Otterbein University Digital Commons @ Otterbein

Nursing Student Class Projects (Formerly MSN) Student Research & Creative Work

Summer 2015

Cardiac

Ashley Miner Otterbein University, [email protected]

Follow this and additional works at: https://digitalcommons.otterbein.edu/stu_msn

Part of the Cardiovascular Diseases Commons, Medical Pathology Commons, and the Commons

Recommended Citation Miner, Ashley, "Cardiac Tamponade" (2015). Nursing Student Class Projects (Formerly MSN). 74. https://digitalcommons.otterbein.edu/stu_msn/74

This Project is brought to you for free and open access by the Student Research & Creative Work at Digital Commons @ Otterbein. It has been accepted for inclusion in Nursing Student Class Projects (Formerly MSN) by an authorized administrator of Digital Commons @ Otterbein. For more information, please contact [email protected]. Cardiac Tamponade Ashley Miner, RN, BS Otterbein University, Westerville, Ohio

Introduction Pathophysiological Processes Research Topic References References- cont. “Cardiac tamponade (CT) is a life- threatening condition and a medical emergency Implications for Nursing What is the Topic? characterized by pathologic accumulation of fluid in the pericardial sac that compresses The topic the author chose to research Underlying Significance of they myocardium, prevents adequate cardiac filling, and reduces cardiac output” (Schub Care is cardiac tamponade. Cardiac tamponade & Boling, 2015, p.1). Fluid builds up in the pericardial sac, which then causes increased Chandraratna, P. N., Mohar, D. S., & occurs when fluid builds up in the Implications for nursing care include close Schub, T., & Boling, B. (2015, March Pathophysiology Pathophysiology cardiac pressure and leads to compression of the . Cardiac tamponade results from Sidarous, P. F. (2014). Role of pericardial cavity, which is the cavity that monitoring of the . After placement 27). Cardiac tamponade. quick accumulation of even small amounts of fluid. “A rapid accumulation of pericardial in the treatment of surrounds the heart. Cardiac tamponade of pacer wires or a central venous line, a Retrieved from The pathophysiology of cardiac fluid will quickly compress the heart, resulting in decreased cardiac output, , and cardiac tamponade. can occur due to various reasons, including Cardiac tamponade occurs as fluid chest x-ray needs to be obtained to ensure http://web.b.ebscohost.com/ tamponade is significant so providers can be (ultimately, if undiagnosed) death” (Ikematsu & Kloos, 2012, p. 264). Echocardiography, 31(7), 899-910. myocardial infarctions, , accumulates in the pericardial sac and correct placement prior to using them. The ehost/pdfviewer/pdfviewer?s proactive instead of reactive. The doi:10.1111/echo.12605 traumas, and placement of pacer wires. causes increased compression on the chest x-ray would also rule out . id=21167a60-7788-425c- pathophysiology is important to know how , , and shortness of heart. A reduction in diastolic filling occurs Vital signs need to be obtained at least every 95a5- tamponade occurs and for what signs to breath are common symptoms that occur as the pressure of the four hours to ensure patient stability. Nurses Corl, K. A., Sears, W. N., Gregg, S. C., & f0bb80bc67b3%40sessionmgr monitor. Because cardiac tamponade can with cardiac tamponade. increases and thus causes the heart also need to be knowledgeable of equipment Lindquist, D. G. (2015). Resuscitative 112&vid=5&hid=128 occur quickly due to the rapid filling of the and a pericardial chambers from filling properly. Because used, such as chest tubes and pleurovacs. for nontraumatic pericardial sac, it is important to monitor the window are two interventions that are the right side of the heart has lower The nurse needs to be able to recognize if a pericardial tamponade: case reports Zakaria, S., Desai, D., Jeudy, J., & patient closely. One of the most important commonly used to treat cardiac diastolic pressures, the atrium and clot is present and drainage is decreased, and review of the literature. Thorn, E. (2011). Aortic