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. (20 points)

1. The patient is experiencing pericardial pain. To alleviate this discomfort, what

position could the nurse assist the patient with maintaining?

 Pericardial pain refers to pain felt due to friction or pressure in the pericardial layers.
Pain experienced by the patient may be affected by position as patients may
experience pain relief as they lean forward. So, generally, the safest posture for a
patient with pericardial pain is sitting while leaning forward, since one of the distinct
characteristics of this position is the tendency to decrease pain severity while the
patient sits up and leans forward. This position tends to reduce pressure on the
parietal pericardium, particularly with inspiration.

2. When planning Mr. Nathaniel’s care, what should the nurse understand are the
objective of pericarditis management?

The nurse should understand that the objectives of pericarditis management are:

 To treat the cause and eliminate the source of infection while sustaining the cardiac
output and avoiding any major (or minor) complications.
 Understanding to the disease itself and how to reduce the pain and contribute to the
management of pericarditis
 Assess pain management and relieved pain
 Assess pain of 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 a febrile patient.
3. The nurse is auscultating Mr. Nathaniel’s chest for pericardial friction rub. Where
will the nurse auscultate in order to locate the rub?

 The nurse should auscultate the pericardial friction rub with the diaphragm of the
stethoscope on the left lower sternal edge or apex during end expiration with the
patient sitting up and leaning forward (or on hand and knees) allows the best
detection of the rub. The rub that can be heard has rasping or scratching sound that
is very much similar to leather rubbing against leather.