Pericardial effusion and cardiac tamponade: Nursing process (ADPIE)

Lydia Smith is a 42-year-old female client with a history of metastatic breast cancer currently being treated with radiation therapy.

She presents with shortness of breath and chest pain while at the radiation therapy clinic this morning.

She states she started having intermittent chest pain two days prior that feels like heavy pressure under her sternum.

Her radiation treatment is postponed temporarily, and her oncologist sends her for several cardiac tests including a chest x-ray, electrocardiogram or ECG, and an echocardiogram, to determine the cause of her symptoms.

Her cardiac test results confirm a large pericardial effusion, and she is directly admitted by her oncologist to a telemetry unit pending pericardiocentesis.

When extra fluid builds up in the pericardial cavity, it is known as pericardial effusion, which can then develop into cardiac tamponade depending on how much extra fluid there is and how quickly it accumulates.

Cardiac tamponade puts pressure on the outside of the heart restricting its movement.

As a result, the heart is unable to pump normally, causing compromised cardiac functioning and resulting in decreased cardiac output.

The heart sits inside a two-layered pouch called the pericardium.

Within this pouch there is the pericardial cavity which is filled with a small amount of fluid that lets the heart slip around as it beats.

Typically, there is approximately 15 to 50 milliliters of fluid in the pericardial cavity at any given time.

The pericardial cavity can stretch to accommodate a gradual accumulation of fluid without immediate adverse effects.

When fluid accumulates gradually, the pericardium can hold as much as 1.5 liters of fluid before tamponade sets in.

In contrast, if there is a rapid buildup of fluid, even as little as 100 milliliters, does not allow the pericardial cavity to stretch and can compress the heart, leading to cardiac tamponade.

A rapid accumulation of fluid can occur as a result of trauma to the chest.

For example, a stab wound can puncture a blood vessel and fill the pericardium with blood, or blunt trauma like hitting your chest with a steering wheel during a car crash causing the rupture of many small blood vessels.