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N430 Flashcards > Chest Tube, Chest Trauma, Thoracic Surgery > Flashcards

Chest Tube, Chest Trauma, Thoracic Surgery Flashcards

1
Q

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.

A 
PLEURA
PARIETAL
PULMONARY
VACUUM
The pleural space is a potential space that normally has only 5-15ml of pleural fluid.
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2
Q

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)

A

BLUNT

PENETRATING

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3
Q

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).

A

DISAPPEARS

PNEUMOTHORAX

HEMOTHORAX

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4
Q

In a closed pneumothorax air enters through the ______ pleura and in a ______ pneumothorax air enters through the visceral pleura.

A

PARIETAL

OPEN

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5
Q

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.

A

REMOVE

PREVENT

RESTORE

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6
Q

Thoracostomy (AKA chest tube) ______ depends on what it will drain.

A

SIZE

Fluid needs bigger tube than air

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7
Q

______ positive pressure from pt helps push air and fluid out of the chest (cough, valsalva maneuver).

A

EXPIRATORY

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8
Q

______ 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.

A

GRAVITY

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9
Q

______ can improve the speed at which air and fluid are pulled from the chest, (but may also delay healing)

A

SUCTION

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10
Q

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).

A

RECEIVES

AIR

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11
Q

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.

A

ARRIVAL

100 ML/HOUR

4 HOURS

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12
Q

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 ______.

A

2 CM

BUBBLING

CONTINUOUS

NORMAL

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13
Q

______ is expected fluctuation that reflects pressures in pleural space. If this does not occur then it means there is an ______ or lungs expanded.

A

TIDALING

OBSTRUCTION

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14
Q

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.

A

MEASURE

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15
Q

______ 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.

A

SUCTION

WATER

SLOWLY

GENTLE

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16
Q

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.

A

SEMI-FOWLERS

INFORMED CONSENT

MEDICATE

DRAINAGE

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17
Q

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

A

SUTURES

PETROLATUM

CLAMPED

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18
Q

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.

A

WET, DRY

Q1H X 4 THEN Q4H & PRN

OUTPUT

100 ML/HOUR

CREPITUS

19
Q

Monitoring for an air leak involves checking for continuous bubbling in the ______ ______ chamber. If observed check if all connections are ______.

A

WATER SEAL

TIGHT

20
Q

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.

A

INSERTION

HOLES

CLAMP, CLAMP

21
Q

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 ______.

A

DEPENDANT

AMOUNT

COLOR

DIAGNOSIS

22
Q

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.

A

INSERTION

CREPITUS

PAIN

INCENTIVE SPIROMETER

SUCTION

INCREASE

23
Q

Pre-CT removal. When CXR shows lung ______, no ______ in water seal. Fluid drainage

A

EXPANDED

TIDALING

LESS THAN 100 ML IN 24 HOURS

SUTURE

PETROLATUM

24
Q

During CT removal have pt perform ______ ______ while CT is removed. Air tight ______ applied.

A

VALSALVA MANEUVER

DRESSING

25
Q

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.

A

CXR

FOUR

PNEUMOTHORAX

26
Q

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.

A

PLEURODESIS

TALC

27
Q

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.

A

SUCTION

MECHANICAL

28
Q

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 ______ ______.

A

FRACTURED RIBS

ATELECTASIS

PNEUMONIA

INCENTIVE SPIROMETER

29
Q

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.

A

FLAIL CHEST

PARADOXICAL

VENTILATION

POSITIVE PRESSURE

30
Q

Blood in the pericardial sac is called ______ ______. It causes compression of myocardium because pericardium doesn’t stretch thus preventing the _______ from filling.

A

CARDIAC TAMPONADE

VENTRICLE

31
Q

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.

A

REMOVE

BULKY

SUCKING

OCCLUSIVE

32
Q

______ 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.

A

TENSION

VENTILATOR

33
Q

______ 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.

A

TENSION

DECOMPRESSION

34
Q

Blood in the pleural space is known as a ______ and may or may not occur in conjunction with a ______.

A

HEMOTHORAX

PNEUMOTHORAX

35
Q

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.

A

PLEURAL EFFUSION

CHYLOTHORAX

36
Q

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.

A

LOBECTOMY

37
Q

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.

A

PNEUMONECTOMY

38
Q

A ______ ______ is removal of one or more lung segments which is done to remove bronchovascular lung segment.

A

SEGMENTAL RESECTION

39
Q

A ______ ______ is the removal of small, localized lesions that occupy only part of a segment making it the most conservative approach.

A

WEDGE RESECTION

40
Q

A ______ is the removal of stripping of thick, fibrous membrane from visceral pleura that is indicative of empyema unresponsive to conservative management.

A

DECORTICATION

41
Q

LVRS is _______ ______ ______ ______ that involves reducing lung volume by multiple wedge excisions or VATS.

A

LUNG VOLUME REDUCTION SURGERY

42
Q

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.

A

VIDEO ASSISTED THORACIC SURGERY

43
Q

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

A

Chest surgery standards for post-op care include in ICU, pain control, CT management, TCDB with IS, ROM, mobilize

44
Q

Which side does patient lie on after a pneumonectomy?

A

ON OPERATIVE SIDE because???

N430 Flashcards (7 decks)

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