Effects on the Cardiovascular System: Pericarditis

Transcription

1 Effects on the Cardiovascular System: Authors: Ayda G. Nambayan, DSN, RN, St. Jude Children s Research Hospital Erin Gafford, Pediatric Oncology Nursing, St. Jude Children s Research Hospital; Nursing Student, School of Nursing, Union University Content Reviewed by: Judith Wilimas, MD, St. Jude Children s Research Hospital Cure4Kids Release Date: 6 June 2006 (A -1) is an inflammation of the pericardium that may result from radiation to the mediastinum or from the underlying disease process. Complications of pericarditis include edema, thrombosis, fibrosis, destruction of pericardial capillaries and pericardial or cardiac tamponade. Assessments Symptoms of pericarditis may include fever and pleuritic chest pain. A pericardial friction rub may be heard by auscultation. Depending upon the extent of the inflammatory process and the amount of exudates in the pericardial sac, heart sounds may be muffled or appear distant on auscultation. Systemic symptoms of malaise, a general feeling of being sick and a lack of appetite may also be seen in patients. Patients with pericarditis may prefer a forward-leaning or sitting position rather than lying down. Diagnostic examination may include an electrocardiogram, an echocardiogram and a chest x-ray. Planning A plan of care is expected to result in the following. minimal complications related to pericarditis an understanding by the patient and family of the risk factors and care requirements associated with pericarditis an understanding by the patient and family about the signs and symptoms of cardiac tamponade (A 2) Module 7 - Document 16 Page 1 of 5

2 Implementation Mild symptoms associated with pericarditis can be treated with rest and nonsteroidal antiinflammatory drugs. Acute symptoms can be treated with corticosteroids and antipyretic agents (for example, acetaminophen). The major challenge for nurses is the provision of rest. Play and other physical activities should be adjusted to avoid an increase in the cardiac workload. Complications of pericarditis include arrhythmias (atrial fibrillation and supraventricular tachycardia, heart block); constrictive pericarditis (fibrosis and thickening of the pericardium), which can lead to heart failure; and cardiac tamponade (diastolic cardiac filling that is impaired because of increased intrapericardial pressure). Therefore, the nurse must monitor the patient s vital signs, particularly the heart rate and rhythm to detect arrhythmias. Patient and Family Education The patient and family should be taught alternative activities that support the patient s need for play but do not add burden to the heart. The patient and family should also be familiar with signs and symptoms of compromised cardiac function (A 3) and should be taught to promptly report their occurrence to an appropriate health care provider. The nurse should instruct the family regarding the use of aspirin and other salicylate products to manage the patient s fever. Aspirin should not be used for several reasons: - in children and adolescents younger than 15 years, aspirin and other salicylate drugs may cause Reye s syndrome (a potentially fatal disease characterized by encephalopathy and fatty infiltration of the liver, pancreas, heart, kidney, spleen and lymph nodes). - Aspirin inhibits platelet aggregation and may cause increased bleeding in patients with thrombocytopenia secondary to chemotherapy induced bone marrow suppression. Evaluation The desired outcomes of care should include successful treatment progression with minimal cardiac effects. Helpful Web Links: American Heart Association, Dallas, TX Pericardium and emedicine Midwest Heart Specialist Module 7 - Document 16 Page 2 of 5

3 APPENDIX A 1 is an inflammation of the pericardial sac. Normal pericardium pericarditis (inflammation of the pericardium) Cardiocaribe.com, Colombia Module 7 - Document 16 Page 3 of 5

4 A 2 Cardiac Tamponade Accumulation of fluid in the pericardial sac A- 3 Signs and Symptoms of Compromised Cardiac Function Severe drop in blood pressure Increasing work of breathing Weak, irregular or slow pulse (less than 60/min) Decreased heart sounds Distended or bulging veins, especially of the neck (jugular) veins Bluish skin color or cyanosis Severe anxiety or panic Fatigue Weakness Fainting Module 7 - Document 16 Page 4 of 5

5 Acknowledgments Authors: Ayda G. Nambayan, DSN, RN, St. Jude Children s Research Hospital Erin Gafford, Pediatric Oncology Education Student, St. Jude Children s Research Hospital; Nursing Student, School of Nursing, Union University Content Reviewed by: Judith Wilimas, MD, St. Jude Children s Research Hospital Edited by: Julia Cay Jones, PhD, ELS, Freelance Biomedical Editor, Memphis, TN Cure4Kids Release Date: 6 June 2006 Cure4Kids.org International Outreach Program St. Jude Children's Research Hospital 332 N. Lauderdale St. Memphis, TN You may duplicate and redistribute this content in its entirety for educational purposes provided that the content is made available free of charge. This content may not be modified or sold. You can assist us in the development of additional free educational materials by sending us information about how and when you show this content and how many people view it. Send all comments and questions to nursing@cure4kids.org. St. Jude Children's Research Hospital, 2006 Last printed 6/28/2006 1:46 PM Last Updated: 28 June 2006; AS X:\HO\IO Edu Grp\Projects\NURSING COURSE\NCEnglish\Edited\Module 7\M7 Final Revisions\NEM07D16V12.doc Module 7 - Document 16 Page 5 of 5