Chest Tube, Chest Trauma, Thoracic Surgery Flashcards
Lungs are surrounded by a thin tissue called the ______ which is a continuous membrane that folds over itself. ______ pleura lines the chest wall, visceral pleura (or ______ pleura) covers the lung. Normally there is a ______ in the pleural space which keeps them together and allows the lung to expand and contract.
PLEURA PARIETAL PULMONARY VACUUM The pleural space is a potential space that normally has only 5-15ml of pleural fluid.
Categories of traumatic thoracic injuries include ______ trauma (such as steering wheel to chest, seat belt injury, crush injury) and ______ trauma (such as gunshot or stab wound to chest)
BLUNT
PENETRATING
When air or fluid enters pleural space between parietal and visceral pleura the -4cmH20 pressure gradient that keeps lung against chest wall ______. This condition is called a ______ (air in space), ______ (blood in space).
DISAPPEARS
PNEUMOTHORAX
HEMOTHORAX
In a closed pneumothorax air enters through the ______ pleura and in a ______ pneumothorax air enters through the visceral pleura.
PARIETAL
OPEN
Standard Tx for thoracic conditions include ______ fluid & air as promptly as possible, ______ drained air & fluid from returning to the pleural space, and ______ negative pressure in the pleural space to re-expand the lung.
REMOVE
PREVENT
RESTORE
Thoracostomy (AKA chest tube) ______ depends on what it will drain.
SIZE
Fluid needs bigger tube than air
______ positive pressure from pt helps push air and fluid out of the chest (cough, valsalva maneuver).
EXPIRATORY
______ helps fluid drainage as long as the chest drainage system is BELOW THE LEVEL OF THE CHEST and there are NO KINKS OR DEPENDENT LOOPS.
GRAVITY
______ can improve the speed at which air and fluid are pulled from the chest, (but may also delay healing)
SUCTION
Collection chamber ______ fluid and air directly from pt. Fluid stays and ______ vents to next chamber. Surface is designed to write on and calibrated in ml. Measure every shift and PRN. Change entire unit only when full (holds 2000ml).
RECEIVES
AIR
Mark CT drainage immediately upon ______ of pt. Expect approximately ______ ml/hour post-op. View/mark amount every _______ hours until amount starts to slow down. Mark at end of every I&O period.
ARRIVAL
100 ML/HOUR
4 HOURS
The water seal chamber contains ______ cm of sterile water which acts as a one way valve. ______ is seen immediately after insertion as air is removed. If ______ this is an air leak. If intermittent during exhalation, coughing, sneezing, this is ______.
2 CM
BUBBLING
CONTINUOUS
NORMAL
______ is expected fluctuation that reflects pressures in pleural space. If this does not occur then it means there is an ______ or lungs expanded.
TIDALING
OBSTRUCTION
Monitoring for an air leak via water seal chamber (+1 to +5) provides a way to ______ the leak and monitor it over time to see if it is getting better or worse.
MEASURE
______ control chambers have wet and dry units. Wet units require the addition of ______ to the -20 cm mark for -20 cm H2O suction. Have someone ______ turn dial on suction source while watching the suction chamber. Want only ______ bubbling in wet suction chamber.
SUCTION
WATER
SLOWLY
GENTLE
CT to -20cm suction insertion involves pt in ______ position turned slightly to side. ______ ______ has been obtained. Pre______ (CT insertion hurts), Set up ______ container suction source and tubing for both wet and dry and add water to suction compartment if using wet suction. (Both require 2cm sterile water for water seal/air leak compartment.
SEMI-FOWLERS
INFORMED CONSENT
MEDICATE
DRAINAGE
After insertion to -20 suction the MD ______, places air tight dressing (______ gauze), CT tube ______ until connected to 6 foot long drainage tube then start suction
SUTURES
PETROLATUM
CLAMPED
After insertion to -20 suction and hooked up to suction ______ shows gentle bubbling and ______ indicator appears. VS & respiratory assessment every ______ hour X ______ then every ______ & PRN. Check & mark ______. Expect drainage with hemothorax and p thoracic surgery (Call if > ______ ml/hour). Palpate for ______ above and around CT site.
WET, DRY
Q1H X 4 THEN Q4H & PRN
OUTPUT
100 ML/HOUR
CREPITUS
Monitoring for an air leak involves checking for continuous bubbling in the ______ ______ chamber. If observed check if all connections are ______.
WATER SEAL
TIGHT
To fix an air leak start at CT ______ site. Cross clamp close to pt chest. If bubbling stops, the problem is ______ or the ______ in the CT are slightly exposed because tube isn’t in far enough. If bubbling doesn’t stop methodically move ______ down the drainage tubing one ______ at a time.
INSERTION
HOLES
CLAMP, CLAMP
Standard nursing management of CT includes no ______ loops, secure connections, drainage ______ and ______ at SOS and q4h, mark container, PRN and at EOS. Know how much to expect based on ______.
