Clinical meaning
Uremic pericarditis occurs in advanced renal failure (typically BUN greater than 60 mg/dL) when retained uremic toxins cause inflammation and fibrinous exudation in the pericardial space. Unlike other forms of pericarditis, uremic pericarditis is hemorrhagic (uremic platelet dysfunction impairs hemostasis), does not typically show diffuse ST elevation on ECG (because the inflammation is often epicardial rather than involving the myocardium), and does not respond to NSAIDs or colchicine -- the treatment is intensive dialysis. The pericardial inflammation can produce a friction rub (scratchy, three-component sound best heard with the patient leaning forward at end-expiration), chest pain (sharp, pleuritic, relieved by sitting forward), and pericardial effusion. If effusion accumulates rapidly or becomes large, cardiac tamponade can develop (Beck triad: hypotension, JVD, muffled heart sounds; pulsus paradoxus greater than 10 mmHg; electrical alternans on ECG). The nurse monitors for pericardial friction rub at each assessment, auscultates heart sounds noting any muffling (suggesting effusion), monitors vital signs for tamponade (pulsus paradoxus, tachycardia, hypotension), assesses JVP, assists with emergent pericardiocentesis if tamponade develops, coordinates intensified dialysis schedule (daily dialysis often required until pericarditis resolves),...