Cardiac tamponade

CARDIAC TAMPONADE

1. . cardiac Tamponade Ms. JINUMOL 1 st Year M.sc NURSING NUINS

2. .

3. Pericardium is the membranous sac surrounding the heart. Pericardium consist of 2 layer, the visceral and parietal layer. There are about 50 ml of pericardial fluid in the pericardial cavity. PERICARDIUM

4. The normal function of pericardium is to maintain An optimal Cardiac Shape Reducing the friction between beating heart and adjacent structure. Protecting the heart from other disease which are caused by other organs. Eg T.B , cancer etc. Preventing the overfilling of the heart. ‘

5. “Cardiac Tamponade is compression of the heart resulting from fluid or blood within the pericardial sac.” ( Brunner) Cardiac Tamponade is defined as significant compression of the heart by accumulating pericardial content. ( Susan l Wood) DEFINITION

6. . .

7. Exact Etiology is idiopathic. Viral Pericarditis Neoplastic invasion of pericardium Nephrogenic Pericardial disease Heart Failure Acute MI Chest trauma Cancer Kidney Failure Tuberculosis Hypothyroidism ETIOLOGY

8. Pericarditis Heart Tumor Radiation therapy Recent Invasive heart procedure SLE Dermatomyositis RISK FACTORS

9. Due to etiological factors Accumulation of Fluid within Pericardium pressure within the heart increases Impairment in contraction and relaxation PATHOPHYSIOLOGY

10. Decrease in Systemic Circulation Decrease oxygen supply towards body tissues. Increase in pulse, Decrease BP , distended jugular vein. Loss of consciousness and sudden Death. .

11. Classical Features Beck’s Traid. CLINICAL FEATURES Beck’s Traid Decreased heart sound Decreased Arterial pressure Distended Jungular Vein

12. Tachypnea Dyspnoea Cough Dysphagia Oliguria Syncope Convulsion Restlessness Drowsiness Chest discomfort OTHER FEATURES

13. Agitation Stupor Weakness Loss of Appetite Weight loss

14. History collection Cardiovascular diseases eg CAD, MI, Cardiomyopathy Medication History General Physical examination Tachypnea : Reflects elevated pulmonary venous pressure. Tachycardia : low cardiac output state Hypotension ( severe cases ) due to decreased stroke volume. DIAGNOSTIC MEASURES

15. Jugular venous distension ( due to impaired venous return) Muffled heart sound due to fluid inside pericardium. Blood investigation Complete blood count Renal function test Liver function test PT, INR Beck’s traid. ( ↓sed heart sound, arterial pressure, distended jugular vein)

16. Trop T ANA Assay RH Factor HIV Testing Mantoux test CK-MB ( creatine kinase , muscle brain)

17. ECG sinus Tachycardia, low voltage QRS Complex

18. Water bottle shaped heart. Chest x-ray – large globular heart

19. This is a test used high frequency sound waves to examine size , shape and motion of heart. Echo-cardiogram

20. CT- Scan MRI Coronary angiography . Cardiac catherization

21. The Main Aim Of Client With Cardiac Tamponade Is Save the patient life . Improve the heart functions . Relive from symptom. MANAGEMENT

22. Supplemental oxygen to reduce work load on the heart. IV fluids to maintain normal BP Antibiotics Inotropic drugs if patient is severely hypotensive drugs eg Dopamine, Dorbutamine. Avoid diuretics or vasodilators Bed rest with leg elevation : helps to return venous return. Medical Management

23. Positive pressure ventilation should avoided. ( It may decrease venous return and aggravate the symptoms of tamponade) .

24. 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 . Surgical management

25. Pericardiocentesis is the removal by needle of pericardial fluid from the sac surrounding the heart for diagnostic or therapeutic purposes. R emoval of 5 to 10 ml may dramatic increase stroke volume and cardiac output by 25 to 50% and reassess for improvement repeated when it necessary. .

26. Whenever Possible, An Echocardiogram (Ultrasound Test) Should Be Performed To Confirm The Presence Of The Pericardial Effusion And To Guide The Pericardiocentesis Needle During The Procedure. Because Of The Risk Of Accidental Puncture To Major Arteries Or Organs In Pericardiocentesis . PRECAUTIONS TO PERFORM PROCEDURE

27. PERICARDIOCENTESIS

28. Nursing assessment Nursing Diagnosis. Ineffective Breathing Pattern related to: hyperventilation . Goal – Patient breath effectively as evidenced by no tachypnea, vital signs are within normal ranges . Intervention. Monitor strictly vital signs, especially respiratory frequency . Monitor the breathing, chest expansion, regularity of breathing, mouth breathing and muscle use a respirator. NURSING MANAGEMENT

29. Give the semi-Fowler position . Teach clients a deep breath. Give oxygen as indicated. Give medication as indicated. Decreased cardiac output related to reduced ventricular filling secondary to increased intrapericardial pressure. Goal : To maintain cardiac output of the patient as evidenced by client HR, BP, Pulse pressure. .

30. Nursing Interventions. Continuously monitor ECG for dysrhythmia formation, which may result of myocardial ischemia secondary to epicardial coronary artery compression. Monitor the BP every 5 to 15 minutes during the acute phase. Note the colour, presence / quality of the pulse . Auscultation of breath sounds and heart sounds. Listen to the murmur. Maintain bedrest in a comfortable position during the acute period. Provide adequate rest periods . Assess the form of self-care activities, if indicated. .

31. Activity intolerance related to restlessness, fatigue Deficient knowledge related to disease condition

32. Cardiac Tamponade is a potentially life threatening condition that is un common. It can result directly from malignant or metastatic process .Proper treatment measures should be started at right time to prevent further complications. CONCLUSION

33. Write an assignment on complications and nursing care of patients with Cardiac Tamponade. ASSIGNMENT

34. BLACK M. JOYCE, Medical Surgical Nursing, published by Elsevier, Edition 8 th ,volume -2,page no.1406 Brunner and Suddarth’s,Textbook of medical surgical nursing, published by Lippincott Williams and Wilkins, Edition 11 th ,volume 1,page no. 854 Smeltzer C. Suzane,Textbook of medical surgical nursing, published by Lippincott ,Edition 9 th , page no. 789 BIBLIOGRAPHY

35. Woods l Susan, Cardiac Nursing, Lippincott Williams and Wilkins Publications edition 5 th pg no 829-830 .

36. . THANKYOU