DEPENDANT
AMOUNT
COLOR
DIAGNOSIS
More standard nursing management includes checking ______ site for dry, occlusive, intact dressing. Check for ______ near site (AKA subcutaneous emphysema). Check for ______ and keep it under control. Check VS, LS, encourage use of ______ ______, coughing, splinting. OOB tid (take ______ off temporarily). Expect an ______ in drainage when pt gets OOB.
INSERTION
CREPITUS
PAIN
INCENTIVE SPIROMETER
SUCTION
INCREASE
Pre-CT removal. When CXR shows lung ______, no ______ in water seal. Fluid drainage
EXPANDED
TIDALING
LESS THAN 100 ML IN 24 HOURS
SUTURE
PETROLATUM
During CT removal have pt perform ______ ______ while CT is removed. Air tight ______ applied.
VALSALVA MANEUVER
DRESSING
Post CT removal obtain ______ later in shift or next morning. Auscultate lung sounds, check RR and O2sat every ______ hours and PRN. Watch for recurrent ______. Continue TCDB and use IS. Pain medication administration so patient will move.
CXR
FOUR
PNEUMOTHORAX
If PTX keeps happening p CT is clamped ______ can be performed which involves instilling sterile ______ in pleural space to create adhesions that keep the parietal and visceral pleura together.
PLEURODESIS
TALC
Mobile chest drains and one way valves have no ______ control chamber. Uses ______ one way valve. Smaller and lighter, chela, easy ambulation, can discharge home with drain.
SUCTION
MECHANICAL
Most common type of chest injury is ______ ______ (SS pain on inspiration, splinting, shallow breaths) that often results in ______ and then ______. Give pain medication and get patient to use ______ ______.
FRACTURED RIBS
ATELECTASIS
PNEUMONIA
INCENTIVE SPIROMETER
Multiple rib fractures cause ______ ______ that results in ______ chest wall movement (sinks in or bulges out c mediastinal shift to the uninjured side). Goal is adequate ______. No strapping or binding so stabilize with ______ ______ ventilation or intubation and mechanical ventilation.
FLAIL CHEST
PARADOXICAL
VENTILATION
POSITIVE PRESSURE
Blood in the pericardial sac is called ______ ______. It causes compression of myocardium because pericardium doesn’t stretch thus preventing the _______ from filling.
CARDIAC TAMPONADE
VENTRICLE
For a penetrating chest wound do not ______ the object until pt in a safe environment. Stabilize object with a ______ dressing. If no object stuck in pt cover the ______ wound with a ______ dressing secured on three sides.
REMOVE
BULKY
SUCKING
OCCLUSIVE
______ pneumothorax is a life threatening emergency that is at high risk with ______ patients because of the positive pressure that increases and compresses the other lung, reduces venous return, and decreases cardiac output.
TENSION
VENTILATOR
______ pneumothorax (SS severe dyspnea, cyanosis, air hunger, agitation, tracheal deviation away form affected side, crepitus, distended neck veins, decreased BP, shock) treatment is immediate needle ______ then CT insertion.
TENSION
DECOMPRESSION
Blood in the pleural space is known as a ______ and may or may not occur in conjunction with a ______.
HEMOTHORAX
PNEUMOTHORAX
Excess fluid in the space that surrounds the lungs is known as ______ ______. If the fluid is a milky white the condition is called ______ from the presence of lymphatic fluid in the space.
PLEURAL EFFUSION
CHYLOTHORAX
A ______ (removal of one lobe of lung) is most common lung surgery (for lung cancer, TB, fungal infections) that needs CT p surgery. Lung tissue expands to fill up space left by resected lobe.
LOBECTOMY
A ______ is the removal of an entire lung. Used for cancer (most common) when a lobectomy or segmental resection will not remove all diseased lung.
PNEUMONECTOMY
A ______ ______ is removal of one or more lung segments which is done to remove bronchovascular lung segment.
SEGMENTAL RESECTION
A ______ ______ is the removal of small, localized lesions that occupy only part of a segment making it the most conservative approach.
WEDGE RESECTION
A ______ is the removal of stripping of thick, fibrous membrane from visceral pleura that is indicative of empyema unresponsive to conservative management.
DECORTICATION
LVRS is _______ ______ ______ ______ that involves reducing lung volume by multiple wedge excisions or VATS.
LUNG VOLUME REDUCTION SURGERY
VATS is ______ ______ ______ ______ that is a technique with a rigid scope c a distal lens inserted into the pleura and image shown on a monitor screen that allows surgeon to manipulate instruments passed into the pleural space through separate small intercostal incisions.
VIDEO ASSISTED THORACIC SURGERY
Chest surgery standards for pre-op care include baseline data (CXR, ABG, PFT’s, labs), cardiac function PRN, Teaching of CT post-op, keeping pain controlled post-op so able to use IS, TCDB, ROM, move
Chest surgery standards for post-op care include in ICU, pain control, CT management, TCDB with IS, ROM, mobilize
Which side does patient lie on after a pneumonectomy?
ON OPERATIVE SIDE because???
