pericardial tomponade

1. PERICARDIAL
TEMPONADE
RN,BSN
MOUSA DERHEM
1

2. ● Overview about topic
○ Definition
○ Pathophysiology
○ Signs and symptoms
○ Treatment
● Patient and Problem
○ History
○ Nursing Physical Assessment
○ Related Treatments
○ Nursing care plan
● References.
Outline

3. The pericardium is composed of two layers:
Visceral pericardium and The parietal layer
Normally the pericardial space or sac contains
up to 50 ml of serous fluid
Pericardium
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4. Cardiac tamponade is a serious medical
condition in which blood or fluids fill the
space between the sac that encases the
heart and the heart muscle.
This places extreme pressure on your
heart. The pressure prevents the
heart’s ventricles from expanding fully
and keeps your heart from functioning
properly. So the heart can’t pump enough

5. • Cardiac tamponade is the accumulation of blood or
other fluid in the pericardial sac puts pressure on the
heart, which may Prevent it from pumping
effectively..

6. Pericardial tamponade can develop suddenly as a result
• Trauma : both stabbing and blunt
• Rupture of the aorta Aortic dissection
• Rupture of the ventricle after a heart attack
• Post myocardial infarction
• complications of Heart surgery (open heart surgery, CABG)
• Drugs and medications ( antihypertensives e.g.
minoxidil, hydralazine , procainamide)
Causes

7. Pleural effusion due to various causes exert pressure in heart walls
Impairs relaxation and filling of the ventricles Chambers do not fill
properly
Less cardiac output (too little
oxygen reaches the tissues)
Increase venous pressure
Hypotension,
shock ,
Reflex
tachycardia
↑JVP hepatomegaly ascites
peripheral edema
Rales
Systemic Congestion Pulmonary congestion

8. • Chest discomfort
• Pleuritic pain
• Tachypnea and dyspnea on exertion that
progresses to air hunger at rest are the key
symptoms
• Convulsions, unconscious
• Most patients are weak and faint at presentation
and can have vague symptoms such as anorexia,
dysphagia, and cough
• The initial symptom may also be one of the
complications of tamponade, such as renal
failure

9. • Elevated venous pressure , Distended neck veins
• Kussmaul’s sign{distended neck veins}
• Hypotension
• Narrow pulse pressure
• Dyspnoea
• Cyanosis of lips and nails
• Restlessness and anxiety
• Pain in the right upper abdomen, Upset stomach
• Fever, for any infection

10. • Beck's triad (cardiology)
• Hypotension
• Muffled heart sounds
• jugular venous distension
• Other
• Pulsus paradoxus

11. • History Collection :- Collect history regarding the etiological factors and
symptoms
• Physical Examination :-Beck's triad, Pulsus paradoxus (a drop of at least
10 mmHg in arterial blood pressure on inspiration) ,There may also be
general signs & symptoms of shock (such as tachycardia , more than 90
beats) per minute breathlessness and decreasing level of consciousness) ,
Can be bradycardia? (uremia and patients with hypothyroidism) ,Rub is
a frequent finding in patients with inflammatory effusions

12. Electrocardiographic Findings :- May be associated
with ST segment , low voltage QRS complexes , In some
cases, electrical alternans will be present in which case the
height of the QRS varies from beat to beat , Tachycardia
will likely be present as well , Combined P and QRS
alternation is virtually specific for tamponade

13. • Echocardiogram :-This scan provides a detailed
image of the heart, which may help to detect the
fluid in the pericardial sac or a collapsed ventricle.
• Chest X-ray:- An X-ray of the chest shows if the
heart is abnormally large or an unusual shape due
to fluid build up..

14. • Computerized tomography (CT) scan:- A CT scan
of the chest can confirm the presence of extra fluid in
the pericardium.
• Magnetic resonance angiogram (MRA):- An MRA
uses a magnetic field and radio waves to detect any
abnormalities in how the blood flows through the blood
vessels of the heart.

15. Heart failure
Pulmonary edema
Bleeding
Shock
Death

16. The main aim of client with cardiac Tamponade is :
1. Save the patient life
2. improve the heart functions
3. Relive from symptoms
Treatment that are administered for
cardiac tamponade include:
1. IV fluids to maintain normal BP
2. Antibiotics
3. Supplemental oxygen to reduce work load on the
heart

17. 4.Bed rest and leg elevation
• 5. Inotropic drugs ( Dobutamine)
• Mechanical ventilation with positive airway
pressure should be avoided in patients with
tamponade, because this further decreases cardiac
output

18. PERICARDIOCENTESIS
• Pericardiocentesis, also called a pericardial tap, is a
surgical invasive procedure ( use both diagnostic and
therapeutic purpose) in which abnormal or excessive
fluid is removed from the pericardium sac the sac
around your heart. Or Pericardiocentesis is the
removal by needle of pericardial fluid from the sac
surrounding the heart for diagnostic or therapeutic
purposes.

