23 terms

Pneumothorax: Spontaneous, tension, traumatic. Flail Chest

Pneumothorax: Spontaneous, tesion, traumatic. Flail Chest
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Manifestations of Pleuritis
-Abrupt Onset
- Unilateral Pain that increases with movement
-Pleural Friction Rub
Pleuritis: How to treat innefective breathing pattern R/T pain?
-NSAIDS
-Codeine
-Splinting
-Posistion for comfort
Define Pneumothorax
Air is in pleaural space between viceral and parietal linings with partial or total lung collapse.
What is a Spontaneous (closed with no apparent cause) Pneumothrax caused by?
Rupture of bleb (blisters) on lung in COPD or Congenital (present from birth
Pneumothorax: Symptoms
-Dyspnea (labored breathing)
-Dry hacking cough
-Asymmetric chest movement
-Diminished or absent BS over affected side
-Hyperresonance on percussion
-Subcutaneous Emphysema (gas and air in SQ tissue)
-Diminished or absent tactile fremitus (vibration felt by a hand placed on a chest during transmission of the spoken voice to the chest wall.
Pneumothorax: Interventions
-Monitor for sx of respiratory distress
-Monitor ABGs and 02 sat
-Pain Control
-Position in Fowlers
-Prepare for and assist with chest tube insertion or flutter valve
Pneumothorax: Diagnosis
Based on Symptoms and Chest X-Ray
Pneumothorax: Treatment
Needle aspiration or chest tube
Traumatic Pneumothorax
An injury creates an opening in chest wall destroying negativity and lungs collapse. Air moves in and out of the pleural space.
Traumatic Pneumothorax: Closed
Caused by blunt chest trauma (fall, blow, violent cough, sudden deceleration causing a pleural tear)
Traumatic Pneumothorax: Open
(Penetrating or "sucking chest wound")
Traumatic Pneumothorax: Iatrogenic
resulting from a therapeutic procedure (Central Venous Line insertion, thoracentesis, surgery)
Traumatic Pneumothorax: Symptoms
-possible mediastinal shift
-often have severe resp. distress & dyspnea
Traumatic Pneumothorax: Interventions
-Cover to cntrl bleeding and keep clean. If dressing is applied do so at end experation and use a FLAP DRESSING (non-porous) to let air escape
-If dressing applied, assess for tension pneumothorax
-If impaled object, stabilize with bulky dressing DO NOT REMOVE implaed object.
-Prepare for thoracotomy & chest tube insertion
-Assess for blood loss & sx of shock
-Monitor ABGs and O2
-Posistion in Flowlers
-Prepare for and assist with chest tube insertion or flutter valve
Tension Pneumothorax
Life Threatening. Air accumulates in pleaural cavity during inspiration but cannot leave during expiration- one way valve. Complete collapse of affected lung with increased pressure in chest resulting in mediastinal shift and impaired venous return to heart. Ventilation and circulation is compromised.
Tension Pneumothorax: Cause
-Traumatic pneumothorax
-Mechanical Ventilation
-Faulty chest drainage system
-Prolonged clamping of chest tube
Tension Pneumothorax: Symptoms
-Trachial deviation to uneffected side
-JVD
-Mediastinal shift
-Hypotension
-Increased Heart Rate
Displacement of Point of maximal Impulse
-Cardiac Arrythmias
Tension Pneumothorax: Interventions
Emergency Situation!!
-Prepare for needle thorocotomey (insertion of large bore needle into chest wall at 2nd ICS to release air tension.
-Needle aspiration or chest tube
Flail Chest
Multiple fractures of two or more ribs in two or more places creating a flail segment. This segment may lacerate lung tissue with subsequent hemopneumothorax plusthe structural integrity of the chest wall is destroyed. The rib segment "flails" with ventilation or paradoxical movement of the chest wall.
Flail Chest: cause
Traumatic Injury
Flail Chest: Symptoms
-Flail segment sinks in with inspiration and out with expiration.
- Severe pain with respiration (at fracture site)
-Dyspnea and resp distress
-Shallow Respirations (Decreased tidal Volume)
-Breath sounds may be absent on affected side
Flail Chest: Interventions
-Stabilize flail segment with hand and tape horizontally
-EKG to determine heart damage
-IV site
-Monitor for pulmonary contusion
-Monitor for Cardiac tamponade (Becks triad) Decrease in BP, Muffled Heart sounds, JVD
Pulmonary Embolism
clot or other material lodges in vessels of the lung