Chest Trauma/ Tubes Flashcards
Rib Fractures
- Nursing care: splint w/ pillow, IS, cough + deep breathing, pain meds
- Increase risk pneumonia b/c poor cough/deep breathing (pain)
Flail Chest
2x + adjacent rib fractures => chest wall/lung instability
* paradoxical chest movement
* horrible ventilation - medical emergency
NC: chest tube, analgesis, intubation
Ruptured Diaphragm
subtle injury - often missed
nonspecific symptoms: poor ventilation, bowel strangulation
* bowel sounds in lung fields
* medical emergency!!
Pneumothorax
air in pleural space => shrinks lung
s/s: asymmetric chest expanison, diminished/absent, breathe sounds, dsypnea, SOB, decrease pulses ox, very painful, tracheal deviation (late)
Spontaneous pneumo: increase same s/s
* tall, thin white males
Tension penumo: air in pleural space
* same s/s
* tracheal deviation towards unaffected side
Hemothorax: blood in pleural space
* could be tension too
* same s/s, maybe crackles
Chest Tubes
Purpose: remove air/fluid from pleural space -> reinforce lung expansion
* placed @ bedside - sedate, pain meds
- Collection chamber
- Water-seal chamber
- Water or Dry Suction Chamber
Chest Tubes
Nursing Care
-
collection chamber
* measure output freq
* clamp when changing container (after its full)
* hemo volume should subside over time ( should be < 100cc/hr after intial phase)
* chest tube remains lower than pt -
Water Seal Chamber (filled w/ blue fluid)
* maintain 2 cm of fluid in chamber
* monitor air leaking- tidaling = normal (expansion + relaxation present), no more tidaling …. no more air in pleural or check bubbling, no air in pleural - confirm w/ good physical assessment
- bubbling = not in right spot ( when pt not doing ananything), coughing may cause bubbling, determine where the leak is - equipment or w/i pt
-
Suction Chamber (Wet + Dry)
*dry suction - controls pnematic pull, usually @ -20, controlled, by the dial (dr.orders), No fulid in this chamber, less suction
* water suction- larger chamber, contains water that creates pneumatic pull ( dr. order for cm amount, usually about 20 cm) , ensure volumes remains constant
complications: dislodegemt: tape 3 side of dressing, or use occlusive dressing (vaseline)
disconnected: do not rettach -> submerge in sterile water, get new systems
Trauma
General
IV access, fluids, type + screen, preg status
Trauma
Primary Survey
- Airway
- Breathing + ventilation
- Circulation + Hemorrhage Control
- Disability + Neuro Status
- Exposure/ Environmental Control
Trauma
Secondary Survey
(AMPLE)
Allergies
Med, drug use
PMH
Last Meal
Events r/t injury (witness?)
Trauma Labs
ABG
CBC
CMP
Coags
Amylase/Lipase
Tox Screen
Preg Test
Urinalysis
Spinal Cord Injuries
Movement + Sensory Issues
Quadraplegia- cervical injury + higher (arms + legs)
Paraplegia- thoracic or lower injury (legs only)
Complete: complete disection of cord
* Will never regain movement/ sensation in affected limbs
Incomplete: cord not completely severed
* Possibilty of progression
* Some part of cord still intact
* ASIA scale to determine severity
Stable or unstable
* Little chance of becoming paralyzed (stable)
* Chance of paralyzing injury, log rolling + collars (unstable)
Complications:
Autonomic Dsyreflexia: w/ acute or chronic SCI
* inappropriate compensation to stimuli
* Tightens everything up - profound HTN
* HTN -> bounding HA, facial flushing, sweating
Care: reduce noxious stimuli
* empty bowel/bladder
* straighten sheets, turn pt
* no need to call Dr. unless interventions are unsuccessful
C4 increase - breahting probs
Primary Spinal Cord Injury
neuro damage @ movement of impact
Secondary Spinal Cord Injury
Complex biochemical processes, occurs w/i mins + can last days -> wks
(common w/ spinal swelling)
Solumedrol for cord swelling
Long term management for SCI
skin breakdown
DVT prophylaxis
bowel + bladder consideration
rehab
Manage neurogenic shock !
Abdominal Injuries
cardiac tamponade
* beck’s traid: distened neck vein, distant heart sounds, hypotn
thorough abd assessment- look for s/s for specific organ injuries
* cullen’s sign: belly button brusing
* Gray’s turner: flank brusing
* Kehr’s sign: clavicle pain w/ abd palpation - splenic rupture
* SubQ emphysema: colon, stomach
* Seat belt signs
Dx: FAST: focused assess: w/ sonography for trauma
* bedside abd US (will see clear organs or fluids (bleed))
Pelvic Fractures: risk for bladder issues, check for hematuria
Trauma Complications
Infection
Fat emboli
* risk for big bone fracture pts
* bone marrow emboli
* s/s: PE
Compartment Syndrome
* Increase pressure=> ischemia + necrosis
* s/s: disproportionate pain, numbness, diminished pulses = late
* Treat: faschiotomy
