PRESENTED BY GROUP 9
DONNA MC CARTHY, TISHARA MC CARTHY
VITRA KUARSINGH RAMPERSAD
CARDIAC TAMPONADE
• Cardiac tamponade is also known as pericardial
tamponade, cardiac compression or
simply tamponade.
• It is associated with pericardial effusion.
• Cardiac tamponade can occur acutely(a rapid
increase of fluid into pericardial space, as little as
200 mL) or sub acutely (slow accumulation of
fluid into pericardial sac over weeks or months,
causing pericardium to stretch and accommodate
up to 2 L of fluid without severe increases in
intrapericardial pressure.
DEFINITION
1.Cardiac tamponade is a life-threatening compression of
the heart by fluid or blood accumulated in the pericardial sac.
2.Cardiac tamponade is a medical emergency that occurs with the
collection of material such as fluid, blood, pus, or clots leading to
increased intrapericardial pressure causing compression of all
cardiac chambers and ultimately hemodynamic collapse.
Cardiac tamponade can be the consequence of:
1.Pericarditis
ETIOLOGY
2.Pericardial effusion
3.Malignant disease
4.Renal failure
5.Radiation therapy
6.Invasive cardiac procedures with
perforation
7.Cardiovascular surgery
ETIOLOGY
8.Chest trauma
9.Aortic dissection
10.Anticoagulant therapy
RISK FACTORS
1.HIV
2.History of heart failure
3.TB
4.Lupus and some other autoimmune conditions
5.Medications eg, phenytoin, hydralazine
PATHOPHYSIOLOGY
As a result of the surrounding tense pericardial fluid, the heart
is compressed, and the diastolic pressure within each chamber
becomes elevated and equal to the pericardial pressure.
The compromised cardiac chambers cannot
accommodate normal venous return, so the systemic and
pulmonary venous pressures rise.
PATHOPHYSIOLOGY
• The increase of systemic venous pressure results in signs of
right-sided heart failure (e.g., jugular venous distention),
whereas elevated pulmonary venous pressure leads to
pulmonary congestion.
• In addition, reduced filling of the ventricles during diastole
decreases the systolic stroke volume, and the cardiac output
declines
PATHOPHYSIOLOGY
These derangements trigger compensatory mechanisms aimed at
maintaining tissue perfusion, initially through activation of the
sympathetic nervous system (e.g., elevation of the heart rate).
Nonetheless, failure to evacuate the effusion leads to inadequate
perfusion of vital organs, shock, and ultimately death.
CLINICAL MANIFESTATIONS
Manifestations may vary
based on the severity of the
tamponade. These include:
1.Jugular vein distention
2.Hypotension
3.Muffled or distant heart
sounds
CLINICAL MANIFESTATION
CLINICAL
MANIFESTATIONS
• Pulsus paradoxus (a decrease in
systolic blood pressure greater then 10
mmHg during inspiration)
• Anxiety and restlessness
• Chest pain radiating to neck, shoulders,
or back
• Presyncope, syncope, unconsciousness
• Dyspnea
• Oligo-anuria
CLINICAL
MANIFESTATIONS
• Shock
• Cyanosis
• Orthopnea
• Edema
• Cough
• Dysphagia
• Fever (dependent on etiology)
DIAGNOSTIC EVALUATION
1.Medical history and history of present illness.
2. Physical exam: This will include taking vital signs such as pulse,
blood pressure checking for pulsus paradoxus (blood pressure drops
unusually each time you take a breath)and respiration.
Auscultation of heart and breath sounds.
DIAGNOSTIC EVALUATION
3. Echocardiogram:
-Determine the presence of pericardial fluid
- Exact distribution of pericardial fluid
- Cause of tamponade, if possible
- Determine the safest and most logical method of pericardial drainage, if needed.
4. Electrocardiography- May demonstrate diminished QRS and T-wave voltages.
DIAGNOSTIC
EVALUATION
5. Chest X-ray – shows
an enlarged, globeshaped heart or “water
bottle” (“Bocksbeutel”)
appearance if cardiac
tamponade is present.
DIAGNOSTIC EVALUATION
6. Thoracic CT scan – looks for fluid accumulation in the chest or
changes to the heart.
