A patient diagnosed with pericarditis presents with chest pain that worsens when lying flat and improves when sitting forward. What is the primary reason for this positional relief in pericarditis?

C) Reduced pressure on the pericardium

A) Reduced pressure on the diaphragm

C) Reduced pressure on the pericardium

Which symptom reported by the patient is characteristic of pericarditis?

A) Sharp retrosternal chest pain that worsens with deep breaths

B) Dull, aching pain that radiates to the left arm

C) Sudden, severe headache with visual disturbances

D) Pain in the lower abdomen with nausea

Which position is recommended for a patient experiencing sharp chest pain that lessens when sitting up and forward?

C) Sitting up and leaning forward

D) Lying flat with legs elevated

Which position should the nurse encourage the patient to assume to help alleviate the sharp chest pain described in the scenario?

B) Sitting up and leaning forward

D) Reclining at a 45-degree angle

Which of the following diagnostic results is most consistent with a diagnosis of pericarditis?

A) Elevated C-reactive protein (CRP) levels

B) Decreased erythrocyte sedimentation rate (ESR)

C) Normal echocardiogram showing no effusion

D) Abnormal renal function tests

When explaining the results of the echocardiogram to the patient with pericarditis, which statement by the nurse is most appropriate?

B) 'The echocardiogram shows a mild pericardial effusion, which we will monitor with follow-up visits.'

A) 'The fluid around your heart is causing tamponade, which is an emergency condition.'

B) 'The echocardiogram shows a mild pericardial effusion, which we will monitor with follow-up visits.'

C) 'Your heart is functioning normally, and there is no fluid accumulation present.'

D) 'The results indicate a severe effusion that will require immediate surgical intervention.'

What is the primary role of NSAIDs in the management of pericarditis?

A) To reduce inflammation and relieve pain

What is the primary purpose of the NSAID regimen prescribed to the patient with pericarditis?

A) To reduce pain and inflammation

C) To treat bacterial infection

Which of the following vital signs indicates that the patient's condition is stable and not currently experiencing any acute distress?

B) Heart rate of 74 beats per minute

A) Blood pressure of 140/90 mmHg

B) Heart rate of 74 beats per minute

C) Respiratory rate of 22 breaths per minute

D) Temperature of 100.4°F (38°C)

What is the most appropriate action for the nurse to take based on the patient's current status and recent lab results?

B) Encourage the patient to gradually increase physical activity while monitoring for any symptoms.

A) Discontinue all medications since the patient is improving.

B) Encourage the patient to gradually increase physical activity while monitoring for any symptoms.

C) Advise the patient to resume their previous level of physical activity without restrictions.

D) Schedule immediate follow-up appointments due to the risk of acute complications.

pericarditis - Nursing Case Study

Pathophysiology

• Primary mechanism: Inflammation of the pericardium, the protective sac around the heart, often due to infection, injury, or autoimmune conditions, results in irritation and swelling, causing chest pain and other symptoms.

• Secondary mechanism: Fluid accumulation between the pericardial layers, known as pericardial effusion, can result from inflammation, potentially leading to increased pressure on the heart.

• Key complication: If fluid builds up too much, it may cause cardiac tamponade, a serious condition where the heart is compressed, impairing its ability to pump blood effectively.

Patient Profile

Demographics:

34-year-old male, office worker

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Sharp chest pain, worsens with inspiration and lying flat

• Key symptoms: Mild fever, chest discomfort, pain relieved when sitting up

• Vital signs: Blood pressure 118/76 mmHg, heart rate 82 bpm, respiratory rate 18 breaths per minute, temperature 37.3°C (99.1°F)

Section 1

Initial Assessment Findings:

Upon conducting a thorough initial assessment, the nurse notes that the patient appears slightly anxious, likely due to the discomfort from the chest pain. The patient reports that the pain is sharp and located retrosternally, exacerbating with deep breaths and when lying flat, but alleviating when sitting forward. Upon auscultation, a pericardial friction rub is heard, which is a classic sign of pericarditis. The patient's lung sounds are clear bilaterally, and there is no jugular venous distension or peripheral edema, indicating no signs of heart failure or significant fluid overload at this stage.

The nurse performs a focused cardiovascular assessment, noting that the patient's vital signs remain stable, with a blood pressure of 118/76 mmHg, heart rate of 82 bpm, respiratory rate of 18 breaths per minute, and a temperature slightly elevated at 37.3°C (99.1°F). An ECG is performed, which shows diffuse ST-segment elevation and PR-segment depression, consistent with pericarditis. These findings, along with the patient's clinical presentation, support the diagnosis of early-stage pericarditis without significant complications at this time.

Based on these findings, the nurse collaborates with the healthcare team to plan further diagnostic evaluations, including blood tests to check for inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, and potentially an echocardiogram to assess for any pericardial effusion. Education is provided to the patient about the condition, emphasizing the importance of managing symptoms and monitoring for any changes that may indicate progression, such as increased shortness of breath or swelling. The patient is reassured about the typically benign nature of the condition when caught early and managed appropriately.

