OM VERMA ASSISTANT PROFESSOR MEDICAL - SURGICAL NURSING GRACIOUS COLLEGE OF NURSING ABHANPUR

2. PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF
NURSING

8. CON……….
 Cardiac tamponade is a life threatening
complication caused by accumulation of fluid in
the pericardium.
According to lippin cott
 This fluid ,which can be blood,pus ,or air in the
pericardial sac, accumulates fast enough and
in sufficient quantity to compress the heart and
restrict blood flow in and out of the ventricles.
This a cardiac emergency.
According to Lewis

9. Cardiac tamponade is define as
compression of the heart due to fluid
accumulation within the pericardium .
According to Brunner and sudharth

10. INCIDENCE
CARDIAC TAMPONADE
occurs in about 2
out of 10,000 people

13. ETIOLOGY

18. IDIOPATHIC
relating to or denoting any disease or condition
which arises spontaneously or for which the
cause is unknown.

19.  In this condition, blood or fluid collects in the pericardium,
the sac surrounding the heart. This prevents
the heart ventricles from expanding fully. The excess pressure
from the fluid prevents the heart from functioning normally.
As a result, the bodydoes not receiveenough blood.
 Cardiac tamponadecan occurdue to:
 Dissecting aortic aneurysm(thoracic)
 End-stage lung cancer
 Heart attack (acuteMI)
 Heartsurgery
 Pericarditis caused by bacterial or viralinfections
 Wounds to theheart

20.  Other possible causesinclude:
 Heart tumors
 Hypothyroidism
 Kidney failure
 Leukemia
 Placement of central lines
 Radiation therapy to thechest
 Recent invasive heartprocedures
 Recent open heartsurgery
 Systemic lupuserythematosus

21. gunshot or stab wounds
blunt trauma to the chest from a car or industrial accident
accidental perforation after cardiac catheterization,
angiography, or insertion of a pacemaker
punctures made during placement of a central line, which
is a type of catheter that administers fluids or medications
cancer that has spread to the pericardial sac, such as
breast or lung cancer
a ruptured aortic aneurysm

22. pericarditis, an inflammation of the pericardium
lupus, an inflammatory disease in which the immune
system mistakenly attacks healthy tissues
high levels of radiation to the chest
hypothyroidism, which increases the risk for heart
disease
a heart attack
kidney failure
infections that affect the heart

24. Fluid within the pericardium put pressure on the heart
The presuure prevent the heart from expanding completely and
filling to capacity with blood
Less blood leaves the heart
Too little o2 reached the tissues
1. Faster heart beat
2. Faster breathing
3. Feeling of panic
4. Swelling neak vein
5. Loss of consciousness
6. Sudden death

25. SYMPTOMS
 Elevated venous pressure {increased venouspressure}
 Distended neck veins
 Kussmaul’s sign{distended neckveins}
 Hypotension
 Tachycardia
 Narrow pulsepressure

26. SYMPTOMS CONT…….
Dyspnoea
Cyanosis of lips and nails
Restlessness and anxiety
Diaphoresis
Muffled heartsounds

27. SYMPTOMS
 Pulsus paradoxus
 Decreased friction rub
 Decreased QRS voltage

28. Beck's triad (cardiology)
 Beck's triad is a collectionof three medical signs associated with
acute cardiac tamponade, an emergency condition wherein fluid
accumulates around the heart and impairs its ability to pump
blood. The signs are low arterial blood pressure, distended neck
veins, and distant, muffled heartsounds.[1]

30. Physiology
 The fall in arterial blood pressure results from
pericardial fluid accumulation toa degree that it impairs
ventricular stretch, thus reducing stroke volume, amajor
determinant of systolic bloodpressure.
 The rising central venous pressure is evidenced by
distended jugularveins while in a non-supineposition. It
is caused by reduced diastolic filling of the right
ventricle, due to pressure from the adjacent expanding
pericardial sac. This results in a backup of fluid into the
veins draining into the heart, most notably, the jugular
veins

31. •The suppressed heart sounds occur due to the
muffling effects of the fluidsurrounding the
heart.

32. INVESTIGATIONS-
 The following testsare also used fordiagnosis:
 Echocardiogram —a test that uses high-frequency
sound waves (ultrasound) to examine the size, shape,
and motion of the heart. This is the primary test used
to diagnose and manage cardiac tamponade.
 Cardiac catheterization —a tube-like instrument
inserted intothe heart througha vein orartery (usually
in thearm or leg) to detect problems with the heartand
its blood supply
 Chestx-ray —a test that uses radiation to take a
pictureof structures inside the body, especially
bones

34. CONT……..
 CT scan —a type of x-ray that uses a computer to
make pictures of structures inside thechest
 MRI scan —a test that uses magnetic waves to
make pictures of structures inside thechest
 Coronary angiography —x-rays taken aftera dye
is injected into the arteries; allows the doctor
to look for abnormalities in the arteries
 Electrocardiogram (ECG, EKG) —a test that
records the heart’s activity by measuring
electrical currents through the heart muscle

