Chest Tubes and Tracheostomies

Question 1

does a endotracheal tube need a incision in the neck?

Answer 1

NO, and it is quick to insert

Question 2

What is a endotracheal tube used for?

Answer 2

it can be used for short-term mechanical ventilation,
and it’s useful for administering inhaled gases

Question 3

When Bryan’s family arrives, the nurse explains that the physician needed to insert a tracheostomy, and that
(compared to an endotracheal tube), a tracheostomy:
* Allows a client to be weaned from the ventilator sooner and more easily
* Presents a higher risk of ventilator-acquired pneumonia (VAP)
* Creates more difficulty for clients with eating and communicating
* Presents a higher risk of laryngeal injury

Answer 3

• Allows a client to be weaned from the ventilator sooner and more easily

Question 4

Is a tracheostomy tube or a endotracheal tube more secure?

Answer 4

tracheostomy tube

Question 5

What is the purpose of the pilot balloon

Answer 5

allows healthcare providers to easily see whether the tracheostomy cuff is inflated, just by looking.

Question 6

Why is having a inner canula helpful and how often is it changed?

Answer 6

• having an inner cannula that can be
  removed makes it much easier to clear the client’s airway.
• It is usually changed daily.

Question 7

What is the purpose of a obturator?

Answer 7

The obturator is used to initially insert the tracheostomy, then afterwards, it’s removed

Question 8

**Which of the following statements is correct about the tracheostomy cuff? **
* When the cuff is inflated, it keeps the inner cannula in place
* When the cuff is inflated, it helps to prevent aspiration of gastric contents into the client’s lungs
* The cuff should be inflated to a high pressure to maintain a tight seal in the trachea
* The cuff needs to be inflated while the client is being weaned from a ventilator

Answer 8

• When the cuff is inflated, it helps to prevent aspiration of gastric contents into the client’s lungs

Question 9

what is one of the first steps as a patient is getting weaned off their trach?

Answer 9

one of the first steps is to see if the client is able to
tolerate having the tracheostomy cuff deflated.

Question 10

When a client has a new tracheostomy, what are 5 ADDITIONAL safety equipment items that must kept at the bedside ?

Answer 10

1. replacement tracheostomy tubes,
2. an obturator
3. a spare inner cannula,
4. spare trach ties (or a trach collar),
5. equipment to replace the tracheostomy tube if it gets dislodged.

Question 11

**Which of the following findings meet the criteria on the IH Early Warning Signs poster, to call the doctor or the critical care outreach team? **
* Heart rate 110 beats/minute
* Oxygen saturation 91% with high-flow supplemental oxygen at 30%
* Respiratory rate 28 breaths/minute
* Drop in systolic blood pressure of 25 mm Hg below the client’s baseline

Answer 11

• Respiratory rate 28 breaths/minute

Question 12

NERDS indicates the signs of a a)…

Answer 12

a) local infection

Question 13

STONEES indicates the signs of a a)..

Answer 13

a) systemic infection, one that has extended deep into the tissues, or has spread throughout the body

Question 14

What is subcutaneous emphysema.

Answer 14

when air leaks
into the subcutaneous tissues around the tracheostomy.

Question 15

What are clinical manifestations of subcutaneous emphysema

Answer 15

swelling of the neck, or extending up into the jaw or down into the chest, and on palpation, the tissues can feel crackly,

Question 16

**Respiratory Therapist checks on Bryan and discovers that he’s experiencing mucous
plugging. This problem is caused by: **
* Respiratory infection (e.g. pneumonia) leads to the formation of muco-purulent plugs
* Lack of humidity in the inhaled air causes secretions to become thick and sticky
* Narrowing and plugging of the trachea is caused by over-inflation of the tracheostomy cuff
* Aspiration of gastric contents results in plugging of the airways

Answer 16

• Lack of humidity in the inhaled air causes secretions to become thick and sticky

Question 17

What are four complications that can occur with a tracheostomy

Answer 17

1. Trachea Stenosis
2. Tracheomalacia: trachea becomes weak and flaccid.
3. Granuloma formation
4. tracheoesophageal fistula: NG tube pushing on trach cuff can cause this or tools in surgery.

Question 18

How many times a day should routine tracheostomy care be done

Answer 18

twice a day

Question 19

Routine trach care includes what four things?

