1. PRESENTED BY SARABJIT KAUR
MSc Nursing 1st year

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

5. DEFINATION
 Cardiac tamponade is a life threatening complication caused by
accumulation of fluid in the pericardium
 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.

8.  Causes
 In this condition, blood or fluid collects in the pericardium,
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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 body does not receive enough blood.
Cardiac tamponade can occur due to:
Dissecting aortic aneurysm (thoracic)
End-stage lung cancer
Heart attack (acute MI)
Heart surgery
Pericarditis caused by bacterial or viral infections
Wounds to the heart

9.  Other possible causes include:
 Heart tumors
 Hypothyroidism
 Kidney failure
 Leukemia
 Placement of central lines
 Radiation therapy to the chest
 Recent invasive heart procedures
 Recent open heart surgery
 Systemic lupus erythematosus

11. SYMPTOMS
 Elevated venous pressure {increased venous pressure}
 Distended neck veins
 Kussmaul’s sign{distended neck veins}
 Hypotension
 Tachycardia
 Narrow pulse pressure

12. SYMPTOMS CONT…….
 Dyspnoea
 Cyanosis of lips and nails
 Restlessness and anxiety
 Diaphoresis
 Muffled heart sounds

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

14. Beck's triad (cardiology)
 Beck's triad is a collection of 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 heart sounds.[1]

15. Physiology
 The fall in arterial blood pressure results from
pericardial fluid accumulation to a degree that it impairs
ventricular stretch, thus reducing stroke volume, a major
determinant of systolic blood pressure.
 The rising central venous pressure is evidenced by
distended jugular veins while in a non-supine position. 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

16. • The suppressed heart sounds occur due to the
muffling effects of the fluid surrounding the heart.

17. INVESTIGATIONS The following tests are also used for diagnosis:
 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 into the
heart through a vein or artery (usually in the arm or leg) to detect
problems with the heart and its blood supply
 Chest x-ray —a test that uses radiation to take a picture of
structures inside the body, especially bones

19. CONT……..
 CT scan —a type of x-ray that uses a computer to make pictures of
structures inside the chest
 MRI scan —a test that uses magnetic waves to make pictures of
structures inside the chest
 Coronary angiography —x-rays taken after a 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

20. MANAGEMENT
 Treatments are administered to:
 Save the patient's life
 Improve heart function
 Relieve symptoms

21. CONT…………..
 Treatments that are administered for cardiac tamponade
include:
 Pericardiocentesis —a procedure to drain the fluid around
the heart
 Fluids to maintain normal blood pressure
 Antibiotics

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

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

25. CONT…………
 Cardiovascular
 Jugular vein distention
 Reflex tachycardia
 Muffled, distant heart sounds
 Skin
 Cool
 Pale
 May be clammy

26. NURSING DIAGNOSIS
 Ineffective Breathing Pattern related to: hyperventilation
Goal: Patterns breath effectively as evidenced by no tachypnea,
vital signs are within normal ranges
NURSING INTERVENTIONSMonitor strictly vital signs, especially respiratory frequency.
 Monitor the contents breathing, chest expansion, regularity of
breathing, mouth breathing and muscle use a respirator..

27. CONT……
 Give the semi-Fowler position if not contraindicated. Rationale:
Facilitates lung expansion
 Teach clients a deep breath. Rationale: With the deep breathing
exercise can increase oxygen intake.
 Give oxygen as indicated. Rationale: Oxygen adequate to avoid the
risk of tissue damage.
 Give medication as indicated. Rationale: Medications that can
affect the respiratory ventilation.

28. 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 cardiac compression.

29. CONT…….
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Decreased cardiac output related to reduced ventricularfilling
secondary to increased intrapericardial pressure.
 GOALS-To maintain cardiac output of the patient as evidenced by
client HR,BP,Pulse pressure
 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.

30. CONT………….
.
3. Note the color, presence / quality of the pulse.
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4. Auscultation of breath sounds and heart sounds. Listen to the
murmur.
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5. Maintain bedrest in a comfortable position during the acute
period.
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6. Provide adequate rest periods / adequate. Assess the form of
self-care activities, if indicated.

31. CONT……………
 7. Assess signs and symptoms of CHF.
 Activity intolerance related to restlessness, fatigue
 GOAL-To increase the ability of Client to perform activities of
daily routine
 Assess the ability of client to perform activities of daily life.
 Assess patient’s need for assistive devices.
 Assess the degree of ability performed by client

32. 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 the patient

33. 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

34. BIBLIOGRAPHY
 BLACK M. JOYCE, Medical Surgical Nursing, published
by Elsevier, Edition 8th ,volume -2,page no.1406
 Brunner and Suddarth’s,Textbook of medical surgical
nursing, published by Lippincott Williams and Wilkins,
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