Chest Tubes & Pulmonary Disorders Flashcards
Describe Kussmaul’s Breathing.
Air hunger - marked by increase in depth and rate of breathing.
Define Cheyne-Stokes breathing.
Periodic breathing characterized by rhythmic waxing and waning of the depth of respirations.
Define Rhonchi
Rhonchi - Low-pitched, coarse, loud, moaning/snoring sounds heard primarily on expiration, that arise from the large airways (i.e., trachea or bronchi).
What is the implication of a chest drainage tube that is clamped, kinked or has pressure applied to it?
Kinking, looping or pressure on the drainage tubing can produce back pressure, which may force fluid back into the pleural space or impede its drainage.
Fluctuation of the water level in the water seal chamber (aka tidaling) is normal during respiration (rises with inspiration and returns to Norma upon expiration), in which situations does tidaling stop?
1) When the lung has re-expanded
2) When the tubing is obstructed (by clots, fibrin or a kink)
3) When a loop of tubing hangs below the rest of the tubing
4) When motor or wall suction is not working properly.
Distinguish between the 3 following types of Pneumothoraxes:
1) Simple Pneumothorax
2) Traumatic Pneumothorax
3) Tension Pneumothorax
1) Simple Pneumothorax - When air enters the pleural space via a ruptured bleb or a bronchpleural fistula.
2) Traumatic Pneumothorax - When air enters the pleural space via chest wall wound or a laceration in the lung itself (air escapes from the the lungs and into the pleural space with each breath).
3) Tension Pneumothorax - When air enters the pleural space but cannot escape, causing tension on the lungs and collapsing it. This also causes the great vessels and the trachea to shift toward the unaffected side of the chest (mediastinal shift) .
Describe Subcutaneous Emphysema.
This is when air escapes into the tissue under skin takes on a misshapen, swelling and puffy appearance. It produces a crackling sound upon Palpation. It is usually self limiting as the air is absorbed spontaneously over time.
When is it ok to clamp the drainage tubing momentarily? What does clamping the tube put the patient at risk for?
1) When checking for air leaks
2) When changing the draining apparatus
* Clamping puts the patient at risk for a Tension Pneumothorax
Differentiate between the 3 following terms:
1) Hemothorax
2) Hydrothorax
3) Empyema
4) Fibrothorax
1) Hemothorax - Blood in the pleural space
2) Hydrothorax - Water in the pleural space
3) Empyema - Pus in the pleural space
4) Fibrothorax - Fibrosis of the pleural space surrounding the lung
What size tube is used and where is it placed (anatomically) in order to remove the following from the pleural space:
1) Air
2) Fluid
1) Air - 28 to 32 French chest tube place anteriorly in the 2nd intercostal space.
2) Fluid - 32 to 40 French chest tube placed mid-axillarily between the 7th and 8th intercostal space
Define Fremitus
Fremitus is a vocal vibration detected on palpation, it is often presenting patients with pneumonia.
What is the difference between Hypoxia and Hypoxemia?
1) Hypoxia - Deceesed oxygen supply to the tissues.
2) Hypoxemia - Dcrease of oxygen content in arterial blood.
What is the FiO2 available delivered to the patient at the following rates:
1) Room Air
2) 1L/min
3) 2L/min
4) 3L/min
5) 4L/min
6) 6L/min
1) Room Air - 21%
2) 1L/min - 24%
3) 2L/min - 28%
4) 3L/min - 32%
5) 4L/min - 36%
6) 5L/min - 40%
* Each additional liter of oxygen flow is approximately and addition of 4% FiO2.
What are the 5 mentioned complications of Severe Acute Asthma?
1) Rib fractures
2) Pneumothorax
3) Pneumomediastimun
4) Atelectasis
5) Pneumonia
What is Pulsus Paradoxus?
Pulsus Paradoxus (a sign of Asthma) is an abnormally large decrease in systolic BP and pulse wave amplitude during inspiration.
What types of Tx should the nurse administer to treat Acute Asthma?
1) Inhaled bronchodilators - SABA (2-4 puffs q20 mins)
2) IV or Oral steroids - Solumedrol or Decadrone (120-180
mg/day x 2days) then 60-80 x 3-4 days.
3) Single dose of Mg Sulfate IV - To induce bronchial smooth muscle relaxation (1.2 - 2g ).
Which Short-acting Bronchodilators are used to treat Asthma?
