Chest trauma and restrictive respiratory Flashcards
define pneumothorax
presence of air in the pleural space resulting in complete or partial collapse of the lung
what is closed vs open pneumothorax
closed: no associated external wound
open: opening in chest wall (like trauma or injury)
define hemothorax
accumulation of blood in the intrapleural space
define chylothorax
presence of lymphatic fluid in the pleural space bc of leak in the thoracic duct
what dressing do you put on a open pneumothorax?
a dressing with a vented dressing (secured on 3 sides) to allow air to escape from the vent
define tension pneumothorax
pneumothorax with rapid accumulation of air in the pleural space
Beverly high inrapleural pressures
basically this is a medical emergency with both respiratory and card affected. pt can die from inadequate CO/hypoxemia
what are clinical manifestations of pneumothorax
1) no air in affect area. so auscultating is highly important
2) rapid shallow respirations
3) hyper-resonance
what are clinical manifestations of tension pneumothorax
1) trachea deviation to the unaffected side
2) the pt can go into cardiac arrest if the issue is not relieved. NO OTHER INTERVENTION WILL WORK OTHER THAN RELEASING THE AIR through needle decompression
discuss fractured ribs
- ribs 5-10 mostly common fractured bc they are less protected by the chest muscles
- pt will experience pain especially with inspiration at the site thus the pt might be reculant to take deep deep breaths which can lead to atelectasis
- usually use splints to help
discuss flail chest
multiple rib fractures causing instability of the chest wall
- affected flail are will move paradoxically to the intact portion of the chest during respiration. this movement prevents adequate ventilation
what are clinical manifestations of flail chest
crepitus of the rib (ribs will feel like rice crisps)
what does chest tubes and pleural drainage do? and know how to insert it and the positions pt need to be in and the chest tube machine**
remove air and fluid from the pleural space
what are some other tools use to drain the pleural area
1) heimlich valves
2) small chest tubes aka pigtail catheters
what are some nursing chest drainage managements?
1) keep tubing loosely coiled below chest level.
2) keep all connections between chest tubes, draining tubing, and drainage collection tight and tape at connections
3) observe for air fluctuations (tidalling) and bubbling in water seal chamber. if tidalling is observed then the drainage system is blocked, lungs are re-expanded, or the system is attached to suction
4) suspect a system leak when bubbling is continuos. if bubbling continues, theres an air leak or leak from the pt
how do you check for a leak?
momentarily clamp the tubing . if the bubbling stops then the leak is above the clamp
if it continues, notify MD
is a chest tube usually clamped or changed?
no it is not routinely clamped nor changed. physician order needed
what is the chest tube complications?
malposition is the most common complication.
- observe for tidalling
-ausultate breath sounds
-measure amount of draining
which cancer is the most preventable?
lung cancer (smocking cessation)
where does cancer originate?
the epithelium of the bronchus and grows slowly (8-10 years to reach 1cm in size)
what surgeries are used?
1) thoracotomy - always results in 1-2 chest tubes
2) video-assisted thoracoscopic surgery - may or may not require chest tube
3) lobectomy - remove one lobe
4) pneumonectomy - remove entire lung
5) segmental resection - remove segments of lungs
define restrictive respiratory disorders
characterized by a restriction in lung volume caused by decrease of lungs or chest wall
define pleural effusion
a collection of fluid in pleural space
1) transudative pleural effusion - non-inflammatory conditions
2) exudate pleural effusion - from are of inflammation
3) empyema - pleural effusion that contains pus
type of effusion is determined by thoracentesis (removal of the fluid in the pleural space)
what’s the max draining when doing thoracentesis?
1000 - 1200 mL at one time
discuss pleurisy
inflammation of the pleura usually caused by pneumonia, tb or chest trauma
discuss atelectasis
complete or partial collapse of lung or segment of lung that occurs when the alveoli become deflated
discuss interstitial lung disease
pulmonary inflammation and fibrosis
occupational and environmental exposures are the MOST COMMON cause.
develops into 2:
1) idiopathic pulmonary fibrosis: scar tissue in the connective tissue of the lungs due to inflammation or irritation
2) sarcoidosis: chronic multi-systen granulomtous disease of unknown cause
what will you hear with pulmonary edema
crackles
define pulmonary embolism
blockage of pulmonary artery by a thrombus, fat or air embolus.
embolus travels through vessels until it lodges and obstructs perfusion of the alveoli
what are clinical manifestations of pulmonary embolism
1) pain on inspiration
2) crackles
3) hypoxemia and LOW PaCO2
discuss complication of pulmonary embolism
death of the lung tissue aka pulmonary infarction and pulmonary hypertension
what testing tools are used for diagnostic pulmonary embolism?
D-dimer (using dye)
Spiral CT scan
what are some care for pulmonary embolism
prevent PE with venous thromboembolism prophylaxis and use incentive spirometer
medications: fibrolytic and anticoagulative medications.
what is the blood work for pulmonary edema?
aPTT - how long it takes blood to slow
if it is:
low - quick clotting
normal - 25-25 seconds
high - longer time to clot
