In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient’s health problems?
1. A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized.
2. A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation.
3. A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge.
4. A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels.
Pericarditis is a disease that causes the inflammation of the pericardium. The pericardium is a double layer sac that holds the heart and aids it in its function.The layers of the pericardium contain a small amount of fluid between them to prevent friction. The inflammation caused by the pericarditis causes the two layers of the pericardium to rub against each other.
Answer and Explanation:
When a patient has pericarditis, the ECG will show an elevated ST segment. T wave inversions cannot occur in the presence of ST segment elevations. So, the nurse would be most justified in ruling out pericarditis in case 1 as the patient ECG is showing T wave inversions.
Pericarditis cannot be ruled out in case 2 as a history of atrial fibrillation increases the risk of developing pericarditis. Pericarditis cannot be ruled out in case 3 as the patient is experiencing chest pain that is moving towards the neck and shoulders. This type of pain exhibited by the patient is a symptom of pericarditis. An increase in white blood cell levels, erythrocyte sedimentation rate and C-reactive protein levels is seen in cases of pericarditis. So, pericarditis cannot be ruled out in case 4
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