Pericarditis is an inflammation of the pericardium, which is the membranous sac that encloses the heart and great vessels. The inflammatory response causes an accumulation of leukocytes, platelets, fibrin, and fluid between the parietal and the visceral layers of the pericardial sac, thus producing a variety of symptoms, depending on the amount of fluid accumulation, how quickly it accumulates, and whether the inflammation resolves after the acute phase or becomes chronic.

An acute pericardial effusion is caused by an accumulation of fluid in the pericardial sac. The fluid accumulation interferes with cardiac function by compressing the cardiac chambers. Chronic constrictive pericarditis usually begins as an acute inflammatory pericarditis and progresses over time to a chronic, constrictive form because of pericardial thickening and stiffening. The thickened, scarred pericardium becomes nondistensible and decreases diastolic filling of the cardiac chambers and cardiac output. Chronic pericardial effusion is a gradual accumulation of fluid in the pericardial sac. The pericardium is slowly stretched and can accommodate more than 1 L of fluid at a time.

Between 26% and 86% of people with pericarditis have illnesses that are considered idiopathic (occurring without a known cause). Pericarditis may also be classified etiologically into three broad categories: infectious pericarditis, noninfectious pericarditis, and pericarditis presumably related to hypersensitivity or autoimmunity. Infectious pericarditis may be caused by a viral infection such as the coxsackie B virus. Pyrogenic, tuberulous, mycotic, syphilitic, and parasitic infections may also cause pericarditis. Noninfectious pericarditis may be caused by a number of factors, including acute myocardial infarction, trauma, aortic aneurysm (with leakage into the pericardial sac), uremia, sarcoidosis, and myxedema. Both primary tumors, either benign or malignant, and metastatic tumors in the pericardium may cause pericarditis. Other causes include cholesterol and chylopericardium.

Pericarditis is also thought to be related to hypersensitivity or autoimmunity. Rheumatic fever and collagen vascular disease, such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma, may cause pericarditis. Some drugs, such as procainamide and hydralazine, are thought to cause pericarditis, as can postcardiac injury, such as Dressler’s syndrome, and postpericardiotomy.

Nursing care plan assessment and physical examination
Acute inflammatory pericarditis is most frequently idiopathic; however, the patient may have a history of a viral, bacterial, fungal, or parasitic infection. Take a detailed history of the patient’s symptoms, especially pain. Ask the patient to describe the pain: Is it dull or sharp, and is it persistent? Is the location of the pain retrosternal or left precordial and radiating to the neck, left arm, and trapezius ridge? Ask if the pain is worsened by trunk movement, position, and deep inspiration. Ask about fever, cough, dyspnea, dysphagia, hiccups, nausea, and abdominal pressure (because of the compression of surrounding tissues by the enlarged pericardial sac).

The patient with a chronic pericardial disease may reveal a history of myocardial infarction (Dressler’s syndrome), tuberculosis, chronic renal failure, radiation therapy, malignancies, connective tissue disease, and acquired immunodeficiency syndrome (AIDS). Note a history of increasing dyspnea, fatigue, loss of appetite, nausea, and cough. Chest pain is not usually associated with chronic pericarditis.

Check the patient’s vital signs for tachycardia, tachypnea, and fever. If there is an effusion, the blood pressure may be low and a pulsus paradoxus may be present (an abnormal drop in systolic pressure with inspiration). Inspect the patient’s neck for vein distension because of elevated jugular venous pressures that are caused by chronic pericarditis. Auscultate for heart sounds to establish a pericardial friction rub. Although the presence of a pericardial friction rub is a significant finding, the absence of a rub is not because pericardial friction rub is transient.

Because of severe chest pain, patients with acute pericarditis may be in distress. The patient may be fearful of having a myocardial infarction. Assess the patient’s ability to cope with a sudden illness and severe pain.

Nursing care plan primary nursing diagnosis: Pain (acute) related to swelling and inflammation of the heart or surrounding tissue.

Nursing care plan intervention and treatment plan
Pericarditis is treated by correcting the underlying cause and therefore relieving the signs and symptoms. Acute pericarditis is treated with analgesic and anti-inflammatory agents. Acute pericardial effusions are treated according to the hemodynamic effect on the myocardium. An acute effusion that causes a decreased cardiac output is an indication for pericardiocentesis, which allows for fluid to be removed from the pericardial sac. Cardiac compression is relieved, and cardiac output returns. Other alternatives are a pericardiotomy, which is a surgical incision in the pericardial sac, or pericardial window (fenestration), which is the removal of one or more small portions of the pericardial sac. These surgical procedures are used when pericardiocentesis is unsuccessful or must be repeated because of continued accumulation of fluid.

