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
