Cardiac tamponade and corpulmonale

CORPULMONALE
Its a condition in which the right ventricles of heart enlarges (with right side heart failure ) as a result of disease that affects the structure or function of the lung.
Any disease affecting the lungs and accompanied hypoxemia may result in CORPULMONALE.

1. CORPURMONALE
AND
CARDIAC TAMPONADE
BY: Ms. MahimaKanwar
BSc. (H) Nursing
2
nd
year

2. HEART

3. CORPULMONALE
Its a condition in which the right ventricles of
heart enlarges (with right side heart failure ) as a
result of disease that affects the structure or
function of the lung.
Any disease affecting the lungs and accompanied
hypoxemia may result in CORPULMONALE.

5. ETIOLOGY
Any disease affecting the lungs and accompanied
by hypoxemia may result in corpulmonale.
Severe COPD ,in which change in the airway and
retain secretions reduced alveolar ventilation.
Deformities of Thoracic cage
Massive obesity and conditions that reduce the
pulmonary vascular bed
Primary Idiopathic pulmonary arterial HTN ,
pulmonary embolus.
Disorder of nervous system, Respiratory system,
muscle and chest wall and pulmonary arterial
tree may be responsible.

7. CLINICAL MANIFESTATIONS
Inc. Severe COPD
With loss of muscle
mass in extremities
Neck muscles maybe
enlarged
Dyspnoea become
sever
Hypoxia and Hypoxemia
Inc. Dyspnoea
Barrel chest
Fatigue and weakness
Abnormal breath sound
Inc. Juglar venous pressure
Enlarged and tender liver
Warm and cyanotic
extremities with bounding
pulses
Cyanotic lips
Distended neck vein
GENERAL
APPEARANCE
RESPIRATORY
MANIFESTATIONS

10. COLLABORATIVE THERAPY
Oxygen therapy
Bronchodilator
Diuretics
Low sodium diet
Vasodilator
Calcium channel blocker ( if indicated)
Inotropic agent

11. MANAGEMENT
MEDICAL MANAGEMENT
COPD management includes airways maintenance ,
monitoring drug therapy and oxygen therapy.
Drug therapy
oBeta adrenergic agents
oCholinergic antagonists
oMethylxanthines
oCorticosteroids
AIRWAY MAINTENACE
Improve gas exchange
Clear the airway secretions
Provide oxygen therapy
Intubation and mechanical ventilation

12. SURGICAL MANAGEMENT
PRE-OPERATIVE CARE
Clients are selected for this procedure on the
basis of having end stage emphysema, chronic
bronchitis
Pulmonary rehabilitation before surgery to
maximize lungs
Client must reach a stage in which he is able to
walk 30mins at a time

13. OPERATIVE PROCEDURE
Lung reduction is performed bilaterally ( midline
or traverse)
Each lung is deflated separately and examined
for colour and texture differences

14. POST-OPERATIVE CARE
Maintain bronchodilator and mucolytic therapy
Pulmonary hygiene including spirometery
Chest physiotherapy
Administration of opiods for pain management

15. NURSING MANAGEMENT
Intubation and mechanical ventilation are
required
Instruct about close monitoring of :
1.Fluid retention
2.Weight gain
3.Edema
4.Adherence of therapeutic agents.

16. CARDIACTAMPONADE
Pericardial effusion and cardiac tamponade is an
accumulation of fluid in the pericardiac space.
Cardiac tamponade occurs when the
accumulation compresses the heart and therapy
impedes expansion of the ventricals and cardiac
filling during diastole.

18. ETIOLOGY
Dissecting aortic aneurysm (thoracic)
End stage lung cancer
Heart attack
Heart surgery
Pericarditis caused by bacterial & viral infection
Wound to the heart

20. SIGNANDSYMPTOMS
Neck vein distension
Pulsus paradoxus
Distended heart sound
Cardiac dullness
Compensative tachycardia to compensate for dec.
Cardiac output

22. MEDICAL MANAGEMENT
Patient with small effusions who are not
symptomatic do not require treatment.
The patient are monitored for sign and symptoms
of increasing fluid accumulation.
Radiation therapy or antineoplastic agents
,depending on how sensitive the primary tumor
is to these treatments and degree of symptoms
that exist, in mild effusions and diuretic
medication may be prescribed and carefully
monitored.

23. SURGICAL MANAGEMNET
PERICARDIOCENETESIS
If cardiac function becomes seriously impaired
(puncture of pericardial fluid is performed to
remove fluid from the pericardial sac).
During this procedure the patient is monitored
by continuous ECG and frequent vital signs.
Head of the bed is elevated to 45°to 60°angle.
Resulting decrease in central venous pressure
and associated increase in blood pressure after
withdrawal of pericardial fluid indicate that
cardiac tamponade has been relieved.

24. COMPLICATIONS OF
PERICARDIOCENTESIS
Coronary artery puncture
Myocardium trauma
Dysrhythema
Pleural laceration
Gastric

25. NURSING MANAGEMENT
Monitor vital signs and oxygen saturation
frequently.
Assess for pulsus paradoxus.
Monitor ECG tracing
Assess heart and lungs sounds, neck vein filling
,level of consciousness , respiratory status ,skin
colour and temp.
Monitor and record intake and output
Review lab. findings

26. THANK YOU