Answer 19

• cleansing around the tracheostomy site with sterile saline.
• Changing trach ties
• Changing dressing PRN
• Changing or cleaning the inner cannula

Question 20

How often should inner canulas be checked for patency?

Answer 20

Every 12 hours or more if needed

Question 21

How often should disposable and non-disposable inner canulas be changed or cleaned.

Answer 21

Every 24 hours

Question 22

**If a client with a tracheostomy has a weak, ineffective cough, thick secretions, restlessness, and a decreasing
oxygen saturation level, what intervention should the nurse implement?
**
* Change his tracheostomy dressing
* Deflate the cuff on his tracheostomy
* Suction his tracheostomy
* Administer supplemental oxygen via nasal prongs

Answer 22

• Suction his tracheostomy

Question 23

How many days does it typical take to wean a patient off a tracheostomy

Answer 23

2-7 days

Question 24

what are chest tubes used for?

Answer 24

Chest tubes are drainage tubes used to remove air or fluid from the chest cavity

Question 25

What are (6) indications for a chest tube

Answer 25

* Pneumothorax * Pleural effusion * Hemothorax * Empysema * chylothorax * thoracic – or chest – surgery

Question 26

**A nurse notices that a client with a chest tube is dyspneic and his trachea appears to be shifted to the left side of his neck. What problem should the nurse suspect? ** * Hemothorax * Air embolism * Pulmonary embolism * Tension pneumothorax

Answer 26

* Tension pneumothorax

Question 27

What does it mean if the fluid in the water seal chamber fluctuates with each breath? * The chest tube is functioning correctly * There is an obstruction in the chest tube * The client is developing subcutaneous emphysema * There is an air leak in the chest drainage system

Answer 27

* The chest tube is functioning correctly

Question 28

when a person has a chest tube, breath sounds may be a)... on one side, if the lung is partially collapsed.

Answer 28

a) decreased

Question 29

what are dependant loops?

Answer 29

Dependent loops are dips in the tubing that allow fluid to accumulate.

Question 30

What drainage devices are affected by dependant loops?

Answer 30

Pleur-Evac and P-Eggy Drains.

Question 31

**When would it be appropriate for the nurse to clamp the chest tube on a large, three-chamber drainage system? ** * To assess why tidaling has stopped in the water seal chamber * When changing the chest tube drainage system * When the client leaves the unit (e.g. for a diagnostic test) * When the client develops a tension pneumothorax

Answer 31

* When changing the chest tube drainage system

Question 32

When would it be appropiate to clamp a chest tube?

Answer 32

Looking for air leak, or if a doctor orders it overnight to see if the patient can tolerate not having one,.

Question 33

**A nurse teaches a client about appropriate positioning and mobility with a chest tube. Which statement indicates a misunderstanding that requires further education? ** * “I will keep the head of my bed elevated” * “I can lie on the side containing the chest tube” * “I will call the nurse for assistance before I get out of bed” * “I will be on bedrest until the chest tube comes out”

Answer 33

* “I will be on bedrest until the chest tube comes out”

Question 34

* What are the three spaces found in the thorax?

Answer 34

- The centrally located mediastinum - The right lung cavity - The left lung cavity

Question 35

* How much pleural fluid is produced in about 24 hours?

Answer 35

- 0.3mL/kg of body weight or about 25mL in the average weight of average person

Question 36

* What is the pressure in the pleural space during inhalation and exhalation?

Answer 36

- -8 cmH2O during inspiration. - -4 cmH2O during expiration.

Question 37

# DEFINE o Ventilation: o Respiration:

Answer 37

o Ventilation: the mechanical act of moving air into and out of the lungs. o Respiration: gas exchange across the alveolar-capillary membrane.

Question 38

* What is the name of the nerve that causes the diaphragm to contract?

Answer 38

- The phrenic nerve.

Question 39

* What are the characteristics of pleural pain?

Answer 39

- a sharp, stabbing pain during inspiration as the pleurae move

Question 40

# DEFINE o Open pneumothorax:

Answer 40

“sucking wound” If air enters the pleural space through traumatic penetration, leaving the pleural space open to the atmosphere.