Section 2

Response to Interventions:

Following the initial assessment and diagnosis, the nurse initiates a care plan focused on symptom management and patient education. The patient is started on nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to help alleviate pain and reduce inflammation. The nurse monitors the patient's response to the medication, noting a gradual decrease in pain intensity. The patient reports that the sharp chest pain lessens significantly when sitting up and forward, allowing for improved comfort. The nurse encourages the patient to maintain this position as much as possible, providing extra pillows for support.

Throughout the shift, the nurse closely observes the patient for any adverse effects of the NSAIDs, such as gastrointestinal discomfort or renal side effects, given the patient's stable renal function and normal creatinine levels. The patient's vital signs remain stable, with a slight decrease in heart rate to 78 bpm and maintenance of blood pressure at 116/74 mmHg. The patient’s temperature normalizes to 37.1°C (98.8°F), indicating a positive response to the treatment.

The nurse continues to educate the patient about recognizing early signs of complications, such as increased shortness of breath, persistent fever, or changes in pain pattern, emphasizing the importance of timely communication with healthcare providers. The patient demonstrates understanding by verbalizing the key points and expressing willingness to adhere to the prescribed treatment plan. With these interventions, the patient shows improvement and is reassured that with continued management, the prognosis remains favorable. The healthcare team plans for follow-up evaluations to monitor progress and adjust the care plan as needed.

Section 3

New Diagnostic Results:

As part of the ongoing assessment and to ensure a comprehensive understanding of the patient's condition, the healthcare team orders a series of diagnostic tests. An echocardiogram is performed to evaluate the heart's function and structure, and the results confirm the presence of a mild pericardial effusion without signs of tamponade, supporting the initial diagnosis of pericarditis. The nurse explains these findings to the patient, noting that while there is some fluid accumulation around the heart, it is not posing an immediate threat and can be monitored with regular follow-ups.

Additionally, blood tests are reviewed, including inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are slightly elevated, indicating mild inflammation consistent with pericarditis. The nurse reassures the patient that these levels are expected in this condition and will be monitored to ensure they decrease with ongoing treatment. The renal function tests remain within normal limits, allaying concerns about potential complications from the NSAID therapy.

These diagnostic results provide a clearer picture of the patient's condition and affirm the current treatment plan's effectiveness. The patient is advised to continue the NSAID regimen and maintain follow-up appointments for repeat echocardiograms and blood tests to track progress. The nurse reiterates the importance of reporting any new or worsening symptoms and emphasizes the need for rest and gradual return to normal activities as symptoms improve. This proactive approach helps to ensure that any changes in the patient's status can be rapidly addressed, promoting a positive outcome.

Section 4

Response to Interventions:

Over the following week, the patient adheres to the prescribed NSAID regimen and attends all scheduled follow-up appointments, demonstrating good compliance with the treatment plan. During a routine check-up, the nurse assesses the patient for any changes in symptoms and overall well-being. The patient reports a noticeable reduction in chest pain and discomfort, indicating a positive response to the medication. The nurse observes that the patient appears more at ease and is able to engage in light activities without difficulty, suggesting an improvement in the patient's condition.

A repeat echocardiogram reveals a slight reduction in the pericardial effusion, providing further evidence that the inflammation is subsiding. Blood tests show a decrease in the levels of CRP and ESR, aligning with the improved clinical presentation. Vital signs are stable, with a blood pressure of 120/80 mmHg, heart rate of 78 beats per minute, and respiratory rate of 16 breaths per minute. These findings confirm that the current treatment is effectively managing the pericarditis without any immediate complications.

The nurse takes this opportunity to reinforce the patient's education on the importance of continuing the medication as prescribed and maintaining regular follow-up appointments to monitor progress. The nurse also discusses the potential signs of complications, such as increased chest pain or shortness of breath, and advises the patient to seek medical attention if these occur. This ongoing support and education empower the patient to actively participate in their recovery journey, ensuring any emerging issues are promptly addressed. The plan is to gradually reintroduce more physical activities as tolerated, with a focus on maintaining a balanced lifestyle to support heart health.

Section 5

As the patient continues the treatment regimen, the nurse prepares for another routine follow-up appointment. During this visit, the nurse conducts a comprehensive assessment to ensure the patient is on the path to recovery. The patient now reports minimal chest pain, which only occurs occasionally and is not as severe as before. The patient also mentions being able to sleep better at night without being woken by discomfort. The nurse notes that the patient's physical appearance has improved, with the patient displaying a healthier complexion and exhibiting more energy during the interaction.

Vital signs remain stable, with a blood pressure of 118/76 mmHg, heart rate of 74 beats per minute, and respiratory rate of 16 breaths per minute. The nurse performs a focused cardiac assessment and finds no signs of friction rub, which had been present during earlier visits. This finding suggests a continued positive response to the NSAID therapy and a reduction in inflammation around the heart. The patient remains afebrile, and their oxygen saturation is 98% on room air, indicating adequate oxygenation and no respiratory distress.

The nurse reviews recent lab results, noting that both CRP and ESR levels have returned to within normal ranges, further confirming the resolution of the acute inflammatory process. Given these encouraging results, the nurse discusses with the patient the possibility of slowly increasing physical activity, emphasizing the importance of listening to their body and not overexerting themselves. The patient is encouraged to continue with follow-up appointments and to report any unexpected changes in their condition, ensuring that any potential complications are identified and addressed promptly. This proactive approach supports the patient's ongoing recovery and helps maintain their confidence in managing their health.