Upgrade to remove ads
2432 - Respiratory Disorders and Chest Tubes
Terms in this set (107)
thin membrane around the lungs and inner walls of the chest (2 layers)
space between the two layers of pleura
Pleura that lines the inner chest wall and diaphragm
Pleura that lines the lung itself
Fluid that lines the pleural space
Two types of Trauma
Steering Wheel injury to chest: common related injuries
great vessel tears
Shoulder harness seat belt injury
Fractured clavicle, dislocated shoulder, rib fractures, pulmonary contusion, pericardial contusion, cardiac tamponade
Crush injury (heavy equipment, crushing the thorax)
Pneumothorax and hemopneumothorax, flail chest, great vessel tears and rupture, decreased blood return to heart with decreased cardiac output
Gunshot, stab wound to chest
Open pneumothorax, tension pneumothorax, hemopneumothorax, cardiac tamponade, esophageal damage, tracheal tear, great vessel tears
Open Pneumothorax: describe
Air enters pleural space through opening in the chest wall
Open Pneumothorax: also called
sucking chest wound
Open Pneumothorax: initial treatment
Cover the wound with occlusive dressing, secure on 3 sides to let air out but not in
Open Pneumothorax: what to do if caused by an object
If object that caused pneumothorax in place, do not remove it (MD to address)
Closed Pneumothorax: describe
No external wound
Closed Pneumothorax can include
smoking, male, family history
Closed pneumothorax can be caused by
trauma, laceration of puncture of the lung during subclavian central line insertion, esophageal rupture.
Tension Pneumothorax: can be caused by an
open or closed pneumothorax
Tension Pneumothorax: describe
pressure on the heart and great vessels
Tension Pneumothorax is a ______ medical emergency
true (ie: real real serious)
Tension Pneumothorax leads to
Decreased venous return, decreased cardiac output
Tension Pneumothorax: caused by
mechanical ventilation, clamped or blocked chest tube.
Tension Penumothorax: symptoms
2. chest pain
3. tracheal deviation
4. decreased or absent 5. breath sounds on affected side
6. neck vein distention
blood in the pleural space
blood and air in the pleural space
Pneumothorax: Signs and Symptoms
2. Shortness of breath
3. Respiratory distress
4. Oxygen desaturation
5. Chest pain
7. Absent breath sounds
Pneumothorax: Dx testing
1. Chest X-Ray, stat or routine; portable or not
2. CT Chest - for greater specificity, stat or routine
4. O2 Saturation: continuous pulse ox with audible alarm
ABG's: what it tells you
PaOs: pressure of O2
CO2: pressure of CO2
1. Needle decompression: emergent treatment, pull the air out
2. Thoracentesis: pull fluid out of pleural space
3. Chest tube placement: sterile, can be done at bedside or in surgery
4. Surgical treatment (if recurrent
What is the most common type of injury from blunt trauma?
Rib Fractures: which ribs most commonly injured?
What can fractured ribs damage?
pleura or lungs
MOI: acronym for
Mechanism of Injury
Fx Ribs: clinical manifestations
pain; splinting; rapid, shallow breaths; crepitus; signs/ symptoms of pneumothorax
Flail Chest: describe
1. Two or more fractured ribs
2. Two or more different places
3. Results in unstable, free-floating segment
4. Results in paradoxical respirations
Flail Chest: clinical manifestations
Decreased breath sounds
Unequal chest expansion
Incision into thorax to search for bleeding or damage
VATS - Video Assisted Thoracic Surgery
1. Minimally invasive approach to chest surgery
2. Shorter hospital stay, fewer complications
What type of surgeon does these procedures?
Pleural Effusion: describe
a collection of fluid in the pleural space
Normal levels of fluid in the pleural space
Pleural effusion is not a _____, but rather a ____ _____ _____.
sign of disease
Two types of Pleural Effusion
Transudative and Exudative
Transudative: not typically cause by
heart failure, liver disease, kidney disease
Exudative: ______ cause, usually _______ process
infections, pneumonia, cancer
A collection of purulent fluid in the pleural space
Empyema: can be caused by
infections of surgical wounds
Clinical Manifestations of Pleural Effusions
1. Shortness of breath
2. Pleuritic pain
3. Decreased breath sounds
4. Dullness on percussion
aspiration of intrapleural fluid
Thoracentesis: quantity taken out
usually not more than 1 liter
Thoracentesis: what to monitor for
What to be aware of when you see a pt with a Nasal Cannula
1. What is causing it's use? Don't treat as routine
2. Thorough skin assessment
Nasal Cannula: number of liters
Non-Rebreather: flow rate
Non-Rebreather is all about the ____
They are breathing from it so it must be inflated
What to think when you see a Non-rebreather
This is a major problem, what is the underlying cause, what are we doing to address it
Simple Facemask is not a
Venti Mask: what to think about
1. RT will be setting this up
2. It's important to know the specific design and the liter flow
What does a Venti Mask do?
