Shannen Whiddon. Cardiac tamponade is a condition in which cardiac filling is impeded by an...
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CARDIAC TAMPONAD
EShannen Whiddon
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INTRODUCTION Cardiac tamponade is a condition in
which cardiac filling is impeded by an external force.
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PATHOPHYSIOLOGY Cardiac tamponade is pressure on the
heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium). This large collection of fluid raises the pressure in the pericardial sac, compresses the cardiac chambers, and prevents blood from entering the heart.
(Osborn, Watson, Wraa, 2010)
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PATHOPHYSIOLOGY Phase 1
The accumulation of pericardial fluid causes increased stiffness of the ventricle.
Phase 2The pericardial pressure increases above
the ventricular filling pressure, resulting in reduced cardiac output
Phase 3A further decrease in cardiac output occurs
due to equilibration of pericardial and LV filling pressures
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NCLEX QUESTION The client with congestive heart failure
develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?A. Distant or muffled heart soundsB. HypertensionC. BradycardiaD. Increased urine output
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NCLEX QUESTION The client with congestive heart failure
develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?A. Distant or muffled heart soundsB. HypertensionC. BradycardiaD. Increased urine output
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PATHOPHYSIOLOGY Signs and symptoms
Chest pain, difficulty breathing, weak or absent peripheral pulses
Pulsus paradoxus Abnormally large decrease in systolic blood
pressure during inspiration (>10mmHg)
Beck’s triad (3 D’s)Distended jugular veinsDistant/muffled heart soundsDecreased arterial pressure
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PATHOPHYSIOLOGY Risk factors
Heart surgeryDissecting aortic aneurysmAcute MIHypothyroidismPericarditis Injury to the heartEnd-stage lung cancerRadiation therapy to the chest
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PATHOPHYSIOLOGY Prevalence of disease
Incidence rate: 2 in 10,000 in the U.S. (National Institute of Health, 2011).
Approximately 2% of penetrating injuries are reported to result in tamponade
1 year mortality rate of 76.5% in patients whose tamponade was caused by malignant disease
13.3% mortality rate in patients without malignant disease
Male-to-female ratio of 7:3
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CASE STUDY HPI
A 63 year old woman faints after experiencing the sudden onset of severe chest pain that radiates to her back.
PMHHypertension
AssessmentHR is 110 bpm and BP is 90/50 Jugular veins distendedPulsus paradoxus
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NCLEX QUESTION Which diagnostic test is best at
detecting cardiac tamponade?A. Chest X-rayB. EchocardiographyC. Electrocardiogram (ECG)D. Pulmonary artery pressure monitoring
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NCLEX QUESTION Which diagnostic test is best at
detecting cardiac tamponade?A. Chest X-rayB. EchocardiographyC. Electrocardiogram (ECG)D. Pulmonary artery pressure monitoring
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DIAGNOSIS Echocardiogram
Best diagnostic tool Chest X-Ray
Only helpful if there is at least 200mL of fluid in the pericardial sac
Chest CT or MRI Coronary angiography ECG
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ECHOCARDIOGRAM
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CHEST X-RAY
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CURRENT TREATMENT Pericardiocentesis
Needle aspiration of blood or other fluid from the pericardial sac
Surgical pericardiectomy or pericardial windowProcedure to cut and remove part of the
pericardium Fluids to maintain normal BP Oxygen to reduce the workload on the
heart MUST TREAT THE CAUSE TO PREVENT
RECURRENCE
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PERICARDIOCENTESIS
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MEDICATIONS The role of medication therapy in
cardiac tamponade is limited Occasionally dobutamine may be used
to increase cardiac output Only drugs that do not cause an
increase in systemic vascular resistance
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PROGNOSIS Often good if the condition is treated
promptly Often comes back after treatment This is a medical emergency and if left
untreated, the condition is rapidly and universally fatal
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NURSING DIAGNOSIS
Decreased cardiac output R/T decreased preload and afterload AEB weak or absent peripheral pulses
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REFERENCES Osborn, K., Watson, A., & Wraa, C. (2010). Medical-
Surgical Nursing Preparation for Practice. Pearson Education.
National Institute of Health (2012. May 14). Cardiac Tamponade. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000194.htm
Ross, G. and De Jong, M. (Feb., 1999). Emergency!: Pericardial Tamponade. The American Journal of Nursing. Retrieved from JSTOR.
The British Medical Journal (1972. May 06). Tamponade After Acute Myocardial Infarction. Retrieved from JSTOR.
Mayo Clinic Staff. (2011, April 29). Pericarditis. Retrieved from http://www.mayoclinic.com/health/pericarditis/DS00505/DSECTION=complications
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TAMPONADE VIDEO http://www.youtube.com/watch?v=GhbK
9ide4E0