19. • Monitor strictly vital signs, especiallyrespiratoryfrequency.
• Give the semi-Fowlerposition if not contraindicated.
• Give oxygen as indicated
• Monitor urine output hourly; a drop in urine output may
indicate decreased renal perfusion as a result of decreased
stroke volume secondaryto cardiac compression.
• Continuously monitor ECG for dysrhythmia formation,
which may result of myocardial ischemia secondary to
epicardialcoronary artery compression.

20. 20
•Case study

21. • Monitorthe BP every 5 to 15 minutesduringthe acute
phase.
• Auscultation of breath soundsand heart sounds.Listen to
the murmur.
• Maintainbed rest in a comfortableposition duringthe
acute period.
• Educatethe patientabout the disease conditionand
treatment
• Educatethe patient about the pericardiocentesis
• Encouragethe patient to ask questions

22. Patient history
A 59-year-old Saudi male referred from the office of cardiologist to our hospital
complaining of worsening shortness of breath, weight gain of 6 pounds, leg swelling, and
low blood pressures (BP) down to 80/60mmHg for a few weeks.
Medical history was significant for hypertension, coronary artery disease, diabetes, and a
recent tamponade diagnosed 4 months prior to this hospitalization. Dizziness was his
initial complaint in March.

23. Physical examination
Cardiovascular:
tachycardic, regular rhythm, JVD+,
Decreased heart sounds, variation in
pulse of 12 mmhg during inspiration
Pulmonary:
Tachypneic, crackles B/L, SOB when lying flat
Abdominal:
Soft , non-tender to palpation, BS+
Vitals:
HR: 130
RR: 22
BP:85/65
Temp: 101.4 F
SPO2: 92%

24. Diagnosis

25. Emergent Treatment
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1. Oxygen toreduceworkload on the heart
2. Hypotension Medications to help increase blood pressure to normal levels
A . IVF cautiously and Dobutamine Vasopressors
3. Cardiac Tamponade
A . Pericardiocentesis

26. 26
NURSING CARE PLAN
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27.  Pulsus paradoxus > 10 mm Hg
(hallmark)
 Narrowed pulse pressure (<30 mm Hg)
 Hypotension
 Neurologic
 Anxiety
 Confusion
 Obtunded if decompression is
advanced
Nursing assessment
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28. ● Ineffective Breathing Pattern related to: hyperventilation that
evidenced by shortness of breathing and change vital signs
Nursing diagnosis
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Nursing planning
To maintain Patterns breath effectivelyas evidenced by no tachypnea, vital signs are within
normal ranges
NURSING INTERVENTIONS-
1. Monitorstrictlyvital signs, especiallyrespiratory frequency.
2. Monitorthecontents breathing, chestexpansion, regularity of breathing, mouth breathing and
muscleusea respirator
3. Givethesemi-Fowlerposition if notcontraindicated. Rationale: Facilitates lung expansion
4. Teachclientsadeep breath. Rationale: With thedeep breathing exercisecan increase oxygen intake.
5. Giveoxygen as indicated. Rationale: Oxygenadequate toavoid the riskof tissuedamage.
6. Give medicationas indicated. Rationale: Medications thatcan affect therespiratoryventilation.

29. NURSING INTERVENTIONS
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1. Monitorstrictlyvital signs, especiallyrespiratory frequency.
2. Monitor thecontents breathing, chestexpansion, regularity of breathing,
mouth breathing and muscle usea respirator
3. Give thesemi-Fowler position if not contraindicated. Rationale: Facilitates
lung expansion
4. Teachclientsadeep breath. Rationale: With thedeep breathing exercisecan
increase oxygen intake.
5. Giveoxygen as indicated. Rationale: Oxygen adequate toavoid the risk of
tissuedamage.
6. Give medication as indicated. Rationale: Medications thatcan affect the
respiratoryventilation.
NURSING EVALUATION
After nursing diagnosis patient partially goal met, patient
maintained breathing patterns no tachypnea

30. Decreased cardiac output related to reduced ventricular filling secondary to increased
intrapericardial pressure.
GOALS-
 To maintain cardiac output of the patient as evidenced by client HR,BP,Pulse
pressure
NURSING INTERVENTIONS
1. Continuously monitor ECG for dysrhythmia formation
2. Monitor the BP every 5 to 15 minutes during the acute phase.
3. Note the color, presence / quality of the pulse.
4. Auscultation of breath sounds and heart sounds. Listen to the murmur.
5. Maintain bedrest in a comfortable position during the acute period.
6. Provide adequate rest periods / adequate. Assess the form of self-care activities, if indicated.
Nursing diagnosis 2
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NURSING EVALUATION
After nursing diagnosis patient is maintained cardiac output

31.  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
Health education
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32. 1. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans: Guidelines for
individualizing client care across the life span. FA Davis.
2. Hinkle, J. L., & Cheever, K. H. (2022). Brunner and Suddarth’s textbook of medical-surgical nursing.
Wolters kluwer india Pvt Ltd.
3. Emergency Nurses Association. (2019). Sheehy's Emergency Nursing: Principles and Practice.
Elsevier Health Sciences.
4. https://www.ncbi.nlm.nih.gov/books/NBK568727/
References
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