심낭염 IV: 간호 관리

Nurses should assess for sharp, pleuritic chest pain radiating beneath the clavicle, neck, or left trapezius. During physical examination, auscultate for a characteristic pericardial friction rub and check for muffled heart sounds. Additional objective findings include increased temperature, elevated white blood cell count, decreased oxygen saturation, and signs of cardiac tamponade such as jugular venous distention and pulsus paradoxus.

Chest pain in pericarditis worsens when lying supine and improves when sitting up and leaning forward. Elevated head positioning at 45 degrees facilitates breathing and reduces cardiac workload. Providing an overbed table allows patients to lean forward for support, alleviating discomfort. This positioning strategy is central to nursing management and helps address both pain and ineffective breathing patterns.

Two primary nursing diagnoses include Acute Pain related to pericardial irritation, evidenced by sharp chest pain and guarding signs, and Ineffective Breathing Pattern related to pain, evidenced by shallow breathing, dyspnea, and use of accessory muscles. These diagnoses guide interventions focused on pain management and respiratory support to improve patient outcomes.

Prescribed pain medicine should be administered with food or milk to prevent gastrointestinal upset, a common side effect of analgesics. This nursing intervention protects the patient's GI system while ensuring effective pain relief. Nurses must monitor the patient's response to medication and adjust the care plan accordingly to optimize comfort and recovery.

Nurses should educate patients and families about maintaining a balanced diet, engaging in regular exercise, ensuring adequate rest, and avoiding alcohol. These lifestyle modifications help mitigate symptoms and promote recovery. Education plays a pivotal role in long-term management and helps prevent complications or recurrence of pericarditis.

Nurses must remain alert to signs and symptoms of cardiac tamponade and monitor for heart failure development. Patients with hemodynamic instability or pulmonary congestion require vigilant assessment. The nurse must continuously evaluate the patient's response to interventions and adjust the care plan as necessary to prevent complications and ensure optimal outcomes.

Patients should brush their teeth twice daily to maintain good oral hygiene, which supports overall cardiovascular health. This preventive measure is part of comprehensive nursing management for pericarditis patients. Good oral hygiene reduces the risk of secondary infections and contributes to the patient's overall recovery and well-being during treatment.