Health history- current symptoms and their duration, precipitating factors or activities is known, previous episodes of pneumothorax, smoking hisotry, chronic pulmonary diseases, COPD
Physical- general appearance adn degree of apparent respiratory distress, evidence of chest trauma, vital signs, oxygen sats, skin color, LOC, respiratory excursion, percussion tone, and breath sounds amterior and posterior chest, neck veins inspection, position of trachea, peripheral pulses
Impaired gas exchange- asess VS, respiratory status Q4H, place in high fowlers or fowlers, give oxygen, assess chest tubes, provide rest
Risk for injury- secure the loop of drainage tubing to the sheet or grown, when turning to the affected side, ensure that neither the chest tube nor drainage tubing is kinked or occluded under the patient- teach the patient how to ambulate with the drainage system keeping the system lower than the chest- observe insertion site when changing chest tue dressings for redness, swelling, pain, or drainage- ensure all tubing connections are taped per hospital policy or provider preference
Patients who have had spontaneous pneumothorax need education about their future risk. After a single episode the risk of recurrence is 40-50%. The risk increases with sudequent episodes.
Stress the importance of quitting smoking to redure the risk.
Other activites that can precipitate rtecurrent episodes include mountain climbing or those involving exposure to high altitudes, flying in unpressurized aircrafts and scuba diving. The client may be advised to avoid contact sports
Following a pneumothorax instruct the patient to gradually increase exercise and activity to previous levels. Follow up care and monitoing. Discuss manifestations to report to the doc- upper respiratory infections, fever, cough, or difficulty breathing, sudden, sharp chest pain, or redness, pain, swelling, tenderness, or drainage from chest tube puncture wound
Blood in the pleural space, usually occurs as a result of chest trauma, surgery, or diagnostic procedures.
Hemothorax develops in about 25% of patients with chest trauma, usually due to laceration of the lung, an intercostals vessel or the internal mammary artery. If major thoracic vessels is disrupted, hemorrhage can be massive.
Tumors, pulmonary infarction, and infections such as TB also can cause hemothorax. When significant hemorrhage a risk of shock exists.
Hemothorax causes symptoms similar to those of pneumothorax or pleural effusion. Lung sounds are diminished, and a dull percussion tone is noted over the collected blood, typically at the base of the lung. Chest x-ray is used to confirm the diagnosis of hemorrhage.
Health history- pain, difficulty breathing, circumstances of the injury, including position in the vehicle, use of restraints, speed and type of impact, distance of a fall, surface and position on impact, history of chronic lung or heart disease, smoking history
Physical- airway, breathing, circularion, LOC, color VS, respiratory rate, depth, ease, symmetry of chest movement, lung sounds and percusion tone, presence of bruising, crepitus, or paradoxical chest movement
Acute pain- frequently assess pain, using a standard pain scale, administer analgesics by PCA or on a scheldule to maintain pain control
Ineffective Airway Clearance-assess lungs sounds and RR, depth, and effort 1-2hrs, teach how to splint the affected area with a blanket or pillow when coughing, Suction airway as indicated, elevate the head of the bed
Impaired Gas Exchange-monitor VS, color, oxygen sats, and arterial blood gases, maintian oxygen therapy, Hyperoxygenate prior to suctioning, monitor intake and output, weigh daily and monitor central venous pressure and pulmonary artery pressure, maintain bed rest or activity restriction.
hypoxemia-due to ventilation-perfusion mismatch, impaired gas diffusion, hypoventilation
manifestations- dyspnea, tachypnea, cyanosis, restlessness, apprehension, confusion, impaired judgment, tachycardia, dysrythmias, hypertension, metabolic acidosis
Hypercapnia- due to hypoventilation
dyspnea-respiratory depression, headache, papiledema, tachycardia, hypertension, drowsiness, coma, systemic vasodilation, heart failure, respiratory acidosis
administering oxygen without ventilatory support may further reduce the drive to breath leading to respiratory arrest
used when alveolar ventilation os inadequate to maintain blood oxygen and carbon dioxide levels. specific indications- apnea or acute respiratory failure, Hypoxemia unresponsive to oxygen therapy alone, Increased work of breathing with progressive patient fatigue. Most common indicator is actual or potential respiratory muscle fatigue. Drug OD, neural disorders, chest wall injury, airway problems( asthma, COPD) Disorders that affect aveolar-capillary diffusion( pulmonary contusion, pneumonia, ARDS)
Posistive pressure ventilation increases lung volume, help redistribute fluid from the aveolar to the interstitial space, and help reduce the oxygen demand casued by increased work of breathing.
