chest trauma and chest tubes

Question 1

pleural effusion
what it is
causes
s/s
diagnosis
tx

Answer 1

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

Question 2

thoracentesis

Answer 2

large bore needle inserted into pleural space to collect specimen or remvoe fluid

position pt upright, leaning over bedside table

local anesthetic

bedside procedure

Question 3

lung cancer
risk factor
how we classify it

Answer 3

leading cause of cancer deaths in us

risk factors:
smoking
genetic
exposure

classification: staging (tumor/node/metastasis)

Question 4

lung cancer
s/s
diagnosis
tx

Answer 4

cough (hemoptysis)
dyspnea
pleural effusion
pain
resp infection
weight loss/fatigue/anorexia

diagnosis: brochoscopy, biopsy, CT/CXR, PET scan

tx: chemo/radiation, immunotherapy, surgery

Question 5

bronchoscopy
what it is
what you collect
what you get and have to be for it

Answer 5

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

Question 6

chest surgery

Answer 6

wedge resection: small, local region

lobectomy: remove 1 lobe

pneumonectomy: removal of lung

VATS: (video assisted thoracic surgery)

Question 7

chest surgery postop care

Answer 7

pain management

chest tube management

monitor respiratory function, incision, I/O, VTE risk

Question 8

lung cancer nurse management

Answer 8

breathing issues:
oxygen
bronchodilator
pulmonary rehab

fatigue

psych

Question 9

chest trauma

Answer 9

assess ABC
airway, neck veins, breathing, signs of resp distress, bursing

signs of hemmorrhage

Question 10

fractured ribs
most common ribs
what to look out for
s/s
diagnosis
tx ***

Answer 10

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

Question 11

flail chest ***

Answer 11

floating ribs
paradoxical movements
crepitus
resp distress

Question 12

pneumothorax
what it is and what happens to pressure
types ***

Answer 12

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

Question 13

pnemothorax s/s ***

Answer 13

dyspnea
mild tachycardia
resp distress
asymmetrical chestrise
absent breath sounds on effected side
tracheal deviation

Question 14

pneumothorax management ***

Answer 14

chest tube insertion to drain air/blood

tension pnemo : immediate needle decompression
insert 14-18G needle into 2nd or 3rd intercostal space MCL

Question 15

hemothroax
what it is
tx options
what to monitor ***

Answer 15

blood in pleural space

chest tube placement

may require surgery

may replace blood loss (autotransfusion)

monitor Hgb/Hct, chest tube drainage, signs of hypovolemia

Question 16

chest tube and pleural drainage
what it is
safety needs at bedside ***

Answer 16

attached to a drainage system
sutured into place and occlusive dressing applied

needs:
hemostat (clamp)
sterile water
petroleum gauze

Question 17

drainage systems
different chambers ***

Answer 17

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

Question 18

collection chamber
marking
if full
when to notify MD
drainage change
where to place device ***

Answer 18

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

Question 19

water seal chamber
how much water and what if too high or low
tidaling
intermittent bubbling
continous bubbling***

Answer 19

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)

Question 20

suction control chamber
types
suction amount: too high too low ***

Answer 20

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

Question 21

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) ***

Answer 21

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)

Question 22

suction control chamber: DRY ***

Answer 22

can get higher than wet
use dial to change suction

cennect to wall and tun on wall dial

Question 23

chest tube interventions ***

Answer 23

assess and document drainage color/amount

assses VS, resp status

encourage amulation, TCDB, IS
position: semi or high fowler

pain management

promote chest drainage

Question 24

air leaks
assess
interventions
if bubbling stops***

Answer 24

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

Question 25

complications
accidental removal of chest tube from pt or
disconnection tube from drainage system ***

Answer 25

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

Question 26

complications
obstruftion and disconnection
what to check
interventions
what not to do***

Answer 26

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

Question 27

complications
subcutaneous emphysema
what it is
s/s
interventions ***

Answer 27

collection of air in tissue around insertion site

s/s:crackling on palpation (bubble wrap)

interventions:
report to HCP
monitor for changes (mark it)

Question 28

chest tube removal
what to do before
who removes it
supplies needed
assess for
CXR ***

Answer 28

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)