1) SABA - Albuterol, Levalbuterol, and Terbutaline
2) Cholinergic Antagonists - Atrovent
Which Long-acting Bronchodilators are used to treat Asthma?
1) LABA - Salmeterol, Formeterol.
2) Leukotrine Modifiers - Singulair, Accolate, Zyflo
3) Mast Cell Stabalizers - Cromolyn Sodium Inhalation
4) Xanthines - Theophyline
Which Corticosteroids are used to treat Asthma?
1) Long-term: Flovent Discus, Flonase, Pulmicort, Aerobid.
2) Short-term: Prednisone, Methlyprednisone
What are the 3 most common identified causes of COPD?
1) Smoking
2) Primary Alpha-1 Antitrypsin deficiency (genetic disorder)
3) Recurrent infections
What are the 6 main causes for a High Pressure Alarm on the Ventilator?
1) Increased secretions in airway
2) Wheezing or bronchospasms
3) Endotracheal tube is displaced
4) Ventilator tube is obstructed because of water or a kink in the tubing.
5) Client coughs, gags, or bites on the oral ETT
6) Client is anxious and fights the ventilator
What are the 2 main causes for a Low Pressure Alarm on the Ventilator?
1) Disconnection or leak in the ventilator or in the client’s airway cuff occurs.
2) The client stops spontaneous breathing
1) Ventilation - Movement of gasses in and out of the lungs.
2) Respiration - The exchange of gasses, via diffusion, between the alveoli and the blood.
Describe the difference between Ventilation and Respiration?
What is the difference between Hypoxemic Respiratory Failure and Hypercapneic Respiratory Failure?
1) Hypoxemic RF - Failure to oxygenate resulting in a PaO2 < 60mmHg on FiO2 > 60%. (Can be caused by RDS, pneumonia, Cardiogenic pulmonary edema, and PEs).
2) Hypercapneic RF - Failure to ventilate resulting in a PaCO2 > 50mmHg with pH of < 7.30 and no trend of improvement. (Can be caused by COPD, CNS depression, Cervical spinal cord injuries at C5 and above).
Differentiate between the following ventilation modes:
1) Assist Control
2) Synchronized Intermittent Mandatory Ventilation
3) High Frequency Oscillation Ventilation
4) Pressure Support Ventilation
1) Assist Control - Preset # or breaths (RR) are delivered. PT may trigger more ventilator breaths over. For PTs who cannot breathe on their own or are severely ill.
2) SIMV - Ventilator provides set rate and set TV or pressure. PT can breathe spontaneously between ventilator breaths at their own TV or pressure.
3) HFOV- Provides a RR of 250 to 900/min. No. Spontaneous breaths permitted. TV is very small, it is used for neonate’s and PTs with complete paralysis or sedation.
4) Pressure Support Ventilation - No ventilator breaths provided. Improveds Tav. Preset pressure to supplement the PT’s own spontaneous breath to ⬇ WOB. Can be used in combination with any mode that allows spontaneous breathing.
What are the indications for the use of PEEP on the ventilator?
1) to ⬆ PaO2 and FRC without compromising CO or causing pulmonary barotrauma.
2) To allow a reduction of FiO2 to non-toxic levels.
What is Minute Volume and how is it calculated?
Minute Volume is the total amount of air (volume) inspired in a minute. MV = TV x RR
Ventilator Associated Pneumonia (VAP) care includes which nursing interventions?
1) Daily oral care with Chlorohexadine
2) HOB elevated b/n 30-45 degrees
3) DVT prophylaxis
4) Peptic Ulcer Disease Prophylaxis
5) Daily sedation vacation and assessment of readiness to extubate .
Which two mentioned meds are used for paralyzing PTs on ventilators who are sedated?
1) Verconium
2) Atacurium
Describe the 3 types of weaning ventilator methods?
1) Rapid Weaning - SIMV > CPAP > Extubation
2) AS > SIMV > CPAP > Extubation
3) AC > CPAP > AC > CPAP
What are two main clinical manifestations of ADVANCED COPD.
1) Hyperinflated chest (barrel chest)
2) Flattened diaphragm
In which types of patients are bronchodilators contraindicated?
1) PTs with hypersensitivity
2) PTs with PUD
3) PTs with cardiac disorders
4) PTs with hyperthyroidism
5) PTs with Siezure disorders
