pericarditis /per′ikärdī″tis/ [Gk, peri + kardia, heart, itis] , inflammation of the pericardium associated with trauma, malignant neoplastic disease, infection, uremia, myocardial infarction, collagen disease, or unknown causes. See also acute nonspecific pericarditis. ▪ OBSERVATIONS: Two stages are observed if treatment in the first stage does not halt progress of the condition to the extremely grave second stage. The first stage is characterized by fever; substernal chest pain that radiates to the shoulder or neck; dyspnea; a dry, nonproductive cough; a rapid and forcible pulse; a pericardial friction rub; and a muffled heartbeat over the apex. The patient becomes increasingly anxious, tired, and orthopneic. During the second stage a serofibrinous effusion develops within the pericardium, restricting cardiac activity. If the effusion is purulent (caused by bacterial infection), a high fever, sweat, chills, and prostration also occur. The heart sounds become muffled, weak, and distant on auscultation, and a bulge is visible on the chest over the precordial area. ▪ INTERVENTIONS: The patient is kept in bed, and the head of the bed is elevated 45 degrees to decrease dyspnea. Hypothermia treatment may be necessary to reduce the body temperature. An antibiotic or antifungal and analgesic may be ordered. Oxygen and parenteral fluids are usually given, vital signs are evaluated, and the chest is auscultated frequently. Pericardiocentesis or pericardiotomy may be performed to remove accumulated fluid or to make a diagnosis. ▪ PATIENT CARE CONSIDERATIONS: Emotional support of a patient being treated for pericarditis requires remaining with the person if he or she is anxious and explaining all procedures thoroughly. During recovery, rest periods are planned and the person is urged to avoid fatigue and exposure to upper respiratory infections. The patient is told to report symptoms of recurrence, including fever, chest pain, and dyspnea.