Chronic pericarditis, with or without an effusion, may require a pericardectomy, which involves a thoracotomy incision and carries a much higher mortality (5% to 14%) than the other procedures. Note that, to halt the hemorrhage, a rapidly accumulating tamponade from hemorrhage into the pericardiac space should be managed surgically rather than by pericardiocentesis.

Place the patient in a high Fowler position. Use pillows to increase the patient’s comfort, and encourage the patient to sit upright and lean slightly forward rather than lie supine. If the upright position does not alleviate the pain, have the patient try a side-lying position for 10 minutes. If the patient needs to perform coughing and deep-breathing exercises, provide instruction on splinting the chest with pillows to decrease the pain.

Remain with the patient during periods of increased pain and discomfort. Encourage the patient and family to verbalize their fears and concerns and to ask questions about the treatment and course of the disorder. Inform the patient and family about pericarditis and its causes.
Explain all procedures. Assist the patient and family in distinguishing acute pericarditis from myocardial infarction. Teach them about continuing medications as prescribed even after the pain is gone but to taper use of steroids.

Pericardial effusion ("fluid around the heart") is an abnormal accumulation of fluid in thepericardial cavity. Because of the limited amount of space in the pericardial cavity, fluidaccumulation leads to an increased intrapericardial pressure which can negatively affectheart function. A pericardial effusion with enough pressure to adversely affect heart function is called cardiac tamponade. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of pericardial fluid, or from a structural abnormality that allows fluid to enter the pericardial cavity.
Normal levels of pericardial fluid are from 15 to 50 mL.
Contents
[hide] * 1 Types * 2 Signs and symptoms * 3 Causes * 4 Diagnosis * 5 Treatment * 6 References * 7 External links
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Types[edit]
It may be: * transudative (congestive heart failure, myxoedema, nephrotic syndrome), * exudative (tuberculosis, spread from empyema) * haemorrhagic (trauma, rupture of aneurysms, malignant effusion). * malignant (due to fluid accumulation caused by metastasis)

Water bottle-shaped heart

Sinus tachycardia with low QRS voltage and QRS alternans
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Signs and symptoms[edit]
Chest pain or pressure are common symptoms. A small effusion may be asymptomatic. Larger effusions may cause cardiac tamponade, a life-threatening complication; signs of impending tamponade include dyspnea, low blood pressure, and distant heart sounds.
The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.
It can be associated with dullness to percussion over the left subscapular area due to compression of the left lung base. This phenomenon is known as Ewart's sign.[1]
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Causes[edit] * Pericarditis * Long term usage of cabergoline ingredient (dopamine agonists) * Viral infection (coxsackie virus) * Infection * Inflammatory disorders, such as lupus, rheumatoid arthritis[2] and postmyocardial infarction pericarditis (Dressler's syndrome) * Cancer that has spread to the pericardium * Trichinosis * Kidney failure with excessive blood levels of urea nitrogen * Minoxidil * Hypothyroidism * Heart surgery[3] (postpericardotomy syndrome)
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Diagnosis[edit] *
A CT scan image showing a pericaridal effusion *
A very large hemorrhagic pericardial effusion due to malignancy as seen on ultrasound. closed arrow: the heart, open arrow: the effusion *
Pericardial effusion due to malignancy. Note bulbous heart and primary lung cancer in right upper lobe. *
An ECG showing electrical alternans in a person with a pericardial effusion. *
A pericardial effusion due to pericarditis
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Treatment[edit]
Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as lupus, treatment with anti-inflammatory medications may help. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space called pericardiocentesis. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by cutting through the pericardium creating a pericardial window.