diagnostic tests is a chest x-ray after tamponade. Cardiac tamponade is a are the first to be affected. The which could also point to developing cardiac American Journal of Emergency dissection and pericardial placement of pacer wires or a central venous medical emergency and without any improper filling of the right atrium and the tamponade. Nurses need to be Medicine, 33(4), 600.e5-7. tamponade causing line. The chest x-ray would show intervention, may lead to right ventricle lead to signs of right sided knowledgeable regarding cardiac tamponade doi:10.1016/j.ajem.2014.09.015 compression of the cardiomegaly, which would suggest cardiac and possible death. , such as hepatomegaly and to ensure they intervene appropriately if a pulmonary arteries in a jugular vein distention. Cardiac arrest can tamponade. Daily chest x-rays after cardiac patient’s condition deteriorates. Ekka, M., Ali, I., Aggarwal, P., & Jamshed, N. patient with prior cardiac Why was the Topic Chosen? then occur if the left atrium becomes surgeries are obtained for this reason as (2014). Cardiac tamponade as initial surgery. Journal of Cardiac The author chose cardiac tamponade affected due to the minimal filling and well. The heart is able to withstand fluid presenting feature of primary Surgery, 26(3), 316-318. because she has some past knowledge of . accumulations, as long as the fluid builds up Conclusion in the ED. American doi:10.1111/j.1540- the condition. The author previously gradually. Echocardiograms would also show Journal of Emergency Medicine, Cardiac tamponade has many causes, Cardiac tamponade is a life- threatening 8191.2011.01244.x worked on a cardiac step-down unit and the presence and size of a pericardial 32(6), 683.e1-3. including infections, trauma, surgery, and emergency that can result in death if not would care for that had had effusion. Monitoring for heart rate and doi:10.1016/j.ajem.2013.11.038 placement of pacer wires, a pacemaker, or treated quickly and appropriately. If a pericardial windows performed. Currently, respiratory rate increases and Other References a central venous line. Cardiac tamponade patient presents with , dyspnea, the author works in an emergency can be caused by infections, mainly pressure decreases would also alert Ikematsu, Y., & Kloos, J. A. (2012). Patients' providers to the possibility of developing muffled , and jugular vein department. Two weeks ago, the author pericarditis. Trauma can cause cardiac descriptions of dysphoria associated Cardiac tamponade image tamponade. Because the signs and distention, chest imaging, such as an x-ray assisted another nurse in caring for a tamponade due to perforation of the with cardiac tamponade. Heart & [photograph]. (2013). symptoms of cardiac tamponade are not should be obtained as soon as possible. An patient who was being treated for a pericardial sac and resulting accumulation Lung, 41(3), 264-270. Retrieved from specific until it becomes acute, it is electrocardiogram would also be useful in heartrate of 18 beats per minute. of fluid. Surgery and placement of pacer Figure 1. Chest x-ray showing cardiac tamponade. doi:10.1016/j.hrtlng.2011.08.005 http://www.forensicpatholo important to quickly rule out other determining the presence of a pericardial Transcutaneous pacing was not effective. wires or central lines also cause cardiac gyonline.com/content/cardia conditions, including acute myocardial effusion, which usually precedes cardiac The cardiologist on call placed a tranvenous tamponade due to perforation of the Case Study Kato, N.S. (2014, June 2). Cardiac c-tamponade infarctions, hypothyroidism, and . tamponade. Nurses, doctors, and other pacer while the patient was still in the . “Perforation by a catheter as tamponade. Retrieved from The pathophysiology is significant for An 83 year old female presented to the emergency room with complaints of healthcare providers need to be emergency room. Cardiac tamponade is well as direct infusion of fluid can cause http://www.nlm.nih.gov/medlineplus Cardiac tamponade x-ray