Makes you able to give specific percentages of O2
Bag Valve Mask/Ambu Mask: what is it for?
Patient is not ventilating, so you need positive pressure ventilation - Code Blue
Inspiration: when the volume increases, the pressure inside _______
Pressure within the lungs is called __________ ______.
Phrenic nerve stimulus stops
This decreases the volume of the thoracic cavity
Lung volume decreases, intrapulmonary pressure increases.
If two areas of different pressure communicate, gas will move from the area of higher pressure to the area of lower pressure
What normally keeps the two pleura together and allow the lung to expand and contract?
vacuum (negative pressure) in the pleural space
The Pulmonary Pleura is also called the _______ _______.
What do you do when a pleural injury occurs?
1. Head of the Bed up (if not concerned about cervical injury)
2. Dx tests
3. Tx depends on severity
Other name for chest tubes:
Chest tubes come in different:
sizes, shapes, types of plastic, coated/non-coated
Higher tube placement indicates
Lower chest tubve placement indicates
hemo or hydro
Heimlich Valve: function
lets fluid move one way but not the other
Heimlich Valve: other name
one way flutter valve
Three functions of chest tube drainage devices
1. Allows air and fluid to leave the chest
2. Contains a one-way valve to prevent air & fluid returning to the chest
3. Designed so that the device is below the level of the chest tube for gravity drainage
Treatment goals for pleural injuries
1. Remove fluid & air as promptly as possible
2. Prevent drained air & fluid from returning to the pleural space
3. Restore negative pressure in the pleural space to re-expand the lung - this is why the tube stays in for awhile
Interventions for patients with chest tubes
1. No dependent loops
2. Oxygen therapy
3. Record output
5. ***IS and turn, cough, deep breathe
What is the first intervention when you come on shift for a patient with a chest tube?
1. Make sure previous shift recorded drainage amount and when
2. Get baseline amount of drainage to start recording
Chest Tubes: pertinent nursing problems
Ineffective airway clearance
Impaired gas exchange
What determines the amount of negative pressure that can be transmitted to the chest in a wet suction system?
The depth of the water in the suction bottle
NOT the reading on the vacuum regulator
How do you know that a wet suction system is working?
bubbles in the suction control chamber
Three ways in which a chest drainage system works
1. Expiratory positive pressure
3. Suction - if used
Expiratory positive pressure from the patient helps push air and fluid out of the chest (cough, Valsalva)
Gravity helps fluid drainage as long as the chest drainage system is below the level of the chest
Suction can improve the speed at which air and fluid are pulled from the chest
Is there water in a dry suction system?
What is the advantage of the dry suction system?
Can apply more suction
What does the dry suction system not have?
A Water filled suction control chamber, it has a dry one.
Water seal chamber
How do you know what level the water should be at?
Should the ball be fluctuating in this chamber?
What if it isn't?
Manufacturer will indicate it on the device itself.
Ball will fluctuate with breathing.
Air leak monitor
What does bubbling mean?
potential air leak within the system
What does bubbling in the water seal chamber indicate?
air leak in the system
What would cause an air leak?
Could be change in patient condition, worsening of pneumo
With a chest tube, they will often do a daily ______
Nursing Intervention for SubQ Emphysema
First thing: mark it and watch for progression
Chest Tube: Complications
Chest tube malposition
High Fluid in Water Seal Chamber: chest system may need to be vented
What is the most common chest tube complication?
What can happen when fluid is removed too fast?
If chest tube comes out?
1. Cover hole with dressing that is occluded on three sides
2. Call the doctor
What to notify MD for with chest tubes?
Increasing shortness of breath
Absence of breath sounds
What to do with full suction chamber?
place in biohazard container
Do not change collection device on client with an air leak without an order
When suction discontinued, must disconnect from suction, not just turn off
What to be aware of when you see a pt with a Nasal Cannula
What is a PleurX Catheter?
An at home pleural drainage system for recurrent pleural effusion that patient and family can use.
THIS SET IS OFTEN IN FOLDERS WITH...
2432 - Disaster
2432 - Burns
YOU MIGHT ALSO LIKE...
RNSG 2432 - Pleural injury
356: Chest Trauma and Thoracic Injuries Exam 1
OTHER SETS BY THIS CREATOR
RNSG 1412 - Infertility/ Contraception
PEDI 1412 - High Risk Neonate
1412 - Pregnancy-Related Complications
Complications of Post Partum - Study Cards
OTHER QUIZLET SETS
ESC 1000: Exam #3 Part 1
Accounting exam 4 Review
Philosophy Quiz 5