Pericardial Effusion, Cardiac Tamponade,SIADH Flashcards
What type of excess fluid is involved in pericardial effusion
The fluid may be pus, blood, serum, lymph or a combination
What happens if there is a slow buildup of fluid in the pericardial space
The heart can accommodate for up to 2 yrs without causing noticeable symptoms.
What is the normal level of pericardial fluid
20 ml
It is needed to decrease friction for the beating heart.
What happens If there is s rapid buildup of fluid in the pericardial space
It can compress the heart interfering with myocardial function.
( pericardial fluid increases, reducing venous return to the heart and decreasing CO)
What can pericardial effusion lead to
Cardiac tamponade
What is cardiac tamponade
A MEDICAL EMERGENCY
it is the rapid collection of fluid that interferes with ventricular filling and pumping, decreasing CO
( an increase in intrathoracic pressure which leads to decrease venous return)
What are signs and symptoms of cardiac tamponade?
PARADOXICAL PULSE (the drop in systolic BP by 10mm Hg during inspiration)
MUFFLED HEART SOUNDS
DYSPNEA & TACHYPNEA
NARROWED PULSE PRESSURE ( difference between systolic and diastolic pressures)
DISTENDED NECK VEINS
RESTLESSNESS
What is pericardial effusion?
An abnormal collection of fluid in the pericardial space that threatens normal cardiac function
What does SIADH result in?
Hyponatremia and water intoxication
What are causes of SIADH
Malignant tumors ( oat cell or small cell lung cancer which secrete ADH)
Head injuries, anethestics, lithium, alcohol, Dilantin, stress, ventilators
Cisplatin
Mitomyscin
What are signs and symptoms of SIADH
Neurological symptoms including decreased LOC, confusion. Lethargy, muscle twitches, seizures, Cheyenne stokes which leads to coma and death
How is SIADH treated
Correction of NA deficit
Restriction of fluids
Treat underlying cause
What does the tetracycline ( demeclocycline) cause?
An increase in serum NA, increased osmolality, and a decrease in urine sodium.
What is lithium do in response to ADH
It helps block renal response to ADH, ( monitor for N/V, diarrhea, ataxia, tremors, changes in blood glucose, dysrhythmias)
Take with food
Lasix
Is a loop diuretic to increase excretion of kidneys
Be careful of NA and K+ decreasing.
What are signs and symptoms of hyponatremia
Nausea, vomiting, muscles cramps, weakness, wt. gain from water retention Personality changes ( hostile) Decreased DTR sluggish Oliguria
What is sterile water considered
Hypotonic
What are signs and symptoms of fluid overload
Distended neck veins Crackles Tachycardia Increased BP taut skin
What are complications to monitor for with SIADH
- Water intoxication
- Cerebral edema
- Severe hyponatremia
* suppresses angiotensin system
What labs are assoc with SIADH
Urine sodium ( increased)
Osmolality ( increased)
Serum osmolality. ( decreased less than 270)
For a person on fluid restriction, what can they have to moisten mucous membranes?
Ice chips
Hard candy
What is used to determine ADH
Assay
What is nursing care for SIADH?
Restrict fluids by 500-1000 per day
Good mouth care
Isotonic solutions ( 0.9% na cl)
Monitor I&O
Weigh pt ( 2 lb increase is equivalent to 1L of fluid)
Monitor VS for tachycardia, hypothermia, increase BP
fall precautions bc of altered mental status
Seizure precautions
Monitor for HF
TELEMETRY
reduce environmental stimuli
What are signs and symptoms of hypercalcemia
- Decreased neuromuscular irritability, muscle weakness, depressed DTR leading to confusion, lethargy leading to coma
- Anorexia, n/v, constipation due to decreased motility
- Bradycardia, heart block
- Polyuria, polydipsia
What are complications of hypercalcemia
Peptic ulcer disease
Pancreatitis
Renal calculi ( kidney stones)
What is hypercalcemic crisis
Acute calcium excess which can lead to cardiac arrest; monitor for arrhythmias, decreased DTR, HYPERTENSION
What are meds for hypercalcemia
Isotonic fluids such as 0.9% NSS which helps excrete calcium thru the kidneys ( promotes vascular volume)
Loop diuretics such as furosemide ( Lasix) calcitonin)
Glucocorticoids
What is used in the treatment of hypercalcemic crisis?
IV sodium phosphate or potassium phosphate
What med is used to inhibit bone resorption
Plicamycin ( mithracin)
* increases urinary calcium excretion
What is dietary management of hypercalcemia
Increase intake of acid ash foods, fiber, fluid intake
What is assessment of hypercalcemia
Vital signs( apical)
Neuro assessment ( LOC)
Cardiac status, continuous monitoring if indicated
DTR
bowel sounds
Muscle strength ( pedal pushes and pulls. Hand grasps)
How long should you listen to bowel sounds
3-5 min each quadrant
What does the S3 sound indicate
Fluid overload
What are signs and symptoms of digitalis toxicity
Visual changes
Loss of appetite
Vomiting
Bradycardia
What’s is a pathological fracture
A fracture created when there is no trauma
Loss a calcium in bones leads to what
An increased risk for fractures
What is third spacing syndrome
Shift of fluid fro the cm vascular space ( inside blood vessel) to another area such as abdomen, bowels, soft tissues ( like swelling that occurs with a severe injury, trauma, burns)
How does calcium react with phosphate
It reacts in the opposite way; if phosphate is high calcium will be low.
If phosphate is low, calcium will be high
What is uric acid
The end product of protein metabolism
What is treatment for kidney failure
Hemodialysis
What is treatment for third spacing syndrome
Fluids
Phosphate binding agents ( aluminum hydroxide)
Alpurinol ( for uric acid)
Kayexalate ( binds with potassium)
What is a concern with third spacing
Dysrhythmias
CNS ( changes in LOC)
Renal failure
What are signs and symptoms of third spacing syndrome
Neck veins will be flat, not distended
Caplpillary refill decreased
Increased weak pulse
How do u treat third spacing syndrome
Expand volume give NSS