7. Magnetic resonance angiogram - to see how blood is flowing through
the heart.
DIAGNOSTIC EVALUATION
8. Heart catheterization: This test allows the inside of the
heart and blood vessels to be seen by using a device that’s
inserted into an artery and then threaded toward and into the
heart.
9. Renal profile and Complete blood count
10. Creatine kinase and isoenzymes: elevated in myocardial
infarction and cardiac trauma.
11. HIV testing.
COMPLICATIONS
1.Heart failure
2.Pulmonary edema
3.Bleeding
4.Shock
5.Death
MEDICAL MANAGEMENT
1.Pericardiocentesis: To drain the fluid from
the pericardium using a needle.
2.Inotropic drugs, such as dobutamine: To improve heart
function and lower blood pressure.
3.Anti-inflammatory medicines such as aspirin, ibuprofen,
steroids.
4.Diuretics, such as furosemide or spironolactone.
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT
5.Oxygenation
6.IV fuids
7.Blood transfusion (trauma or open heart surgery)
8.Treatment of the underlying cause
MEDICAL MANAGEMENT
Surgery:
Surgical creation of a pericardial window allows drainage of
the effusion.
Implantation of a pericardio-peritoneal shunt in cancer
patients whose disease is causing the fluid accumulation.
Pericardiectomy to remove the pericardium if all
other interventions fail.
MEDICAL MANAGEMENT
For recurrent tamponade:
Sclerosing the pericardium – introduction of either
corticosteroid, tetracycline or antineoplastic drugs in the
pericardial space.
NURSING
MANAGEMENT
NURSING ASSESSMENT
The Nurse will obtain a history of the patient
focusing on:
NURSING ASSESSMENT
The Nurse will obtain a history of the patient focusing on
any surgery, trauma, cardiac biopsy, viral infection,
insertion of a transvenous pacing wire or catheter, or
myocardial infarction.
The Nurse will elicit a medication history to determine if
the patient is taking anticoagulants or any medication that
could cause tamponade as a drug reaction.
NURSING ASSESSMENT
Assess the patient following the ABC approach. Closely monitoring the
patient ’s vital signs; of blood pressure, temperature, pulse and respiratory
rate. Also noting, skin color and capillary refill.
Assess cardiovascular status: monitor for jugular vein distention and
presence of Kussmaul’s sign (jugular venous distention upon inspiration)
Assess the patients consciousness level for decreased cerebral perfusion.
NURSING ASSESSMENT
• The Nurse will:
• Assess the patient’s and relative's degree of fear and anxiety,
as well as their ability to cope with a sudden illness and
threat to self.
GOALS AND EXPECTED OUTCOMES
The patient will demonstrate
relief of pain with stable vital
signs.
The patient will be able to
maintain adequate cardiac
output.
The patient will demonstrate
utilization of coping
mechanisms to reduce
anxiety.
The patient will maintain
appropriate fluid volume.
NURSING DIAGNOSIS
• Decreased Cardiac Output related to a reduction in
ventricular filling secondary to elevated intrapericardial
pressure as evidenced by irregular heartbeat, pulsus
paradoxus, blood pressure of 89/58, restlessness, dyspnea
upon exertion, and fatigue.
• Acute Pain related to increased intrapericardial pressure as
evidenced by pain score of 10 out of 10, verbalization of
pressure-like chest pain and guarding of the chest.
NURSING DIAGNOSIS
• Risk for fluid overload related to decreasing plasma protein,
increased sodium, and presence of water retention
secondary to cardiac tamponade.
INTERVENTIONS
• PERICARDIOCENTESIS
• The Nurse will obtain baseline vital signs before
pericardiocentesis.
• Have an emergency pericardiocentesis tray available.
• Reinforce the physician’s explanation of a pericardiocentesis
and ensure the patients consent form is signed.
• Prepare the patient for the procedure.
• Measure, describe, and record the amount of pericardial
fluid removed.
INTERVENTIONS
• Label all specimens for laboratory analysis and send them
promptly to the laboratory.
• Cover the site of the pericardiocentesis with a sterile
dressing and inspect the dressing for bleeding or leaking
fluid.
• Reinforce the dressing if it becomes moist.