36. MANAGEMENT
 Treatments are administeredto:
 Save the patient'slife
 Improve heart function
 Relieve symptoms

37.  Medications to help increase blood pressure to normal levels
 Oxygen to reduce workload on the heart

39. CONT…………..
 Treatments thatare administered forcardiac tamponade
include:
 Pericardiocentesis —a procedure to drain the fluid around
the heart
 Fluids to maintain normal bloodpressure
 Antibiotics

41. As cardiac tamponade can result in shock or death,
it always requires emergency medical treatment.
This treatment involves draining excess fluid from
around the heart.
A doctor may use the following methods to remove
the fluid and reduce the pressure on the heart:
Pericardiocentesis. The removal of fluid from the
pericardium using a needle.
Pericardiectomy. The surgical removal of part of the
pericardium to relieve pressure on the heart.
Thoracotomy. A surgical procedure that allows the
draining of blood or blood clots around the heart.

42. ASSESSMENT
 Pulsus paradoxus > 10 mm Hg (hallmark)
 Narrowed pulse pressure (<30 mm Hg)
 Hypotension
 Neurologic
 Anxiety
 Confusion
 Obtunded if decompression isadvanced

43. CONT…………
 Cardiovascular
Jugular veindistention
Reflex tachycardia
Muffled, distant heartsounds
Skin
Cool
Pale
May beclammy

44. NURSINGDIAGNOSIS
 Ineffective Breathing Pattern related to:
hyperventilation Goal: Patterns breath effectivelyas
evidenced by no tachypnea, vital signs are within
normalranges
NURSING INTERVENTIONS-
Monitor strictlyvital signs, especiallyrespiratory
frequency.
 Monitor the contents breathing, chestexpansion,
regularityof breathing, mouth breathing and muscle
use arespirator..

45. CONT……
 Give the semi-Fowler position if not contraindicated.
Rationale: Facilitates lung expansion
 Teachclients a deep breath. Rationale: With thedeep
breathing exercise can increase oxygenintake.
 Giveoxygen as indicated. Rationale: Oxygen adequate to
avoid the risk of tissuedamage.
 Give medication as indicated. Rationale: Medications
thatcan affect the respiratoryventilation.

46. CONT……….
 Monitor for pulsus paradoxus via arterial tracing
or during manual BP reading.
 Monitor urine output hourly; a drop in urine
output may indicate decreased renal perfusion
as a result of decreased stroke volume secondary
to cardiaccompression.

47. CONT…….
 Decreased cardiac outputrelated to reduced
ventricularfilling secondary to increased
intrapericardial pressure.
 GOALS-To maintain cardiacoutputof the patientas
evidenced by client HR,BP,Pulsepressure
 NURSING INTERVENTIONS-
 Continuously monitor ECG for dysrhythmia formation,
whichmay result of myocardial ischemia secondary to
epicardial coronary artery compression.
 Monitor the BP every 5 to 15 minutesduring theacute
phase.

48. CONT………….
 .
3.Note thecolor, presence / qualityof the pulse.

4.Auscultation of breath sounds and heart sounds.
Listen tothe murmur.

5.Maintain bedrest in a comfortableposition during
the acute period.

6.Provide adequate rest periods / adequate. Assess the
form of self-care activities, if indicated.

49. CONT……………
 7. Assess signs and symptoms of CHF.
 Activity intolerance related to restlessness,fatigue
 GOAL-To increasethe abilityof Client to perform
activitiesof
dailyroutine
 Assess theability of client to performactivitiesof
daily life.
 Assesspatient’s need for assistivedevices.
 Assess thedegreeof ability performed by client

50. CONT……………
 Assess the degree of ability performed by client
 Help the people closest to identify the risk of
hazards that may arise.
 Minimize the sources of the hazards in the
environment.
 Deficient knowledge related to disease
condition
 GOALS – To increase knowledge of the patient
 Assess the level of knowledge of thepatient

51. CONT……………
 Educate the patient about the disease condition
 Educate the patient about the treatment
 Educate the patient about the
pericardiocentesis
 Encourage the patient to ask questions

52. PREVENTION
It is not possible to prevent all cases of cardiac
tamponade. However, people can reduce their risk
by doing the following:
reducing exposure to bacterial or viral infections
receiving treatment for medical conditions, such as
lupus and hypothyroidism
protecting heart health through a balanced diet
and regular exercise
attending regular medical checkups
avoiding smoking

53. COMPLICATIONN
Cardiac tamponade is a clinical syndrome
caused by the accumulation of fluid in
the pericardial space, resulting in reduced
ventricular filling and subsequent hemodynamic
compromise. The condition is a medical
emergency, the complications of which include
pulmonary edema, shock, and death.

54. BIBLIOGRAPHY
 BLACK M. JOYCE, Medical Surgical Nursing, published
by Elsevier, Edition 8th ,volume -2,pageno.1406
 Brunner and Suddarth’s,Textbook of medical surgical
nursing, published by Lippincott Williams andWilkins,
Edition 11th ,volume 1,page no.854
Smeltzer C. Suzane,,Textbook of medical surgical nursing,
published by Lippincott ,Edition 9, page no. 789
 http://www.etsu.edu.com