Primary Nursing Diagnosis

Pain (acute) related to swelling and inflammation of the heart or surrounding tissue

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom severity

INTERVENTIONS. Analgesic administration; Anxiety reduction; Environmental management: Comfort; Pain management; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

Pericarditis is treated by correcting the underlying cause and therefore relieving the signs and symptoms. Acute pericarditis is treated with analgesic and anti-inflammatory agents. Acute peri-cardial effusions are treated according to the hemodynamic effect on the myocardium. An acute effusion that causes a decreased cardiac output is an indication for pericardiocentesis, which allows for fluid to be removed from the pericardial sac. Cardiac compression is relieved, and cardiac output returns. Other alternatives are a pericardiotomy, which is a surgical incision in the

716 Pericarditis pericardial sac, or pericardial window (fenestration), which is the removal of one or more small portions of the pericardial sac. These surgical procedures are used when pericardiocentesis is unsuccessful or must be repeated because of continued accumulation of fluid.

Chronic pericarditis, with or without an effusion, may require a pericardectomy, which involves a thoracotomy incision and carries a much higher mortality (5% to 14%) than the other procedures. Note that, to halt the hemorrhage, a rapidly accumulating tamponade from hemorrhage into the pericardiac space should be managed surgically rather than by pericar-diocentesis.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Nonsteroidal anti

Varies with drugs

Aspirin, indomethacin,

Reduce pain and inflammation

inflammatory

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