DE SAGUN, LEILA CAMILLE A.

BSN3Y1-1B
312-LEC-CU6

CONSIDER THE SCENARIO AND ANSWER THE FOLLOWING QUESTIONS:

MR. NATHANIEL IS A 46-YEAR-OLD MAN WHO HAS DEVELOPED SYMPTOMS OF ACUTE
PERICARDITIS SECONDARY TO VIRAL INFECTION. DIAGNOSIS WAS BASED ON
CHARACTERISTIC SIGN OF A FRICTION RUB AND PAIN OVER THE PERICARDIUM. (30
POINTS)

1. THE PATIENT IS EXPERIENCING PERICARDIAL PAIN. TO ALLEVIATE THIS

DISCOMFORT, WHAT POSITION COULD THE NURSE ASSIST THE PATIENT
WITH MAINTAINING?

 Advise bed rest or chair rest in a sitting-upright and leaning-forward position.

Instruct patient to resume activities of daily living as chest pain and friction rub abate
Administer medications, monitor, and record responses.
Instruct patient to resume bed rest if chest pain and friction rub recur.

2. WHEN PLANNING MR. NATHANIEL’S CARE, WHAT SHOULD THE NURSE

UNDERSTAND ARE THE OBJECTIVES OF PERICARDITIS MANAGEMENT?

 The nurse should understand that the objectives of pericarditis management are:
 To treat the cause and remove the source of infection while preserving cardiac
output and preventing any major (or minor) complications.
 Understanding to the disease itself and how to alleviate the pain and contribute to
the management of pericarditis
 Assess pain by observation and evaluation while having patient vary
positions to determine precipitating or intensifying factors. (Is pain influenced
by respiratory movements. Assess pericardial friction rub (a pericardial friction
rub is continuous, distinguishing it from a pleural friction rub). Ask patient to
hold breath to help in differentiation: audible on auscultation, synchronous with
heartbeat, best heard at the left sternal edge in the fourth intercostal space where
the pericardium comes into contact with the left chest wall, scratchy or
leathery sound, louder at the end of expiration and may be best heard with
patient in sitting position. Monitor temperature frequently, because pericarditis
causes an abrupt onset of fever in a previously afebrile patient.
3. THE NURSE IS AUSCULTATING MR. NATHANIEL’S CHEST FOR A PERICARDIAL
FRICTION RUB. WHERE WILL THE NURSE AUSCULTATE IN ORDER TO LOCATE
THE RUB?

 The nurse should auscultate in the diaphragm of the stethoscope over the left lower
sternal edge or apex during end expiration with the patient sitting up and leaning forward
(or on hands and knees) allows the best detection of the rub and increases the likelihood
of observing this finding. A pericardial friction rub, also pericardial rub, is an audible
medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra
heart sound of to-and-fro character, typically with three components, ONE systolic and
TWO diastolic.