27 - Respiratory Flashcards by jessica quintos

Blunt Trauma

when chest stricks or is struck by an object
-external injury may appear minor but internal organs may be severely damaged
-rib + sternum can lacerate lung tissue

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Penetrating Trauma

foreign object impales or passes thru body tissues
-creates an open wound
-ex) gunshot, stab

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Flail Chest

fracture of 2 or more adjacent ribs in 2 or more places w loss of chest stability

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Flail Chest
Manifestations

paradoxical breathing
the flailed area is sucked in during inhale, + bulge out during exhale

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Pneumothorax

air entering the pleural cavity
-pleural cavity is normally neg,
-when air enters, becomes pos
-cause collapse of lung

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types of pneumothorax

OPEN> air enters thru opening in chest wall

CLOSED> no external wound

TENSION> air enters pleural space but cannot escape

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penetrating chest wound aka…

sucking chest wound
bc air enters pleural space thru chest wall during inspiration

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Tension Pneumothorax

air enters pleural space but cant escape
-mediastinum shifts towards unaffected side
»compresses good lung + heart
»medical emergency

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Tension Pneumothorax
manifestations

-severe dyspnea
-marked tachycardia
-tracheal deviation
-decr/absent breath sounds on affected side
-neck vein distention
-cyanosis
-profuse diaphoresis

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Hemothorax

accum of blood in pleural space fr injury to chest wall, diaphragm, lung, blood vssls, mediastinum
-can occur w pnmthrx

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Pneumothorax
emergency Tx

-vent dressing
-chest tube to water-seal drainage
-if object is still in place, do not remove> stabilize w bulky dressing
-thoracentesis

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____ pneumothorax is a medical emergency requiring urgent ________ followed by __________

tension;
needle decompression;
chest tube insertion to water-deal drainage

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vent dressing

occlusive dressing that is secured on 3 sides
INSPIRATION: neg pressure is created> dressing pulls against wound> prevents air fr entering

EXPIRATION: pressure rises> dressing is pushed out> air escapes thru wound under dressing

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repeated spontaneous thorax may need…

surgical tx w…
-partial pleurectomy
-stapling
-pleurodesis

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chest tube effects

-drain the pleural space
-re-establish neg pressure
-allow for proper lung expansion

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chest tube
sizes + purpose

about 20 in long

LARGE 36-40F: drain blood
MED 24-36F: drain fluid
SMALL 12-24: drain air

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chest tube
standard site for insertion

midaxillary

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flutter/heimlech valve

used to remove air fr pleural space

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drainage unit
3 compartments

1 Collection Chamber
2 Water-Seal Chamber
3 Suction Control Chamber

Drainage Unit
Collection Chamber

receives fluid + air fr pleural space
-fluid stays in chamber
-air moves on to 2nd compartment (water-seal chamber)

Drainage Unit
Water-Seal Chamber

contains 2 cm of water
»acts as one-way valve
»incoming air bubbles thru

Tidaling

fluctuation of water w/in water-seal chamber
»up+down reflects respiration
»as lung re-expands, tidaling should slow + eventually stops

if tidaling stops suddenly..

assess chest tube
-there might be an OCCLUSION

normal bubbling in water-seal chamber

-brisk bubbling when first applied
-intermittent bubbling during exhalation, cough, sneeze
-ceases when air leak is resolved

Drainage Unit Suction Control Chamber

applies suction to chest tube -regulated by amt of water in the chamber -normally -20cm -normal pressure needed for delicate tissue or older/frail

if chest tube becomes disconnected...

re-establish water-seal by immersing chest tube in sterile water

when can chest tubes be clamped?

-switching to new drain unit -checking for air leaks -no more than 10 secs?

if volume of 1-1.5L of fluids is removed rapidly...

following can occur: -reexpansion pulmo edema -severe hypotension

expected draining amt

<200mL in first hour <100mL after

Thoracotomy

surgical incision into chest -to gain access to heart, lungs, esophagus, thoracic aorta, or anterior spineT

Thoracentesis

aspiration of intrapleural fluid for dx or therapeutic purpose

Pulmonary Embolism

blockage of 1 or more pulmo arteries by a thrombus, air, fat, or tumor

most common site for PE

lower lobes

most PEs are derived from...

DVT

Saddle Embolus

large thrombus lodged at an arterial bifurcation

PE risk factord

-immobility -surgery (esp pelvic + lower extremity) -hx VTE -cancer -obesity -smoking -prolonged air travel -HF -pregnancy -clotting disorders

PE manifestation

varies depending on extent **dyspnea** -mild-mod hypoxemia -tachypnea -cough -chest pain -hemoptysis -crackles -wheezing -fever -tachycardia -syncope

PE complications

10% mortality -pulmo infarction -pulmo HTN >>>dilatn or hypertrophy of R ventricle

PE dx

-D-dimer -Spiral/Helical CT Scan -ventilation perfusion VQ Scan -ABG is important but not dx

Spiral/Helical CT Scan

-IV injection of contrast to view blood vssls

ventricular perfusion V./Q Scan

2 parts: 1 perfusion scanning : IV injection of radioisotope>scan pulmo circltn 2 ventricular scanning: inhalation of radioactive gas

PE nursing actions

-bedrest in semi-fowler -O2 therapy -maintain IV line -turning -coughing -deep breathing -incentive spirometry

PE drug therapy

-diuretics if HF -anticoag like heparin or lovenox, warfarin -fibrinolytics (tissue plasminogen activator tpa, or alteplase) -

PE surgery

-embolectomy

heparin... monitor...

aPTT, platelet

warfarin... monitor...

INR

anticoag for PE lasts for...

3 months indefinitely for recurrent