Pericarditis

Assignment!
You are caring for a 32-year-old male client who pushes his call light stating he is experiencing intermittent, sharp precordial chest pain that radiates to his neck since being admitted during the night. He gets relief if he sits and leans forward, but the pain gets worse with swallowing. He rates the pain at 5 out of 10 on a numerical scale. He has not received any medication for the pain since admitted to your floor. On physical examination, a pericardial friction rub can be heard. From your morning report, you are aware that he had an upper respiratory tract infection two weeks ago.
Based on the client’s presenting symptoms and physical findings, discuss the most probable diagnosis that would support your response with evidence from the literature.
 
Peers Response to assignment
 
Peer 1: Luisa Perez posted
According to the symptoms experienced by the patient and the physical findings during assessment the patient has pericarditis. Pericarditis is the inflammation of the pericardium and the condition can be acute or chronic (McCance & Huether, 2019). Acute pericarditis is often autoimmune or caused by a viral infection (McCance & Huether). Heart attack or heart surgery, other medical conditions, injuries, or medications are also other possible causes of pericarditis (Heart.org). It was mentioned that the patient had a respiratory tract infection two weeks ago during morning report. This information helped us tremendously in narrowing down the diagnoses. McCance & Huether (2019) state, “Possible sequelae of pericarditis include recurrent pericarditis, pericardial constriction, and cardiac tamponade” (p. 1088). Symptoms include retrosternal chest pain that worsens with respiratory movements and when in a recumbent position, pain that radiates to the back (McCance & Huether). This would explain why the patient gets relief when sitting up or leaning forward and that the pain radiates to his neck. McCance & Huether state, “A friction rub- a scratchy, grating sound- may be heard at the cardiac apex and left sternal border and is caused by the roughened pericardial membranes rubbing against each other” (p. 1088). The friction rub was heard during physical examination of the patient.
 
Resources
Heart.org. (2016). What is Pericarditis? Retrieved from  https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
McCance, K. & Huether, S. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). St. Louis, MO: Elsevier.
 
 
Peer 2: Dianne Nalwoga posted
A 32-year-old male client complains of intermittent sharp precordial chest pain that radiates to his neck getting relief when he sits and leans forward, but also states that the pain gets worse with swallowing. He rates the pain at 5 out of 10. Upon auscultation, a pericardial friction rub can be heard. Patient has a history of upper respiratory tract infection that he suffered two weeks ago. Based on the patient’s complaints, the probable diagnosis would be acute pericarditis.
“Acute pericarditis is acute inflammation of the pericardium. The etiology of acute pericarditis is most often idiopathic (autoimmune) or caused by viral infection” (McCance & Huether, 2019). This is consistent with the patient’s findings as it is evident that the patient in question had an upper respiratory infection just a couple weeks prior. Highly specific to acute pericarditis is “chest pain, a pericardial friction rub, electrocardiographic changes” (Mullen, 2014). A friction rub is a scratchy, grating sound that may be heard at the cardiac apex and left sternal border and is caused by the roughened pericardial membranes rubbing against each other (McCance & Huether, 2019). This is indicative of chest pain that is exacerbated in the supine position that is relieved by sitting upward and leaning forward. To further explore the underlying cause of pericarditis and its severity a physician may order tests such as EKG, Chest X-ray, electrocardiographic (ECG), ultrasound, CT scan, and MRI. Individuals with acute pericarditis also report dysphagia, restlessness, irritability, anxiety, weakness, and malaise (McCance & Huether, 2019). CT scan of the neck and chest can be used to confirm cardiomegaly pressing against the esophagus which can cause dysphagia the thus leaning forward motion to relieve pressure on the esophagus.
The purpose of treating acute pericarditis is to alleviate and prevent complications. “Because of the brevity of the duration of the illness, treatment is generally supportive based on symptoms and aimed at alleviating the causative factor if possible” (Mullen, 2014). Nonsteroidal anti-inflammatories at high doses can help reduce the inflammation and associated pain. However, indomethacin should be avoided in patients with confirmed or suspected coronary artery disease because of its vasoconstrictive effects (Mullen, 2014).
References
McCance, K. & Huether, S.  (2019).  Pathophysiology:  The Biologic Basis for Disease in Adults and Children (8th ed.).  St. Louis, MO:  Elsevier.
Mullen, B. A. (2014). Acute Chest Pain in the Young Adult. Journal for Nurse Practitioners, 10(2), 128–135.