providers to recognize the signs and generalized weakness. Upon arrival, patient was pale and diaphoretic. Cardiac monitor knowledgeable on the presentation of cardiac relevant to the author’s nursing practice CT; the right atrium is the most common /ency/article/000194.htm showed sinus with a heart rate of 29 beats per minute. Initial blood pressure tamponade to intervene quickly and prevent [radiograph]. (2013). because the author knows the condition site of catheter perforation” (Schub & symptoms of cardiac tamponade and to was 102/44 and respiratory rate of 24 breaths per minute. Patient was complaining of cardiac tamponade from causing a patient’s Retrieved from could result from the placement of the Boling, 2015, p. 1). intervene before the condition becomes midsternal chest pressure at a 2 on a 1/10 pain scale. The patient was alert and oriented death. Kim, R., Siouffi, S., Silberstein, T., Costa, S., http://medicalplanzone.com pacer wires. severe and causes death. but lethargic upon arrival, with a GCS of 15. An initial EKG was obtained which showed a Brown, J., & Greenberg, M. (2010). /cardiac-tamponade-x-ray/ with a left . A portable chest x-ray was obtained Management and clinical outcomes of Graph 1. Pressure/volume curve of the pericardium with fast accumulating pericardial which showed cardiomegaly and small bilateral pleural effusions. 1.5 mg of atropine acute cardiac tamponade Pressure- volume curve [graph]. fluid leading to cardiac tamponade with a smaller volume (A) compared with the slowly given by medics in squad prior to patient’s arrival, another 1 mg of atropine given in ED. complicating electrophysiologic (2012). Retrieved from accumulating pericardial fluid reaching cardiac tamponade only after larger volumes (B). No change in HR to either dose. A dopamine drip was started at 30.4 mL/ hr. 1 g of procedures: a single-center case http://eurheartj.oxfordjourn calcium chloride, 50 mEq of sodium bicarbonate, and 500 cc bolus were given. Staff series. Pacing & Clinical als.org/content/early/2012/ Electrophysiology, 33(6), 667-674. 11/01/eurheartj.ehs372 • Dyspnea attempting to transcutaneously pace patient, but unable to capture. Patient then being doi:10.1111/j.1540- • Chest pain bagged with 100% oxygen due to ineffective respirations. BP now 64/18 and HR 18. 8159.2010.02691.x • Hypotension Patient given 20 mg etomidate and 50 mg rocuronium to prepare for intubation. Propofol • drip then initiated at 10 mcg/kg/min. ET tube 22 cm at the lip, secured with tube holder. • Cardiologist now at bedside to place transvenous pacer. Foley catheter and nasogastric Laidler, S. (2013). Cardiac tamponade • Musculoskeletal pain tube inserted. Cardiologist remains at bedside to place triple lumen central venous following heart surgery. British • Beck’s triad- diminished heart sounds, catheter in left subclavian vein due to poor peripheral access and the need for pressers. Journal of Cardiac Nursing, 8(10), hypotension, & jugular vein distention is Vitals then were HR 80 A-V paced on the monitor, RR 16, SpO2 97% on ventilator, BP 504-510. classic for cardiac tamponade 123/44. Patient then transported to ICU. • Feeling of anxiety Patient’s lab results showed sodium 131, potassium 6.1, chloride 95, BUN 51, Mahon, L., Bena, J. F., Morrison, S. M., & • Feeling of restlessness creatinine 6.20, calcium 8.4. Troponin was 0.028 and TSH 6.600. Abdominal CT was Albert, N. M. (2012). Cardiac • Fever negative as was head CT. Patient did have history of ischemic with tamponade after removal of • Abdominal distention preserved ejection fraction. 2D echo from previous admission five months prior showed temporary pacer wires. American • on echocardiogram biatrial enlargement, mild to moderate left , and enlargement of Figure 2. Cardiac tamponade due to Journal of Critical Care, 21(6), 432- • Cardiomegaly on chest x-ray right ventricle. 2D echo obtained during this admission revealed moderate dilation of left 440. doi:10.4037/ajcc2012585 ventricle, left ventricular diastolic dysfunction, and a severely dilated left atrium.