1. Shannen Whiddon

2.  Cardiac tamponade is a condition in which cardiac filling is impeded by an external force.

3.  Cardiac tamponade is pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle (myocardium) and the outer covering sac of the heart (pericardium). This large collection of fluid raises the pressure in the pericardial sac, compresses the cardiac chambers, and prevents blood from entering the heart. (Osborn, Watson, Wraa, 2010)

5.  Phase 1  The accumulation of pericardial fluid causes increased stiffness of the ventricle.  Phase 2  The pericardial pressure increases above the ventricular filling pressure, resulting in reduced cardiac output  Phase 3  A further decrease in cardiac output occurs due to equilibration of pericardial and LV filling pressures

6.  The client with congestive heart failure develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?  A. Distant or muffled heart sounds  B. Hypertension  C. Bradycardia  D. Increased urine output

7.  The client with congestive heart failure develops cardiac tamponade. Which of the following signs and symptoms would the nurse assess?  A. Distant or muffled heart sounds  B. Hypertension  C. Bradycardia  D. Increased urine output

8.  Signs and symptoms  Chest pain, difficulty breathing, weak or absent peripheral pulses  Pulsus paradoxus Abnormally large decrease in systolic blood pressure during inspiration (>10mmHg)  Beck’s triad (3 D’s)  Distended jugular veins  Distant/muffled heart sounds  Decreased arterial pressure

9.  Risk factors  Heart surgery  Dissecting aortic aneurysm  Acute MI  Hypothyroidism  Pericarditis  Injury to the heart  End-stage lung cancer  Radiation therapy to the chest

10.  Prevalence of disease  Incidence rate: 2 in 10,000 in the U.S. (National Institute of Health, 2011).  Approximately 2% of penetrating injuries are reported to result in tamponade  1 year mortality rate of 76.5% in patients whose tamponade was caused by malignant disease  13.3% mortality rate in patients without malignant disease  Male-to-female ratio of 7:3

11.  HPI  A 63 year old woman faints after experiencing the sudden onset of severe chest pain that radiates to her back.  PMH  Hypertension  Assessment  HR is 110 bpm and BP is 90/50  Jugular veins distended  Pulsus paradoxus

12.  Which diagnostic test is best at detecting cardiac tamponade?  A. Chest X-ray  B. Echocardiography  C. Electrocardiogram (ECG)  D. Pulmonary artery pressure monitoring

13.  Which diagnostic test is best at detecting cardiac tamponade?  A. Chest X-ray  B. Echocardiography  C. Electrocardiogram (ECG)  D. Pulmonary artery pressure monitoring

14.  Echocardiogram  Best diagnostic tool  Chest X-Ray  Only helpful if there is at least 200mL of fluid in the pericardial sac  Chest CT or MRI  Coronary angiography  ECG

17.  Pericardiocentesis  Needle aspiration of blood or other fluid from the pericardial sac  Surgical pericardiectomy or pericardial window  Procedure to cut and remove part of the pericardium  Fluids to maintain normal BP  Oxygen to reduce the workload on the heart  MUST TREAT THE CAUSE TO PREVENT RECURRENCE

19.  The role of medication therapy in cardiac tamponade is limited  Occasionally dobutamine may be used to increase cardiac output  Only drugs that do not cause an increase in systemic vascular resistance

20.  Often good if the condition is treated promptly  Often comes back after treatment  This is a medical emergency and if left untreated, the condition is rapidly and universally fatal

21.  Decreased cardiac output R/T decreased preload and afterload AEB weak or absent peripheral pulses

22.  Osborn, K., Watson, A., & Wraa, C. (2010). Medical-Surgical Nursing Preparation for Practice. Pearson Education.  National Institute of Health (2012. May 14). Cardiac Tamponade. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/000194.htm  Ross, G. and De Jong, M. (Feb., 1999). Emergency!: Pericardial Tamponade. The American Journal of Nursing. Retrieved from JSTOR.  The British Medical Journal (1972. May 06). Tamponade After Acute Myocardial Infarction. Retrieved from JSTOR.  Mayo Clinic Staff. (2011, April 29). Pericarditis. Retrieved from http://www.mayoclinic.com/health/pericarditis/DS00505/DSECT ION=complications

23.  http://www.youtube.com/watch?v=GhbK9id e4E0 http://www.youtube.com/watch?v=GhbK9id e4E0