Page 1710 - Saunders Comprehensive Review For NCLEX-RN

providing resources required for the
continued administration of IV
antibiotics.

4. Client education (Box 52-7)

XIII. Cardiac Tamponade

A. Description

1. A pericardial effusion occurs when the space between
the parietal and visceral layers of the pericardium fills
with fluid.
2. Pericardial effusion places the client at risk for cardiac
tamponade, an accumulation of fluid in the
pericardial cavity.
3. Tamponade restricts ventricular filling, and cardiac
output drops.

Acute cardiac tamponade can occur when small volumes (20

to 50 mL) of fluid accumulate rapidly in the pericardium.
B. Assessment

1. Pulsus paradoxus
2. Increased CVP
3. Jugular venous distention with clear lungs
4. Distant, muffled heart sounds
5. Decreased cardiac output
6. Narrowing pulse pressure
C. Interventions
1. The client needs to be placed in a critical care unit for
hemodynamic monitoring.
2. Administer fluids intravenously as prescribed to
manage decreased cardiac output.
3. Prepare the client for chest x-ray or echocardiography.
4. Prepare the client for pericardiocentesis to withdraw
pericardial fluid if prescribed.
5. Monitor for recurrence of tamponade following
pericardiocentesis.
6. If the client experiences recurrent tamponade or
recurrent effusions or develops adhesions from
chronic pericarditis, a portion (pericardial window) or
all of the pericardium (pericardiectomy) may be
removed to allow adequate ventricular filling and
contraction.
XIV. Valvular Heart Disease
A. Description

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