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?

o 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:

o To treat the cause and remove the source of infection while preserving cardiac
output and preventing any major (or minor) complications.
o Understanding to the disease itself and how to alleviate the pain and contribute to
the management of pericarditis
o 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?

o 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.