University Hospital: Cardiac Tamponade Nursing Case Study Analysis

This case study centers on a 40-year-old female, Martha Myles, admitted to the Emergency Department following a high-speed car crash, presenting with multiple injuries and later developing signs of cardiac tamponade. The assignment focuses on the crucial role of the nurse in identifying and managing this life-threatening condition. The nurse's responsibilities include assessing for Beck's triad, ruling out alternative explanations for Martha's deteriorating condition, and implementing interventions such as monitoring vital signs, arranging for an echocardiogram, and preparing for potential procedures like pericardiosynthesis. The nurse must also provide emotional support, administer oxygen and intravenous fluids, and promptly notify the medical team. The case study emphasizes the importance of continuous assessment, timely interventions, and collaboration within the healthcare team to ensure optimal patient outcomes in a critical situation.

Answer 3
On seeing that Martha’s condition is deteriorating, nurse must make use of her knowledge and
experience to identify the causes of deterioration. Nurse must assess Martha for Beck's triad to
check for cardiac tamponade. Beck’s triad include muffled heart sounds, hypotension and
distension of jugular vein along with head and neck edema symptoms.
Nurse must rule out all the possible alternative explanations for Martha’s low blood pressure,
tachycardia, pain and arrhythmias. In order to further implement nursing interventions for
managing cardiac tamponade, it would be vital to rule out other possibilities.
She must assure the patency of the sumps. She must look for "equalization" of central pressures
throughout the diastole (Doshi, Ramakrishnan, & Gupta, 2015).
She must also look for "loss of the y-descent" which means decrease in pressure decrease due to
tricuspid valve opening in early ventricular diastole. Tamponade is suggested through a loss of y-
descent suggests tamponade (Kearns & Walley, 2018). A hallmark of cardiac tamponade is
pulsus paradoxus which means a low in systolic blood pressure of over 10 mm Hg during
inspiration. Nurse must assess Martha for pulsus paradox as it is always present in cases with
severe cardiac tamponade.
She must arrange for an echocardiogram, as indicated. This is the best test to assess for
tamponade. Echocardiography is the best and most reliable for assessment of tamponade (Pérez-
Casares, Cesar, Brunet-Garcia, & Sanchez-de-Toledo, 2017).Nurse must contact the
echocardiographer after consulting with professionals in ICU. Treatment for cardiac tamponade

includes returning to the operation room, re-sternotomy, and removal of the clot with hemostasis
of any persistent bleeding (Carlini & Maggiolini, 2017).
Nurse must head to administration of oxygen in order to maintain Martha’s SpO2 over 92%.
Nurse must evaluate Martha respiratory distress. Nurse must monitor Martha’s ECG for
arrhythmias. She must also monitor Martha’s blood pressure very 5 to 15 minutes in this phase.
Nurse must also monitor Martha’s urine output every hour as a reduction in urine output is an
indication of potential lowered renal perfusion due to reduced stroke volume following cardiac
compression. Nurse must also make an assessment of Martha’s consciousness level for
alterations that may suggest reduced cerebral perfusion. She must also check her for anxiety and
confusion. Nurse must alleviate Martha’s anxiety by reassuring her and explaining the
procedures that nurse in conducting on her. Administration of intravenous fluids is another
nursing intervention. Rationale behind the intervention is to elevate the filling pressures since
Martha has acute tamponade.
Nurse must prepare Martha for pericardiosynthesis. She may require emotional and educational
assistance which must be provided to her by the nurse. Nurse must immediately notify the
appointed doctor and cardiac surgeon as soon as she suspects that Martha has developed
tamponade. She must conduct her assessments till the doctor arrives in order to maintain
Martha’s condition so that it does not deteriorates further. Once the doctor arrives, she must
assist them and wait for their further indications.
Reference

BIBLIOGRAPHY Carlini, C. C., & Maggiolini, S. (2017). Pericardiocentesis in cardiac tamponade:
indications and practical aspects. e-Journal of Cardiology Practice, 15.
Doshi, S., Ramakrishnan, S., & Gupta, S. K. (2015). Invasive hemodynamics of constrictive
pericarditis. Indian Heart J., 67(2), 175-82.
Kearns, & Walley. (2018). Tamponade: Hemodynamic and Echocardiographic Diagnosis. Chest,
153(5), 1266-1275.
Pérez-Casares, A., Cesar, S., Brunet-Garcia, L., & Sanchez-de-Toledo, J. (2017).
Echocardiographic Evaluation of Pericardial Effusion and Cardiac Tamponade. Front
Pediatr, 5(79).