Breast cancer is a leading killer after lung cancer high incidence of age since the age of 30 years, Breast cancer is rarely found in the age below 20 years. It is most common after age 50. Early detection and treatment influences the prognosis considerably of Breast cancer. Complete history and physical examination should be done in A woman with a new breast mass. The differential diagnosis of a breast mass can be broad, including malignancies such as primary breast cancer, lymphoma, or sarcoma, or benign breast lesions such as cysts, fibroadenoma, and fat necrosis. Even skin conditions, such as sebaceous cysts, abscesses, or thrombophlebitis may occur with a palpable mass. The history and physical will help aid in the diagnosis, but ultimately a biopsy is confirmatory of the diagnosis.
Causes for Breast Cancer
The origin of breast cancer is a complex interaction between the biologic and endocrine properties of the person and the environmental exposures that may precipitate mutation of cells to a malignancy. Despite known hereditary risk factors, the majority of breast cancers are diagnosed in women with no such risk factors. Although 10% to 20% of breast cancer patients have a family history suggestive of a hereditary susceptibility, only 5% of all breast cancers can be attributed to a known genetic defect
Risk factors for Breast Cancer: * Family history of breast or ovarian cancer * Age, The incidence of breast cancer increases with age and steadily after age 50. Thus, 75% of all cases of breast cancer are diagnosed in postmenopausal women Premenopausal * Parity and lactation: long menstrual cycle, early onset of menses, late menopause. First pregnancy before age 20 or after age 31, The data on lactation are mixed but appear to indicate a decreased risk of breast cancer if women nurse for a long duration * High-fat diet * Endometrial or ovarian cancer * Radiation exposure, Exposure to ionizing radiation, such as in nuclear explosions or medical therapeutics, does appear to increase the risk of breast cancer. * Estrogen therapy * Antihypertensive therapy * Alcohol and tobacco, there is an irrefutable link between alcohol consumption and breast cancer risk. A pooled analysis of 322,647 women showed a positive linear relationship between incremental alcohol intake and increasing breast cancer risk. * Breast disease, Benign breast disease, such as fibrocystic disease, do not increase the risk of breast cancer. Papillomas, sclerosing adenosis, and lobular carcinoma in situ are also known to increase the risk.
Complications for Breast Cancer
Metastasis leads to site-specific complications, bone, brain, and respiratory problems if it spreads to the lung.
Diagnostic tests Breast Cancer * Screening and early detection: Mammography, Breast examinations, High-risk patients * Mammogram * Ultrasound of the breast * Biopsy
Treatment for Breast Cancer
Depends on the stage and type of Breast Cancer * Stage I size less 2 cm No node involvement, no metastasis * Stage II Size Up to 5 cm May have axillary’s node involvement, no metastasis * Stage III Varied (any size) Extended to skin or chest wall, nodes involved (immovable axillary node) * Stage IV Varied Distant metastasis with ipsilateral supraclavicular nodes
Therapy may include a combination of surgery, radiation, chemotherapy, and hormone therapy
Surgical. The goal of surgery is control of cancer in the breast and the axillaries nodes * Lumpectomy * Partial mastectomy (also known as segmental mastectomy or quadrantectomy) removes one-quarter or more of the breast. * Simple or total mastectomy is the removal of the breast but not the lymph nodes or pectoral muscles. * Modified radical mastectomy is the removal of the breast and some of the axillary lymph nodes. * Radical mastectomy is the removal of the breast, pectoralis major and minor, and axillary lymph nodes. The use of this surgery has declined.
Nursing Diagnosis For Breast Cancer
Nursing diagnosis for breast cancer determine with data that we Collect in nursing assessment and result from Diagnostic tests for Breast Cancer
Nursing Assessment Nursing Care Plans for Breast Cancer * Patient History. Assess the patient’s and family’s previous medical history of breast cancer or other Cancers. * Palpation may identify a hard lump, mass, or thickening of breast tissue. Palpation of the cervical supraclavicular and axillary nodes may also disclose lumps or enlargement. * Painless lump or mass in her breast or that she noticed a thickening of breast tissue * Examine the axillary and supraclavicular areas for enlarged nodes. You may note the tumor is firm and immovable. * Assess the patient for pain or tenderness at the tumor site. * Inspect the breast skin for signs of advanced disease: the presence of inflammation, dimpling, orange peel effect, distended vessels, and nipple changes or ulceration
Diagnostic tests Breast Cancer * Screening and early detection: Mammography, Breast examinations, High-risk patients * Mammogram * Ultrasound of the breast * Biopsy
Nursing diagnosis for breast cancer:
Common Nursing diagnosis found on Nursing Care Plans for Breast Cancer * Acute pain * Body image disturbance related to significance of loss of part or all of the breast * Anxiety * Fear * Imbalanced nutrition: Less than body requirements * Impaired physical mobility * Impaired skin integrity * Ineffective coping * Ineffective role performance * Risk for infection * Risk for spiritual distress * Bathing or hygiene self-care deficit * Energy field disturbance
Nursing Care Plans for Breast Cancer
NCPNursing care plans for Breast Cancer. Common nursing diagnosis found in nursing care plan for patient with Breast Cancer: Acute pain, Body image disturbance related to significance of loss of part or all of the breast, Anxiety, Fear, Imbalanced nutrition: Less than body requirements, Impaired physical mobility, Impaired skin integrity, Ineffective coping, Ineffective role performance, Risk for infection, Risk for spiritual distress, Bathing or hygiene self-care deficit, Energy field disturbance
Nursing outcomes Nursing Care Plans for Breast Cancer
