PERICARDITIS introduction and management.pptx

PERICARDITIS

1. PERICARDITIS

2. INTRODUCTION The pericardium is a thin, two layered fluid filled sac that covers the outer surface of the heart. When the pericardium is inflamed ,the amount of fliud between its two layers increases ,compressing the heart and interfering with the hearts ability to function properly

3. DEFINITION : Pericarditis is an inflammation of the pericardium. Pericarditis usually begins suddenly but does not last long. INCIDENCE Exact incidence and prevalence are unknown Diagnosed in 0.1% of hospitalized patients and 5% of patients admitted for non-acute MI chest pain

4. CAUSES : 1. INFECTION: Viral ( Coxsakie virus B,A, Adenovirus,Mumps ), Bacterial (Pneumococci, Staphylococci, Streptococci), Fungal (Histoplasma, Candida Species, Infections such as toxoplasmosis,

5. CAUSE CONT. Chest trauma / injury Connective tissue disorders e.g.systemic lupus erythematosus Lung disease (Tuberculosis), HIV (Human Immunodeficiency Virus). Side effects some medication such as Isoniazid,Tetracycline , Malignancy, Scleroderma

6. CAUSE CONT. Uremia, Radiation Induced, Myxedema, Acute MI, Dissection of Aortic Aneurysm,

7. CAUSE CONT. Ankylosing spondylitis, Inflammatory bowel disease, Rheumatic fever, Cancer (including leukemia).

8. S/S Sharp, Stabbing Chest pain over the center or left side of the chest, A low grade fever 2. Trouble breathing 3. Palpitations, 5. Weakness,

9. S/S CONT. Irritability Fatigue Loss of appetite Irregular heart beat Anxiety and fatigue, Cyanosis,

10. S/S CONT. Cough, Hoarseness, voice weakness or complete aphonia , Dysphagia, Distended neck veins, Abdominal or leg swelling for long term pericarditis.

11. Medical history Physical exam, Laboratory investigations Blood test- CBC- C-reactive protein (CRP), Blood Urea Nitrogen (BUN), ESR. - may be elevated DIAGNOSIS

12. DIAGNOSIS Blood test cont Leukocytosis-Elevated WBC Blood cultures done to identify organism responsible for infective process and to ascertain appropriate drug for eradication;

13. INVESTIGATIONS CONT. Imaging ECG, Echocardiography, CXR Cardiac CT scan/ MRI,

14. TREATMENT 1. Antibiotic (To treat bacterial infection), 2. Antifungal medicines will be used for fungal pericarditis, 3. Non-Steroidal anti Inflammatory Drug (to reduce pain and inflammation), 4. Diuretics ( to remove excess fluid),

15. TREATMENT 5. Pericardiocentesis (To drain the excess fluid from pericardium) , 6. Pericardiectomy (In case of constructive pericarditis), 7. Hemodialysis (To treat uremic pericarditis), 8. Antipyretics, 9. Analgesics.

16. NURSING INTERVENTION 1. Monitor patient pain level and evaluate pain within 30 minutes. 2. Administer prescribed pain medication such as morphine to relieve pain. 3. Monitor the patient pain level and effectiveness of analgesics. 4. Provide a comfortable position (sit up and lean forward).

17. TREATMENT 5. Check vital sign and record it continuously. 6. Discuss disease process and signs and symptoms expanding aneurysm or impending aneurysm. 7. If surgical intervention needed, provide psychological support and prepare for surgery.

18. TREATMENT For post surgical patients, discuss about warning sign of postoperative complication such as fever, inflammation in surgical site, bleeding and swelling. 9. Daily check of weight. 10. Closely monitor and notify to physician about persistent cough, vomiting or systolic blood pressure above 180mmhg because of the increased risk for hemorrhage.

19. TREATMENT 11. Ensure bed rest until fever, chest pain and friction rub disappear 12. Administer O2 and keep SPO2 ˃90%. 13. Administer medication as order-such as NSAIDs and steroids with food. 14. Ensure administer of antibiotic timely. 15. Continue I.V antihypertensive medication if persistent blood pressure high.

20. TREATMENT Carefully maintain fluid intake and output. 17. Reassure patient that chest pain is not a Myocardial Infarction. 18. Check sign and symptoms for cardiac tamponade at least 8 hourly and PRN. 19. Assist the patient with bathing if necessary.

21. TREATMENT 20. Provide a bedside commode to reduce stress on heart. 21. Tell the patient to resume his daily activities slowly. 22. Build a rapport relationship with patient to reduce anxiety. Surgery:  open surgical drainage is usually the treatment of choice for cardiac tamponade

22. NURSING DIAGNOSIS. Alteration in comfort r elated to  chest pain due to pericardial inflammation as evidenced by facial grimacing . Alteration in comfort r elated to  chest pain due to pericardial inflammation as evidenced by clutching of hands or chest . Altered tissue perfusion r elated to tissue ischemia as evidenced by  abnormal hemodynamic readings

23. NURSING DIAGNOSIS Anxiety r elated to   fear of death as evidenced by poor eye contact and feelings of helplessness . Anxiety r elated to change in health status as evidenced by   restlessness . Anxiety r elated to  threat to body image as evidenced decreased energy, irritability, crying, feelings of helplessness

24. NURSING DIAGNOSIS Knowledge deficit r elated to lack of under- standing of the medical condition as evidenced by development of preventable complications   Knowledge deficit r elated to lack of recall as evidenced by questions regarding the problem

25. COMPLICATION. Pericardial effusion, Constrictive pericarditis, Cardiac tamponade, Fatal hemorrhage, Myocardial ischemia, Stroke,

26. COMPLICATION cont. Paraplegia due to interruption/ compression of anterior spinal artery and nerves. Abdominal ischemia.