Page 68 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 62

CV
and lessened by leaning forward. If pericarditis is not the cause, there are
often no symptoms.
■ Complaints of dull, constant pain, pressure, ache, or discomfort in the left
side of the chest with symptoms of cardiac compression
■ Fever
■ Fatigue
■ Muscle aches
■ Cough, SOB, dyspnea, hoarseness, hiccups
■ Nausea, vomiting, and/or diarrhea
■ Tachycardia, palpitations
■ Lightheadedness, syncope
■ Cool, clammy skin
■ Weakened peripheral pulses, edema, cyanosis
■ Anxiety, confusion
■ Muffled heart sounds
■ May or may not manifest with pericardial friction
■ Dullness of percussion of the left lung over the angle of scapula
(Ewart’s sign)
■ ECG showing ↓ voltage of complexes, diffuse ST elevation with PR depression
Diagnostic Tests
■ Echocardiogram
■ ECG
■ Chest x-ray
■ CBC with differential, ESR, CRP
■ Serum electrolytes
■ Blood cultures and cardiac biomarkers as appropriate
Management
■ Manage pain.
■ Pericardiocentesis or pericardectomy (pericardial window) is performed by
a physician.
■ Position changes decrease SOB.
■ Provide wound care after pericardiocentesis, pericardectomy, or other
pericardial surgical procedures, care of pericardial catheters and chest
tubes.
■ Assess VS, pulses, LOC, respiratory status, skin and temperature changes,
intake and output frequently.
■ Monitor and record any drainage from pericardial catheters and chest
tubes. Refer to Respiratory Tab.
■ Depending on etiology of effusion, administer NSAIDs or antibiotics.
62