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MED SURG > Pericardial Effusion, Cardiac Tamponade,SIADH > Flashcards

Pericardial Effusion, Cardiac Tamponade,SIADH Flashcards

1
Q

What type of excess fluid is involved in pericardial effusion

A

The fluid may be pus, blood, serum, lymph or a combination

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2
Q

What happens if there is a slow buildup of fluid in the pericardial space

A

The heart can accommodate for up to 2 yrs without causing noticeable symptoms.

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3
Q

What is the normal level of pericardial fluid

A

20 ml

It is needed to decrease friction for the beating heart.

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4
Q

What happens If there is s rapid buildup of fluid in the pericardial space

A

It can compress the heart interfering with myocardial function.
( pericardial fluid increases, reducing venous return to the heart and decreasing CO)

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5
Q

What can pericardial effusion lead to

A

Cardiac tamponade

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6
Q

What is cardiac tamponade

A

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)

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7
Q

What are signs and symptoms of cardiac tamponade?

A

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

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8
Q

What is pericardial effusion?

A

An abnormal collection of fluid in the pericardial space that threatens normal cardiac function

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9
Q

What does SIADH result in?

A

Hyponatremia and water intoxication

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10
Q

What are causes of SIADH

A

Malignant tumors ( oat cell or small cell lung cancer which secrete ADH)
Head injuries, anethestics, lithium, alcohol, Dilantin, stress, ventilators
Cisplatin
Mitomyscin

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11
Q

What are signs and symptoms of SIADH

A

Neurological symptoms including decreased LOC, confusion. Lethargy, muscle twitches, seizures, Cheyenne stokes which leads to coma and death

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12
Q

How is SIADH treated

A

Correction of NA deficit
Restriction of fluids
Treat underlying cause

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13
Q

What does the tetracycline ( demeclocycline) cause?

A

An increase in serum NA, increased osmolality, and a decrease in urine sodium.

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14
Q

What is lithium do in response to ADH

A

It helps block renal response to ADH, ( monitor for N/V, diarrhea, ataxia, tremors, changes in blood glucose, dysrhythmias)

Take with food

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15
Q

Lasix

A

Is a loop diuretic to increase excretion of kidneys

Be careful of NA and K+ decreasing.

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16
Q

What are signs and symptoms of hyponatremia

A 
Nausea, vomiting, muscles cramps, weakness, wt. gain from water retention
Personality changes ( hostile)
Decreased DTR
sluggish
Oliguria
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17
Q

What is sterile water considered

A

Hypotonic

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18
Q

What are signs and symptoms of fluid overload

A 
Distended neck veins
Crackles
Tachycardia
Increased BP
taut skin
19
Q

What are complications to monitor for with SIADH

A
  1. Water intoxication
  2. Cerebral edema
  3. Severe hyponatremia
    * suppresses angiotensin system
20
Q

What labs are assoc with SIADH

A

Urine sodium ( increased)
Osmolality ( increased)
Serum osmolality. ( decreased less than 270)

21
Q

For a person on fluid restriction, what can they have to moisten mucous membranes?

A

Ice chips

Hard candy

22
Q

What is used to determine ADH

A

Assay

23
Q

What is nursing care for SIADH?

A

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

24
Q

What are signs and symptoms of hypercalcemia

A
  1. Decreased neuromuscular irritability, muscle weakness, depressed DTR leading to confusion, lethargy leading to coma
  2. Anorexia, n/v, constipation due to decreased motility
  3. Bradycardia, heart block
  4. Polyuria, polydipsia
25
Q

What are complications of hypercalcemia

A

Peptic ulcer disease
Pancreatitis
Renal calculi ( kidney stones)

26
Q

What is hypercalcemic crisis

A

Acute calcium excess which can lead to cardiac arrest; monitor for arrhythmias, decreased DTR, HYPERTENSION

27
Q

What are meds for hypercalcemia

A

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

28
Q

What is used in the treatment of hypercalcemic crisis?

A

IV sodium phosphate or potassium phosphate

29
Q

What med is used to inhibit bone resorption

A

Plicamycin ( mithracin)

* increases urinary calcium excretion

30
Q

What is dietary management of hypercalcemia

A

Increase intake of acid ash foods, fiber, fluid intake

31
Q

What is assessment of hypercalcemia

A

Vital signs( apical)
Neuro assessment ( LOC)
Cardiac status, continuous monitoring if indicated
DTR
bowel sounds
Muscle strength ( pedal pushes and pulls. Hand grasps)

32
Q

How long should you listen to bowel sounds

A

3-5 min each quadrant

33
Q

What does the S3 sound indicate

A

Fluid overload

34
Q

What are signs and symptoms of digitalis toxicity

A

Visual changes
Loss of appetite
Vomiting
Bradycardia

35
Q

What’s is a pathological fracture

A

A fracture created when there is no trauma

36
Q

Loss a calcium in bones leads to what

A

An increased risk for fractures

37
Q

What is third spacing syndrome

A

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)

38
Q

How does calcium react with phosphate

A

It reacts in the opposite way; if phosphate is high calcium will be low.
If phosphate is low, calcium will be high

39
Q

What is uric acid

A

The end product of protein metabolism

40
Q

What is treatment for kidney failure

A

Hemodialysis

41
Q

What is treatment for third spacing syndrome

A

Fluids
Phosphate binding agents ( aluminum hydroxide)
Alpurinol ( for uric acid)
Kayexalate ( binds with potassium)

42
Q

What is a concern with third spacing

A

Dysrhythmias
CNS ( changes in LOC)
Renal failure

43
Q

What are signs and symptoms of third spacing syndrome

A

Neck veins will be flat, not distended
Caplpillary refill decreased
Increased weak pulse

44
Q

How do u treat third spacing syndrome

A

Expand volume give NSS

MED SURG (15 decks)

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