. It is typically felt under the breastbone or sometimes towards the left side of the chest. It may radiate to the left arm and sitting up and leaning forward eases the pain.
Abdominal or leg swelling
Cough
Fatigue or general weakness
Palpitations
Low-grade fever
Shortness of breath when lying down

Causes of Pericarditis

About 90% of cases of pericarditis are idiopathic. The following are known conditions that can cause pericarditis:

Heart attack or heart surgery – history of heart attack or heart surgery can potentially trigger pericarditis or delayed pericarditis also known as Dressler’s syndrome.
Infection, both viral and bacterial – infection can easily cause inflammatory process to start anywhere in the body where the infection reaches.
Systemic inflammatory disorders – autoimmune disorders are also thought to cause pericarditis.
Trauma – pericarditis is highly associated with trauma. It is a common cause of acute pericarditis.
Other health conditions renal failure, AIDS, tuberculosis and cancer are associated with pericarditis.

Complications of Pericarditis

Pericardial Effusion. Accumulation of fluid in the pericardial sac is possible when it gets inflamed. The type of fluid to accumulate depends on the causative factor.
Cardiac Tamponade. This is a life-threatening complication and will need immediate medical attention once suspected and identified. Cardiac tamponade is a condition when the fluid builds up become extremely massive that it puts pressure on the heart preventing it to pump properly leading to a drop in blood pressure.
Chronic constrictive pericarditis. Permanent scarring of the pericardium may occur in cases of chronic pericarditis. It may affect the pumping ability of the heart and it may manifest as severe swelling of the abdomen and legs and shortness of breath.

Diagnosis of Pericarditis

Medical history and physical examination – history and physical assessment will identify presence of risk factors and signs and symptoms. On assessment, the physician may listen to heart sound and may hear pericardial rub which is the sound made by the pericardial layers from rubbing each other.
Laboratory tests – lab tests including a series of blood and urine tests may help identify the possible cause of pericarditis.
Electrocardiogram (ECG) – The tracing of the heart is often done to identify any effect on the heart functions.
Chest X – ray – this imaging can easily give the physician the information related to the size and shape of the heart and clues to the presence of fluid build-up.
Echocardiogram – this procedure involves viewing the pumping ability of the heart through ultrasound.
CT scan of the chest – this imaging can give more details on the shape and size of the heart. It can identify the presence of restrictive pericarditis and can help rule out other heart conditions.
MRI scan of the chest – another form of imaging can be performed if the other forms of imaging are inconclusive.

Treatment of Pericarditis

Treatment options for pericarditis rely on the cause of the disease. However, some cases may not need any treatment and may resolve on its own.

Medication Therapy. Some drugs are used to help manage the symptoms of pericarditis.
- Analgesics – pain killers are often given to cope with the pain associated with pericarditis.
- Anti-gout medication – a certain anti-gout medication can also be used for pain management.
- Corticosteroids – steroids combat inflammation. Corticosteroids are often given in pericarditis to settle the inflammation of the pericardium.
Pericardiocentesis. This procedure involves the insertion of a needle into the pericardial sac to aspirate the fluid build-up. It is completed with the use of an ultrasound machine.
Pericardiectomy. Pericardiectomy is a surgical procedure that involves the removal of the pericardium. It is typically done in cases of constrictive pericarditis.

Pericarditis Nursing Diagnosis

Nursing Care Plan for Percarditis 1

Hyperthermia secondary to the disease process of bacterial pericarditis as evidenced by temperature of 38.0 degrees Celsius, rapid breathing, profuse sweating, and chills

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

Pericarditis Nursing Interventions	Rationales
Assess the patient’s vital signs at least every 4 hours.	To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.	To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.	Use the antibiotic to treat bacterial infection (pericarditis), which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.	To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.	Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan for Percarditis 2

Decreased cardiac output secondary to pericarditis as evidenced by fatigue and inability to do ADLs as normal

Desired outcome: The patient will be able to maintain adequate cardiac output.

Pericarditis Nursing Interventions	Rationales
Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.	To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Heart murmur sound that is new or changed is an important sign of pericarditis. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.
Administer the antibiotics as prescribed.	Use the antibiotic to treat bacterial infection (pericarditis).
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.	To increase the oxygen level and achieve an SpO2 value within target range.
Educate patient on stress management, deep breathing exercises, and relaxation techniques.	Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.
Prepare the patient for surgical intervention.	Pericardiocentesis is a procedure that involves the insertion of a needle into the pericardial sac to aspirate the fluid build-up. Pericardiectomy is a surgical procedure that involves the removal of the pericardium. It is typically done in cases of constrictive pericarditis.

Nursing Care Plan for Percarditis 3

Nursing Diagnosis: Acute Pain related to inflammatory process of bacterial pericarditis as evidenced by chest pain score of 10 out of 10, guarding sign, and shortness of breath

Desired Outcome: The patient will have a pain score of 0 out of 10.

Pericarditis Nursing Interventions	Rationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing.	To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics/ pain medications as prescribed. Administer antibiotics as prescribed.	To provide pain relief to the patient. To treat the underlying infection.
Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic.	To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.	To promote pain relief and patient comfort without the risk of overdose.
Elevate the head of the bed and encourage the patient to sit in semi Folwer’s position. Encourage pursed lip breathing and deep breathing exercises.	To relieve shortness of breath and help in lung expansion. To promote optimal patient comfort and reduce anxiety/ restlessness.

Nursing Care Plan for Percarditis 4

Nursing Diagnosis: Activity intolerance related to acute chest pain as evidenced by pain score of 8 to 10 out of 10, fatigue, disinterest in ADLs due to pain, verbalization of tiredness and generalized weakness

Desired Outcome: The patient will demonstration active participation in necessary and desired activities and demonstrate increase in activity levels.

Pericarditis Nursing Interventions	Rationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.	To create a baseline of activity levels and mental status related to acute pain, fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Explain the need to reduce sedentary activities such as watching television and using social media in long periods. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.	To gradually increase the patient’s tolerance to physical activity. To prevent triggering of acute pain by allowing the patient to pace activity versus rest.
Administer analgesics as prescribed prior to exercise/ physical activity. Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.	To provide pain relief before an exercise session. To allow the patient to relax while at rest and to facilitate effective stress management. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.	To provide a more specialized care for the patient in terms of helping him/ her build confidence in increasing daily physical activity.

More Nursing Diagnosis Pericarditis

Ineffective Breathing Pattern secondary to pericarditis
Fatigue
Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

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