• Patient is placed in bed with the elevation of the lower
extremities – aides to increase venous return.
• Continue to monitor vital signs until they are stable.
NS
INTERVENTIO
• PHYSIOLOGIC NEEDS
• PAIN
• Assess pain using pain scale and administer
anti-inflammatory drugs dobutamine and
analgesics as prescribed for pain and
symptomatic relief.
• Monitor therapeutic effects of medication.
• Educate patient on deep breathing
exercises, and relaxation techniques.
• Help the patient to assume a comfortable
position.
INTERVENTIONS
• OXYGENATION
• The Nurse will:
• Administer supplemental oxygen, via nasal canula as
prescribed. Ensure "NO SMOKING" sign is in place.
• Establish continuous oxygen saturation monitoring
using a pulse oximeter.
• Position patient with head of the bed elevated, in a semifowler’s position
• Review ABG's
INTERVENTIONS
Monitor ECG continuously for any signs of dysrhythmia.
Monitor patient’s vital signs every 15 minutes during the acute phase
Observe for signs of decreasing peripheral tissue perfusion such as slow
capillary refill, facial pallor, cyanosis, and cool, clammy skin.
INTERVENTIONS
• NUTRITION AND ELECTROLYTE BALANCE
• Provide prescribed diet.
• Administer IV fluids as prescribed for volume expansion.
• Ensure that all IVs are infusing properly.
• Monitor and record intake and output, measuring urine
output hourly.
• Monitor for edema and ascites.
• Monitor electrolyte levels.
INTERVENTIONS
• MAINTAINING TISSUE INTEGRITY
• Provide frequent oral hygiene
• Assist with ADLs
• Change linens regularly or as they become soiled.
• Change the patient’s position frequently and with an interval
of at least every 2 hours as tolerated.
INTERVENTIONS
• PROMOTING COMFORT
• Decrease environmental stimuli such as noisy television
• Adjusting the temperature in the room
• Adjusting lighting in the room
• Provide privacy during interventions
• Use communication techniques such as listening and empathy.
• Keep a calm attitude when interacting with the patient.
INTERVENTIONS
• SAFETY AND SECURITY
• The Nurse will monitor the environment for hazards and
remove them.
• Keep the bed in a low position, with side rails elevated.
• The Nurse will instruct the patient on bed rest, to stay in
bed.
INTERVENTIONS
• REDUCING ANXIETY
• The Nurse builds a therapeutic relationship with the patient
and relative.
• Explain the procedures appropriately and keep the
explanations basic so that the patient will easily understand.
• Advise the patient to express his or her feelings and
emotions about the procedure and the condition.
• Acknowledge and be aware of the patient’s feelings and
anxiety.
INTERVENTIONS
• Explain to the patient that the chest pains does not
necessarily lead to myocardial infarction.
• Reassure the patient and the significant others that
monitoring the patient continuously will guarantee prompt
intervention.
• Encourage the patient to be part of setting goals and
planning of care.
• Encourage the patient to have ample sleep and rest.
INTERVENTIONS
• LOVE AND BELONGING
• The nurse involves the patient and relatives in all aspects of
planning care.
• Relatives and friends are encouraged to visit and spend as
much time possible with the patient.
• The nurse engages in active listening and uses touch
appropriately.
INTERVENTIONS
• SPIRITUALITY
• Observe the patient for cues that may indicate an
underlying spiritual need.
• The Nurse engages in active listening and displays a
caring attitude.
• The Nurse accepts the religious beliefs and practices of the
patient and does not try to impose his/her beliefs on the
patient.
• The Nurse engages in prayer for the patient at their request.
PATIENT TEACHING/EDUCATION
Review
Review all medications with the patient—purpose, adverse effects,
dosage, and special precautions.
Educate
Educate the patient on the symptoms of tamponade and when to
return to the hospital.
Encourage
Encourage patient to keep clinic and imaging appointments.
The patient will demonstrate relief of
pain as evidenced by a pain score of 2 out
of 10 with stable vital signs.
The patient will maintain adequate
cardiac output.
EVALUATION
The patient will demonstrate utilization
of coping mechanisms to reduce anxiety.
The patient will maintain appropriate fluid
volume.