Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Cardiac Tamponade
Definition/Etiology:
- Cardiac Tamponade– Pericarditis with a distinct clinical presentation when fluids fills pericardium too quickly.
- Pericardium Analogy: Even though the Pericardium is like the shell covering of the heart it has a space of two layers of material.
- Fist (representing the heart) pushed into the side of a deflated balloon (representing the serous pericardium), therefore enveloped by two individual layers of material.
- Etiology-
- Acute (Fast- ICU)
- Trauma
- Cath Lab procedures, CABG or CPR
- Aortic Dissection
- Trauma
- Chronic (Slower – PCU)
- Infection/Inflammation
- Acute (Fast- ICU)
Pathophysiology:
- Tamponade Pathophysiology
- Fluid RAPIDLY fills up pericardial space
- 50cc → 150cc
- Analog:The pericardium only holds 50cc of fluid, about the amount of a shot glass – at 150cc (3 shot glasses) Pericarditis can turn into Cardiac Tamponade.
- ↑ Pericardium pressure
- ↓ Ventricles filling = ↓ Output
- Fluid backs up = ↑ CVP & ↑ JVD
Noticing: Assessment & Recognizing Cues:
- Subjective Cues: (Just like Pericarditis at first)
- Orthopnea
- Chest pain
- Relieved by leaning forward
- Objective Cues:
- Friction Rub -rubbing fingers next ears
- 85% of patients
- Bell of stethoscope
- Beck’s Triad
- Hypotension
- Distended Neck Veins (↑ CVP)
- Muffled Heart Sounds
- Pulsus Paradoxus
- Manual BP
- Breath in = Korotkoff sounds
- Arterial line
- (dampened waves)
- Manual BP
- Friction Rub -rubbing fingers next ears
Interpreting: Analyzing & Planning:
- Labs
- Troponin
- Myocardial damage
- CBC (WBC with diff)
- Bacterial vs Viral
- ERD/CRP
- Inflammation
- Blood Cultures
- Pericardiocentesis Culture
- Troponin
- Diagnostics
- Echocardiogram
- How BIG is Effusion (Tamponade)
- Heart swings
- ECG
- ST Elevations in most leads “Diffuse”
- Tachyarrhythmias
- ALTERNANS
- Echocardiogram
Responding: Patient Interventions & Taking Action:
- Prepare for Procedure
- Pericardiocentesis
- Partial Pericardiectomy “window”
- Pharmacological Interventions
- IV antibiotics
- NSAIDS
- Steroids
- Colchicine
- Non-Pharmacological
- 02
- Positioning
- Adjunct Medical Therapy
- Infectious Disease
- Cardiac Surgeon
Reflecting: Evaluating Patient Outcomes:
- Treatment is directed toward the underlying disease.
- Hemodynamics, vital signs, and ECG are within normal limits.
- Patient is comfortable, pain free, and without symptoms.
- Patient is free from complications (HF, tamponade).
- Laboratory values and clinical findings return to normal, and blood culture results are negative.
Linchpins (Key Points):
- Notice
- Pericarditis → Cardiac Tamponade
- Becks Triad
- Pulsus Paradoxus
- Pericarditis → Cardiac Tamponade
- Interpret
- ECHO/ECG/LABS
- Respond
- MUST have surgical intervention for life
- Reflect
- Patient’s trends improving
Transcript
References
- Dennison, R., & Farrell, K. (2016). Pass Pccn! Elsevier.
- Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M. Pericarditis in patients with COVID-19: a systematic review. J Cardiovasc Med (Hagerstown) 2021; 22:693.
- Hartjes T. AACN Core Curriculum for Progressive and Critical Care Nursing. [Pageburstls]. Retrieved from
https://pageburstls.elsevier.com/#/books/9780323778107/
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System