Noninvasive-NIV provides ventilator support using a tight fitting mask( obstructive sleep apnea, neuromuscular disease, COPD,
Continuous positive airway pressure-CPAP, applies positive presuure to the airway of a spontaneously breathing, tight fitting mask, endotracheal intubation,
BIPAP, inspiratory positive airway pressure aswell as airway support during expiration, tight fitting mask,( nasal, oral, facial)
Assist-control mode ventilation-ACMV or AC, initiate mechanical ventilation or when pt is at risk for respiratory arrest
Synchronized intermittent mandatory ventilation SIMV, allows pt to breath spontaneous without ventilator assestance between breaths
Health history- current manifestations, their duration, and identified precipitating factors, history of previous episodes, chronic diseases -COPD, occupational lung disease, current meds
Physical- LOC, mental status, VS, color and oxygen sats, respiratory assessment, rate, depth, use of accessory muscles, respiratory excursion, auscultation, cardiovascular asessment, HR, and sounds, neck vein distention, peripheral pulses, evidence of clubbing
Tests- ABGs, chest x-ray, pulmonary artery pressure and wedge pressure readings, cardiac output
Impaired Spontaneous Breathing- assess RR, VS, and O2 sats Q15-30 mins. report worsening ABGs and O2 sats, place in Fowlers and High folwers, prepare for endotracheal intubation.
Ineffective Airway Clearance- suction as needed, obtain sputum culture if purulent, perform percussion, firmly secure endotracheal , assess fluid balance and maintain hydration
Risk for Injury-assess LOC, respiratory, cardiovascular, gastro, genitourinary, skin, report any leakage around the cuff, reposition, keep skin clean and dry, ROM Q4-8hrs, keep side rails up
Maintaining adequate ventilation and respirations is the highest priority
Decreased cardic output- signs monitor VS, pulse Q2hs, assess LOC Q4h, maintain IV fluids, admin meds
Dysfunctional Ventilatory Weaning Response, dyspnea, decreasing O2 sats, cyanosis, increased BP, pulse, RR, diminished breath sounds, decrease LOC, shallowing gasping breaths, deteriorating ABG values,
interventions for dysfunctioning weaning
assess VS Q15-30 mins, place in high folwers or fowlers, fully explain procedure, remain with pt during initial period, limit procedures and activities, provide diversion, begin weaning procedure in morning, avoid administering drugs that may depress respirations.
penetrating occurs when a foreign object enters the body, causing damage to body structure. structure commonly affected brain, lungs, heart, liver, spleen, intestines, and vascular. ex gunshot, stab wound
Other types trauma inhalation injuries from gas, smoke, or steam, burn, freezing injuries and blast injuries. Blast injuries result from the temperature and velocity of air movement and the force of projectiles from the explosion. Blast injuries are more severe in water than air since blast waves travel farther and faster in water. Trauma from blast injuries include pulmonary edema, hemorrhage, damage to ABD organs, burns, penetrating injuries and ruptured ear drum membranes.
All trauma pt receive high flow oxygen until satbilized assessment should include spontaneous breathing, good rise and fall of the chest, determination of skin color, general rate and depth of respirations, ABD or accessory muscle use, position of the trachea, observation of chest wall integrity and presence of JVD, bilateral breath sounds, as well as the presence of any surface trauma.
In addition to suctioning other airway adjuncts are used oral, nasal pharyngeal airways, oxygen delivery devices, laryngeal mask airway, combitube, and endotracheal intubation. Intubation is the preferred method of airway management.