32 terms

Effusions, Pneumothorax & Hemothorax

Exam 2
STUDY
PLAY
Visceral pleura
lines lungs & interlobar fissures
parietal pleura
lines interior thorax, diaphragm & mediastinum
Normal pleural fluid
total volume of fluid is 16 ml or 8ml per hemithorax
total protein concentration is similar to interstitial fluid (1.3-1.4g/dl)
anatomic alterations of the lungs
lung compression; atelectasis; compression of great veins & decreased cardiac venous return
transudate
straw color; fluid from pulmonary capillaries moves into pleural space as a result of increases in capillary pressure & decreases in plasma oncotic pressure
exudate
smelly, cloudy, pus, white; accumulation of fluid from the diseased pleura caused by inflammation (infectious process)
No protein
(transudate) protein free fluids result from increases in hydrostatic pressure in the capillaries. Fluid has a low specific gravity, decrease in proteins & decrease in cell count. total protein concentration is less than 50% of total serum protein level
High protein
(exudate) protein in fluid results in membranes that are not intact which occurs in cases of inflammation. fluid has a high specific gravity, increased protein count, increased cell count, & increased WBC
Major causes of a transudative pleural effusion
CHF
hepatic hydrothorax
peritoneal dialysis
nephrotic syndrome
pulmonary embolus
major causes of an exudative pleural effusion
malignant pleural effusions
malignant mesotheliomas
pneumonias
TB
fungal disease
pleural effusion resulting from diseases of the GI tract
pleural effusion resulting from collagen vascular diseases
other pathologic fluids that separate the parietal from the visceral pleura
Empyema (pus)
Chylothorax (milky fluid)
Hemothorax (blood) (trauma)
Empyema
pus in the pleural cavity
caused by inflammation
Chylothorax
Chyle in the pleural space
chyle is a milky liquid produced from food in the small intestine during digestion
Chyle is primarily composed of fat
transported from intestines via lymphatics to neck & thoracic duct
moves into venous circulation & mixes with blood
most common cause is cancer - can be caused by tumor or trauma in neck or thorax
Hemothorax
blood in pleural space
Hct should be taken if fluid looks bloody
most common cause is trauma
Bedside assessment
chest pain/decreased chest expansion
cyanosis
cough (dry, nonporductive)
tracheal shift
decreased tactile & vocal fremitus
dull percussion note
diminished breath sounds
displaced heart sounds
Radiologic findings
blunting of costophrenic angle
depressed diaphragm
possible mediastinal shift to afected side
meniscus sign
shelf
respiratory care treatment protocols
O2 therapy protocol
hyperinflation therapy portocol
mechanical ventilation protocol
Pleurodesis
talc powder injected into pleural space
General management
chemical or medication injected into chest cavity
-talc
-tetracycline
-bleonycin sulfate
Produces inflammatory reaction between lungs & inner chest cavity (causes lung to stick to chest cavity)
Fibrothorax
fibrous material in the pleural space
(pleural friction rub sound)
Pleurisy
inflammation of pleura with or without pleural effusion
causes deposition of fibrinous exudate
results in decreased movement between pleura
Pleuritic chest pain greater during inspiration causing pt to splint
Pleurisy may precede an effusion
B/S - friction rub
Chest tube (know for board exams)
insert in the 6th midaxillary space when draining fluid
insert in the 2nd midclavicular space when draining air
Pneumothorax
-air in the pleural space
-trauma to the chest
latrogenic pneumothorax
caused by diagnostic or therapeutic procedure such as tracheostomy, mechanical ventilation, thoracentesis, nerve block, cannulation of subclavian vein
Spontaneous pneumothorax
occurs suddenly usually from a bleb or bulla. Typically occurs in tall persons between ages 15-35
Closed pneumothorax
gas in pleural space is not in direct contact with the atmosphere (not caused by trauma)
Open pneumothorax (sucking wound)
pleural space is in direct contact with the atmosphere. Caused by traumatic wound to the chest. During inspiration, mediastinum moves to the unaffected side. During exhalation, the mediastinum moves to the affected side. Called "pendelluft"
Valvular chest wound
when air is allowed into chest cavity during inspiration but a valve (tissue) closes & doesn't allow gas to escape
Tension pneumothorax
occurs when pressure in the pleural space exceeds the pressure in the alveolar space and the mediastinum shifts to the unaffected side. This shift is life threatening as it causes the heart to be compressed as it shifts
Clinical manifestations for pneumothorax
increase HR & RR
Decreased lung volumes
Pain & anxiety
Hyperresonant percussion note
Diminished breath sounds
tracheal shift
increased chest diameter on the affected side
CXR findings for pneumothorax
increased translucency on the affected side (avascular-no vascular markings)
mediastinal shift to the unaffected side
depressed diaphragm
lung collapse
atelectasis
Pneumothorax management
bed rest for small pneumothorax (<20%). Resportion of gas occurs in 30 days
Needle aspiration
Chest tube-inserted in the 2nd midclavicular space for air & inserted in the 6th midaxillary space for fluid
Oxygen