A 58-year-old patient with metastatic lung cancer is admitted with progressive dyspnea, hypotension, jugular venous distention, and muffled heart sounds. Bedside echocardiography shows a moderate pericardial effusion with right ventricular collapse during diastole. Which actions should the nurse prioritize while preparing the patient for emergent pericardiocentesis? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Cardiac tamponade is obstructive shock from pericardial fluid compressing the heart and limiting diastolic filling. Priorities are (1) preload support with IV fluids — preload-dependent physiology means dropping preload (e.g., nitroglycerin) is harmful, (2) continuous monitoring with defib pads ready because PEA arrest is a real risk, (3) oxygenation, and (4) emergent pericardiocentesis preparation. Choice 5 is contraindicated because nitroglycerin reduces preload and can precipitate cardiovascular collapse in tamponade physiology.
Tamponade is preload-dependent: anything that drops preload (nitrates, diuretics, deep sedation) can convert compensated tamponade into PEA arrest. The first nursing actions are volume support, monitoring with defibrillation pads, oxygen, and procedural preparation — definitive treatment is needle/catheter drainage of the effusion under echo guidance.
58-year-old patient with metastatic lung cancer develops progressive dyspnea, hypotension, jugular venous distention, and muffled heart sounds (Beck triad). Bedside echocardiography demonstrates a moderate pericardial effusion with right ventricular diastolic collapse. The provider has called for emergent pericardiocentesis.
Cardiac tamponade — Life-threatening compression of the heart by pericardial fluid causing obstructive shock; classic Beck triad of hypotension, jugular venous distention, and muffled heart sounds.
Pulsus paradoxus — Inspiratory drop in systolic blood pressure greater than 10 mmHg; supports tamponade physiology when present.
Pericardiocentesis — Emergent needle aspiration of pericardial fluid under echocardiographic guidance to relieve cardiac compression.