Republic of the Philippines
BICOL UNIVERSITY POLANGUI
NURSING DEPARTMENT
Polangui, Albay
https://bicol-u.edu.ph/
Email: bupc.nursing@gmail.com
NCM 118: Nursing Care of Client with Life Threatening Condition,
Acute Ill/Multi-organ Problems, High Acuity and Emergency Situation,
Acute and Chronic
1st Semester, SY2023-2024
Lesson No. 3: CARDIAC TAMPONADE
Cardiac Tamponade is the accumulation of excess fluid within the PERICARDIAL space,
resulting in IMPAIRED CARDIAC FILLING, REDUCTION in stroke volume, & EPICARDIAL
CORONARY ARTERY COMPRESSION with resultant myocardial ischemia.
3 Classic signs of Cardiac Tamponade:
1. low blood pressure in the arteries
2. muffled heart sounds
3. swollen or bulging neck vein (distended veins)
Signs and Symptoms:
Blood pressure falls when breathing deeply
Rapid breathing
Heart rate more than 100 bpm
Heart sounds o faintly heard thru stethoscope
Neck veins may be bulging or distended
Weak or absent peripheral pulses
Chest discomfort
Restlessness, agitation
Shortness of breath
Poor tissue perfusion
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Feeling of impending doom
Thread pulse
Physical Examination:
Pulsus paradoxus (physiologic drop in cardiac output)
Narrowed pulse pressure (<30 mm Hg)
Hypotension
Neurologic Examination:
Anxiety
Confusion
Obtunded if decompression is advanced
Cardiovascular Examination:
Jugular vein distention
Reflex tachycardia
Muffled, distant heart sounds
Skin
Cool
Pale
Clammy
CAUSES OF CARDIAC TAMPONADE:
Buildup of pericardial fluid (exudate, transudate, or blood) that can accumulate for several
reasons. Hemorrhage such as from a penetrating wound to the heart or ventricular wall rupture after
an MI, can lead to a rapid increase in pericardial volume.
Other Risk Factors:
- Tend to produce slower growing effusion (TB, myocarditis)
- Autoimmune diseases
- Neoplasms
- Uremia
- Other inflammatory diseases (pericarditis)
Risk Factors:
HIV (+)
End stage renal disease
Occult malignancies
History of coronary heart failure
Tuberculosis
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Pathophysiology:
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Confirmatory diagnosis for Cardiac Tamponade:
Echocardiogram: scan provides detailed image of the heart which may help detect fluid in the
pericardial sac or a collapsed ventricle
Chest x-ray: chest shows whether the heart is abnormally large or unusual shape due to fluid
buildup
Electrocardiogram (ECG or EKG): allows physician to examine the electrical activity of the
heart
CT Scan: confirm the presence of extra fluid in the pericardium
MEDICAL MANAGEMENT/TREATMENTS
Cardiac tamponade can result in shock or death. It always required emergency medical
treatment that involves draining excess fluid from around the heart.
PERICARDIOCENTESIS: procedure involves tehr removal of fluid from the pericardium
using a needle.
- Involves a needle aspiration of pericardial fluid for analysis
- The fluid sample is used to confirm and identify the cause of pericardial effusion (excess
pericardial fluid) and determine appropriate therapy
Special considerations (percardiocentesis)
- Observe the ECG tracing when the cardiac needle is being inserted
- ST segment elevation indicates that the needle has reached the epicardial surface and should
be retracted slightly
- An abnormally shaped QRS complex may indicate perforation of the myocardium
- Premature ventricular contractions usually indicate that the needle has touched the
ventricular wall
- watch for grossly bloody fluid aspirate, which may indicate inadvertent puncture of a cardiac
chamber
- after the procedure, be alert for respiratory and cardiac distress
- watch especially for signs of cardiac tamponade muffled and distant heartbeat, jugular vein
distention, paradoxical pulse and shock
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- cardiac tamponade may result from rapid accumulation of pericardial fluid or puncture of a
coronary vessel, causing bleeding into the pericardial sac
Complications:
- laceration of a coronary artery or the myocardium
- ventricular fibrillation
- vasovagal arrest
- pleural infection
- accidental puncture of lung, liver or stomach
PERICARDIECTOMY: remove part of the pericardium to relieve pressure on the heart.
Complications: laceration and perforation of the myocardium and coronary vessels;
excessive bleeding, atrial and ventricular arrhythmias, ventricular wall rupture, injury to the phrenic
nerve injury, which controls the movement of the diaphragm
THORACOTOMY: surgical procedure allows the draining of blood or blood clots from around the
heart
Complications: infection, bleeding, persistent air leakage from the lung, post-thoracotomy pain
syndrome, which involves persistent chest pain and nerve damage
Nursing Management:
provide oxygen
best rest with legs elevated
start two large bore IVs
give medication as ordered
have fluids available for resuscitation
ECG monitoring
Ensure chest x-ray and echocardiogram are done
Have pericardiocentesis tray ready
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ACTIVITY:
Case scenario:
Thomas, 50 years old, male presents a chief complaint of dizziness in the setting of a recent
ablation procedure for atrial fibrillation. The Nurse verified further and Thomas describe “feeling like
I’m going to pass out” and deny any vertiginous sensation. He further elaborate acute onset of
lightheadedness earlier in the day that occurred at rest and worsens with standing. The nurse asked if
there are associated symptoms, Thomas further verbalized of shortness of breath that is worsened by
exertion, but deny any other complaints, including chest pain, palpitations, or syncope. Vitals are
notable for tachycardia with mild hypotension.
Mr. Thomas is anticoagulated on warfarin. On initial assessments he is notable for tachycardia
and hypotension which continue to decompensate to pulseless electrical arrest if healthcare providers
do not quickly perform bedside pericardiocentesis.
VS:
HR: 110 bpm
BP: 100/60 mmHg
RR: 20 bpm
Temp: 37 C
O2 Sat: 100%
Patent airway, breathing (clear on auscultation bilaterally)
Circulation: tachycardic, capillary refill 2-3 seconds
Past medical history: atrial fibrillation, hypertension, obstructive sleep apnea
Past surgical history: ablation for atrial fibrillation
Medications: amlodipine, warfarin
Allergies: no drug allergies
Social history: no tobacco, alcohol or illicit substance use
Family history: unknown
INSTRUCTIONS: handwritten in a yellow pad paper to be submitted on or before 8:00am,
October 11, 2023. (class presidents to collect the output and submit to my office)
Establish the case of the patient as per case scenario by presenting the history of the patient.
Formulate at three NCP and incorporate the drug study/medication in the intervention with proper
prioritization.
Make you own NCP (STRICLY AVOID COPYING from the internet sources).
MARIA MERCEDES A. REMON, MN
Subject-in-Charge
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