Question 41

# DEFINE o Closed pneumothorax

Answer 41

air enters the pleural space through rupture of the lung and visceral pleura, but the chest wall remains intact

Question 42

# DEFINE o Spontaneous pneumothorax:

Answer 42

a patient may experience pneumothorax for no obvious reason

Question 43

What is a tension Pneumothorax?

Answer 43

air continues to leak into the pleural space with no means of escape = build-up of pressure in the pleural space.

Question 44

Why is a tension pneumothorax so dangerous?

Answer 44

the lung can completely collapse and the pressure can then be transmitted to the mediastinum.

Question 45

On auscultation of a tension pneumothorax how will lungs sound?

Answer 45

Breath sounds will be diminished or distant but not absent

Question 46

# define o Empyema:

Answer 46

an accumulation of pus in the pleural space, caused by pneumonia, lung abscess or contamination of the pleural cavity

Question 47

# DEFINE o Chylothorax:

Answer 47

: the accumulation of lymphatic fluid in the pleural space.

Question 48

# DEFINE o Cardiac tamponade:

Answer 48

Blood can collect between the pericardium and the heart, externally compressing the heart.

Question 49

* How much extra air or fluid can a person usually tolerate in their pleural space (if they don’t have underlying lung disease)?

Answer 49

less than 10% of the pleural space

Question 50

* What could cause diminished breath sounds on the side that a client has a chest tube?

Answer 50

re-accumulation of air or fluid in the pleural space.

Question 51

* What does it mean if the nurse finds that a client with a mediastinal chest tube has muffled heart sounds?

Answer 51

- sign of cardiac tamponade.

Question 52

* What causes re-expansion pulmonary edema?

Answer 52

- can occur after rapid expansion of a collapsed lung in patients with a pneumothorax or with evacuation of large volumes of pleural fluid

Question 53

* What can cause a vasovagal response in a client with a chest tube?

Answer 53

too-rapid removal of fluid.

Question 54

* What two conditions cause a transudative pleural effusion?

Answer 54

- **increased hydrostatic pressure **found in heart failure, which is the most common cause of pleural effusion. - **decreased oncotic pressure **(from hypoalbuminemia) found in chronic liver or renal disease.

Question 55

What colour is transudate fluid

Answer 55

clear or pale yellow | Low protein content

Question 56

* What conditions cause an exudative pleural effusion?

Answer 56

- results from the increased capillary permeability characteristic of the inflammatory reaction.

Question 57

What colour is Exudative fluid?

Answer 57

dark yellow or amber | High protein content

Question 58

* What is a trapped lung?

Answer 58

- occurs when the visceral pleura becomes encased with a fibrous peel or rind. - The fibrous peel causes severe pulmonary restriction.

Question 59

* What are the clinical manifestations of a pleural effusion?

Answer 59

- progressive dyspnea and decreased movement of the chest wall on the affected side. - absent or decreased breath sounds over the affected area.

Question 60

* What are the clinical manifestations of an empyema?

Answer 60

- Clinical manifestations will the same as pleural effusion with the addition of fever, night sweats, cough, and weight loss

Question 61

What treatment is done to allieve a pleural effusion?

Answer 61

thoracentesis

Question 62

* What does intermittent bubbling (or lack of bubbling) in the water seal chamber indicate?

Answer 62

- The presence of an air leak.

Question 63

# Abdomen and chest * What is the maximum amount of fluid that should be drained from the pleural space at one time?

Answer 63

- 1000 mL from your chest. - 2000 mL from your abdomen.

Question 64

* When should a cuffed tracheostomy tube be used?

Answer 64

- Short term mechanical ventilation, high flow oxygen and to prevent secretions like mucus and vomiting.

Question 65

* When should an uncuffed tracheostomy tube be used?

Answer 65

- Most common outside the hospital. - Long- term tracheostomy and during the tracheostomy tube weaning process.

Question 66

* Does a tracheostomy always need a dressing?

Answer 66

- Tracheostomy dressings may not be needed for well-established trach sites if the stoma is well healed and free from rash or redness

Question 67

* What type of tracheostomies have non-disposable inner cannulas?

Answer 67

- Cuffless tracheostomies.

Question 68

* What precautions should be used when suctioning a client’s tracheostomy?

Answer 68

- Limit suctioning time to no more than 15 seconds.