Cardiac tamponade is a serious condition where blood or fluid fills the pericardial sac surrounding the heart, putting pressure on the heart and preventing it from pumping effectively. Signs include chest pain, difficulty breathing, and low blood pressure. Treatment involves removing fluid from the pericardial sac via a procedure called pericardiocentesis to relieve pressure on the heart. Nursing care focuses on monitoring vital signs, administering medications and oxygen, maintaining bed rest, and educating the patient.
Pulmonary Arterial Hypertension Overview
Michael J. Cuttica MD Assistant Professor of Medicine Northwestern Pulmonary Hypertension Program
Northwestern University
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Ischemic heart disease is a condition of recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood. This condition occurs most often during exertion or excitement, when the heart requires greater blood flow.
It contains meaning, pathophysiology, types, risk factors, lab and diagnostic procedures and tests, Rx goals, appropriate medications for ANGINA PECTORIS ..... Enjoy and Learn from it!!!!
Related with cardio vascular system. Angina is Retrosternal chest pain which if left untreated can cause the higher complications with respect to cardiac health of human body. May be this is simple chest pain but if exceeds can cause major damage # prevention is better than cure :-)
Pulmonary Arterial Hypertension Overview
Michael J. Cuttica MD Assistant Professor of Medicine Northwestern Pulmonary Hypertension Program
Northwestern University
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Ischemic heart disease is a condition of recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood. This condition occurs most often during exertion or excitement, when the heart requires greater blood flow.
It contains meaning, pathophysiology, types, risk factors, lab and diagnostic procedures and tests, Rx goals, appropriate medications for ANGINA PECTORIS ..... Enjoy and Learn from it!!!!
Related with cardio vascular system. Angina is Retrosternal chest pain which if left untreated can cause the higher complications with respect to cardiac health of human body. May be this is simple chest pain but if exceeds can cause major damage # prevention is better than cure :-)
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Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
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VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
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to minimize the developme
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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FLATULENCE
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FECAL INCONTINENCE
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Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
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This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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
3
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
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.
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.
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%
25. Emergent Treatment
25
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
27. Pulsus paradoxus > 10 mm Hg
(hallmark)
Narrowed pulse pressure (<30 mm Hg)
Hypotension
Neurologic
Anxiety
Confusion
Obtunded if decompression is
advanced
Nursing assessment
27
28. ● Ineffective Breathing Pattern related to: hyperventilation that
evidenced by shortness of breathing and change vital signs
Nursing diagnosis
28
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
29
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
30
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
31
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
32