Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  45

Causes of Pericardial Disease Idiopathic (presumed to be viral, postviral, or immune-mediated)

In most case series, the majority of patients are not found to have an identifiable cause of pericardial disease. Frequently such cases are presumed to have a viral or autoimmune etiology. Viral (influenza, coxsackie virus, HIV), bacterial (staphylococcus, meningococcus, streptococcus, pneumococcus, gonococcus, Mycobacterium tuberculosis), fungal, parasitic, infective endocarditis with valve ring abscess Autoimmune and autoinflammatory • Systemic inflammatory diseases, especially lupus, rheumatoid arthritis, scleroderma, Sjögren syndrome, vasculitis, mixed connective disease • Autoinflammatory diseases (especially familial Mediterranean fever and tumor necrosis factor associated periodic syndrome [TRAPS]) • Postcardiac injury syndromes (immune-mediated after cardiac trauma in predisposed individuals) • Other—Granulomatosis with polyangiitis (Wegener’s), polyarteritis nodosa, sarcoidosis, inflammatory bowel disease (Crohn’s, ulcerative colitis), Whipple’s, giant cell arteritis, Behçet disease, rheumatic fever • Metastatic—Lung or breast cancer, Hodgkins disease, leukemia, melanoma • Primary—Rhabdomyosarcoma, teratoma, fibroma, lipoma, leiomyoma, angioma • Paraneoplastic • Early infarction pericarditis • MI; early, 24–72 hr; late postcardiac injury syndrome (Dressler syndrome), also seen in other settings (e.g., postmyocardial infarction and postcardiac surgery) • Myocarditis

Infectious

Noninfectious

Neoplasm

Cardiac

• Dissecting aortic aneurysm • Following cardiac surgery

Other

Trauma Metabolic Radiation

Pericardial Effusion • Place the patient in an upright position to relieve dyspnea and chest pain. • Monitor the patient’s renal status (including blood urea nitrogen

levels, creatinine clearance, and urine output) to check for signs of renal emboli and drug toxicity. • Observe for progression to cardiac tamponade.

restrictions on his responsibilities and routines. • Monitor pain. • Provide an analgesic to relieve pain and oxygen to prevent tissue hypoxia. • Before giving an antibiotic, prescribed antibiotic on time to maintain a consistent drug level in the blood. • Assess cardiovascular status frequently, and observe for signs and symptoms of left-sided HF, such as dyspnea, hypotension, tachycardia, tachypnea, crackles, obtain a patient history of allergies. Administer the

Falling arterial pressure Rising venous pressure

Prominent neck veins due to elevated venous pressure

Dyspnea Tachypnea

PICTURING PATHO

Chest pain Tachycardia Distant heart sounds

Hypotension Paradoxical pulse

and weight gain. Check for changes in cardiac rhythm or conduction.

Assessment findings in cardiac tamponade resulting from pericardial effusion include chest pain or fullness, dyspnea, tachycardia, jugular vein distention, hypotension, paradoxical pulse, tachycardia, and distant heart sounds. (Reprinted with permission from Hinkle JL, Cheever KH. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing . 13th ed. Philadelphia: Wolters Kluwer; 2013.)

• Administer oxygen and evaluate ABG levels, as needed, to ensure adequate oxygenation. • Assess cardiovascular status frequently, watching for signs of cardiac tamponade.

Pericardial compression due to fluid-filled pericardial sac