Chest Trauma and Chest Tubes Flashcards
What is a pneumthorax?
air trapped in the pleural space from a hole in the lung (collapsed lung)
What are clinical manifestations of a pneumothorax?
decreased movement of involved chest wall, diminished/absent breath sounds, hyperresonance on percussion
What is priority treatment for patients with a pneumothorax?
patients get a chest tube with flutter valve or chest drainage system if it is greater than 15-20%
What is a tension pneumothorax?
air in pleural space that does not escape which puts more pressure on organs
What are manifestations of a tension pneumothorax?
- cyanosis
- air hunger
- tracheal deviation away from the affected side to the good lung
What is the treatment for a tension pneumothorax?
a thoracentesis is performed where a needle is stuck in the pleural space to release air, this is not permanent so you keep doing it until patients gets a chest tube with drainage system
What is a hemothorax?
blood in the pleural space
What are the clinical manfiestations of a hemothorax?
- dullness of percussion because of blood rather than air
- decreased H&H
- possible shock
What is the main treatment for a hemothroax?
chest tube with drainage
What is a flail chest?
fracture of 2+ adjacent ribs in 2+ places with loss of chest wall stability
What are manifestations of a flail chest?
paradoxical movement of chest wall and respiratory distress
What is a flail chest commonly associated with?
hemothorax, pneumothorax, or a pulmonary contusion which is a chest bruise that starts swelling
What are treatment options for a flail chest?
- Give oxygen to maintain saturation
2. stabilize flail segment with positive pressure ventilation from either CPAP or BiPAP, intubation, or mechanical vent
What is the first compartment of the chest tube do?
receives fluid and air from pleural space. the fluid stays in this chamber and air vents to second
When should the physician be notified when assessing a chest tube?
70 mL/ hour= TOO MUCH so notify the provider
What is the second compartment of the chest tube do?
this is the water seal chamber where there is intermittent bubbling during exhalation.
water will rise during inspiration and fall with expiraiton
What does continuous bubbling indicate?
continuous bubbling indicates an air leak which is BAD
How can a nurse intervene to stop continuous bubbling in the second chamber?
clamp tubing starting closest to patient and work toward system. When bubbling stops, leak is above the clamp
What is the third compartment of the chest tube do?
it is used for suction control
What does the wet suction control do?
20 cm of water controls suctioning and the goal here is to see gentle bubbling
too much bubbling can indicate a leak and too little can indicate no suctioning occurring
What does the dry suction control do and how should it be increased?
visual alert to see if suction is working, and to increase, turn dial on the drainage system not the wall suction
What should the nurse do if the chest tube is pulled out?
cover insertion site with a 3 sided dressing gauze ASAP and only tape 3 sides, leaving one side open so that air can come outside of the unsealed side
What should the nurse do if the suction collection device is pulled out?
air can directly enter into the chest because this is an open chest tube so put the end in sterile water until it can be replaced
Where should the chest tube system be placed?
keep system below insertion site because it it is above, fluid and blood will flow back into the patient
What is the major complication of milking the tube?
do not strip/milk the tubes because it can cause barotrauma which is when the lung is pulled at because of the high pressure
