chest trauma and chest tubes Flashcards
pleural effusion
what it is
causes
s/s
diagnosis
tx
fluid in pleural space
causes:
fluid volume excess, pneumonia, cncer/tumor
s/s: ↓breath sounds, dull percussion, respiratory distress, chest pain, SOA
diagnosis: CXR
tx: thoracentesis, diuretics, chest tube
thoracentesis
large bore needle inserted into pleural space to collect specimen or remvoe fluid
position pt upright, leaning over bedside table
local anesthetic
bedside procedure
lung cancer
risk factor
how we classify it
leading cause of cancer deaths in us
risk factors:
smoking
genetic
exposure
classification: staging (tumor/node/metastasis)
lung cancer
s/s
diagnosis
tx
cough (hemoptysis)
dyspnea
pleural effusion
pain
resp infection
weight loss/fatigue/anorexia
diagnosis: brochoscopy, biopsy, CT/CXR, PET scan
tx: chemo/radiation, immunotherapy, surgery
bronchoscopy
what it is
what you collect
what you get and have to be for it
fiberoptic scope to visualize bronchi
inserted thru nose or mouth
collect specimens for biopsy
sputum cx
suction mucous plugs
stent placment
NPO for 6-12 hours
moderate sedation
pt given topical anesthetic
keep npo until gag reflex returns
chest surgery
wedge resection: small, local region
lobectomy: remove 1 lobe
pneumonectomy: removal of lung
VATS: (video assisted thoracic surgery)
chest surgery postop care
pain management
chest tube management
monitor respiratory function, incision, I/O, VTE risk
lung cancer nurse management
breathing issues:
oxygen
bronchodilator
pulmonary rehab
fatigue
psych
chest trauma
assess ABC
airway, neck veins, breathing, signs of resp distress, bursing
signs of hemmorrhage
fractured ribs
most common ribs
what to look out for
s/s
diagnosis
tx ***
ribs 4-10 most common
watch out for liver/spleen laceration
s/s:
pain on inspiration
shallow respirations
guarding chest
clicking sounds during auscultation
diagnosis: CXR
tx: pain management
flail chest ***
floating ribs
paradoxical movements
crepitus
resp distress
pneumothorax
what it is and what happens to pressure
types ***
air enters the pleural cavity
(changes normal neg pressure to positive in pleural space)
lung collapses
types:
simple (spontaneous)
traumatic (trauma, procedure)
*may be open chest wound (sucking wound)
tension pnemo (emergency)
air is trapped and pos pressure increase with every breath
mediastinal sift occurs
pnemothorax s/s ***
dyspnea
mild tachycardia
resp distress
asymmetrical chestrise
absent breath sounds on effected side
tracheal deviation
pneumothorax management ***
chest tube insertion to drain air/blood
tension pnemo : immediate needle decompression
insert 14-18G needle into 2nd or 3rd intercostal space MCL
hemothroax
what it is
tx options
what to monitor ***
blood in pleural space
chest tube placement
may require surgery
may replace blood loss (autotransfusion)
monitor Hgb/Hct, chest tube drainage, signs of hypovolemia
chest tube and pleural drainage
what it is
safety needs at bedside ***
attached to a drainage system
sutured into place and occlusive dressing applied
needs:
hemostat (clamp)
sterile water
petroleum gauze
drainage systems
different chambers ***
collection/ drainage chamber:
receives fluid or air
same for wet and dry
suction control chamber:
applies suction
can be wet or dry system
water-seal chamber:
2cm of eater
acts as one way valve preventing air from going back to pt
same for wet and dry
collection chamber
marking
if full
when to notify MD
drainage change
where to place device ***
can mark date/time for drainage collected
if full have to change the device (we dont empty)
notify MD if significant bleeding:
* >200ml in first hour or >100ml/hr of drainage
driange should change from:
sanguinous to serosanguinous to serous
must be kept below level of pt chest
water seal chamber
how much water and what if too high or low
tidaling
intermittent bubbling
continous bubbling***
should always be at 2cm:
too low: allow air back into pt
too high: difficult for air to be let out of pt
tidaling is normal: up/down movement of water w/ breath
intermittent bubbling normal:
increase in bubbling is abnormal ( should decrease as pt ↑)
normal bubbling should occur on expiration
continuous bubbling ABNORMAL
indicates air lead (check tubing, insertion site)
suction control chamber
types
suction amount: too high too low ***
wet: sunction is determined by amount of water in the suction control chamber
dry: determined by a dial on drainage device
both will be connected to wall suction
suction amount ordered by HCP:
too high: damage lungs
too low: will not drain effectively
suction control chamber: wet
how suction works
how much to turn on wall suction
is continuous bubbling normal
how to increase suction
how to check amount of water (what to do) ***
amount of suction determined by amount of water in the chamber
connect to wall suction and turn dial on wall until GENTLE bubbling
continuous bubbling in that chamber is NORMAL
bubbling does not increase the suction (only adding water will) but bubbling is normal for wet
periodically check the amount of water (with suction turned off)
suction control chamber: DRY ***
can get higher than wet
use dial to change suction
cennect to wall and tun on wall dial
chest tube interventions ***
assess and document drainage color/amount
assses VS, resp status
encourage amulation, TCDB, IS
position: semi or high fowler
pain management
promote chest drainage
air leaks
assess
interventions
if bubbling stops***
assess bubbling in water seal chamber
continuous bubbling is always abnormal
check all connections
ensure dressing is occlusive
notfiy HCP if it is new or worsening
if bubbling stops:
problem is the system—or
pt lungs have fully expanded
complications
accidental removal of chest tube from pt or
disconnection tube from drainage system ***
removal of chest tube:
*cover insertion site with gloved hand and call for help
*cover with petroleum gauze with one side open
*call HCP monitor for respratory distress (risk for tension pneumo)
chest tube discconects from drainage system:
*insert end of tube into sterile water or sterile NS
*new tube will need to be places
complications
obstruftion and disconnection
what to check
interventions
what not to do***
check pt/tube postion
massage clots in tubing
may milk chest tube, start close to insertion site
NEVER strip the tubing
disconnect from drainage chamber
complications
subcutaneous emphysema
what it is
s/s
interventions ***
collection of air in tissue around insertion site
s/s:crackling on palpation (bubble wrap)
interventions:
report to HCP
monitor for changes (mark it)
chest tube removal
what to do before
who removes it
supplies needed
assess for
CXR ***
need to drain to gravity for 24 hours before removal
pretreat for pain
HCP removes it (nurse has to have training to do it)
supplies: petroleum jelly, dry gauze dressing
assess: wound, VS, Resp symptoms
CXR 30-60 min after removal
(make sure lungs have reexpanded)