Patient will: * Communicate feelings of comfort and decreased pain. * Express that she feels less anxious. * Participate in her own care at the highest level possible within the limitations of her illness. * Express positive feelings about self. * Express increased sense of well-being. * Use situational supports to reduce fear. * Maintain adequate nutrition through oral intake or i.v. fluids. * Maintain optimal muscle strength and joint range of motion. * Patient’s surgical wounds will appear pink without signs or symptoms of complications. * Demonstrate adequate coping behaviors. * Recognize limitations imposed by her illness and will express feelings about these limitations. * Free from signs and symptoms of infection. * Express the importance of her own belief system and inner resources.
Nursing interventions Nursing Care Plans for Breast Cancer * Nursing interventions Nursing diagnosis acute pain related to Surgical procedure; tissue trauma, interruption of nerves, dissection of muscles. Nursing Interventions: Pain Management: Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient. Analgesic Administration: Use of pharmacologic agents to reduce or eliminate pain. Environmental Management: Comfort: Manipulation of the patient’s surroundings for promotion of optimal comfort * Nursing interventions nursing diagnosis anxiety related to change of body image; scarring, loss of body part, sexual attractiveness extent of disease, impact on others; uncertainty of prognosis; denial of own mortality Situational crisis. Nursing Interventions: Anxiety Reduction: Minimizing apprehension, dread, foreboding, or uneasiness related to an unidentified source or anticipated danger. Calming Technique: Reducing anxiety in patient experiencing acute distress * Nursing interventions nursing diagnosis: impaired skin integrity related to surgical removal of skin and tissue; altered circulation, presence of edema, drainage; changes in skin elasticity, sensation; tissue destruction of radiation therapy. Nursing interventions: Wound Care: Prevention of wound complications and promotion of wound healing. Incision Site Care: Cleansing, monitoring, and promotion of healing in a wound that is closed with sutures, clips, or staples. Pressure Ulcer Care: Facilitation of healing in pressure ulcers * Nursing interventions Nursing diagnosis: impaired physical mobility related to neuromuscular impairment; pain, discomfort; edema formation. Nursing Interventions: Exercise Therapy: specify level: Use of active or passive body movement to maintain or restore flexibility; use of specific activity or exercise protocols to enhance or restore controlled body movement. Pain Management: Alleviation of pain or a reduction in pain to a level of comfort acceptable to the patient * Nursing interventions nursing diagnosis: imbalanced nutrition: less than body requirements related to hyper metabolic state associated with cancer consequences of chemotherapy, radiation, surgery anorexia, gastric irritation, taste distortions, nausea emotional distress, fatigue, poorly controlled pain. Nursing Interventions: Nutrition Management: Assisting with or providing a balanced dietary intake of foods and fluids. Weight Gain Assistance: Facilitating gain of body weight Eating Disorders Management * Nursing interventions nursing diagnosis risk for Infection related to Inadequate secondary defenses and immunosuppression such as bone marrow suppression dose-limiting side effect of both chemotherapy and radiation Malnutrition; chronic disease process Invasive procedure. Nursing Interventions: Infection Protection: Prevention and early detection of infection in a patient at risk Infection Control: Minimizing the acquisition and transmission of infectious agents. Surveillance: Purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making
Patient Teaching and Home Healthcare Guidelines for Breast Cancer
Patient Teaching and Home Healthcare Guidelines for Breast Cancer. Clearly explain all procedures and treatments for patient with Breast Cancer. Inform the patient that she may experience phantom breast syndrome a tingling or pins and needles sensation in the area where the breast was removed. Females who have had breast cancer in one breast are at higher risk for cancer in the other breast or for recurrent cancer in the chest wall. For this reason, urge the patient to continue examining the other breast and to comply with recommended follow up treatment
Explain to the patient that she may have an incision drain or some type of suction to remove accumulated fluid, relieve tension on the suture line, and promote healing The patient can expect to return home with dressings and wound drains. Teach how to self-care wound drains, empty the drainage receptacle twice a day, record the amount on a flow sheet, and take this information along when keeping a doctor’s appointment. Teach the patient how to identified symptoms of infection report symptoms of infection or excess drainage on the dressing or the drainage device
Review pain treatment medication instructions for frequency and precautions. Show the mastectomy patient how to ease postoperative pain by lying on the affected side or by placing a hand or pillow on the incision. Point out where the incision will be. Inform the patient that after the operation, she will receive analgesics because pain relief encourages coughing and turning and promotes well-being. Explain that a small pillow placed under the arm anteriorly may provide comfort. Tell the patient that she may move about and get out of bed as soon as possible, usually as soon as the effects of the anesthetic subside or the first evening after surgery.
Teach precautions to prevent lymphedema after node dissection, to help prevent lymphedema, instructs the patient to exercise her hand and arm on the affected side regularly and to avoid activities that might allow infection of this hand or arm. Tell her that infection increases the risk of lymphedema. * Request no blood pressure or blood samples from affected arm. * Urge the patient to avoid activities that could injure her arm and hand on the side of her surgery. Caution her not to let blood be drawn from or allow injections into that arm. She should also refuse to have blood pressure taken or I.V. therapy administered on the affected arm.