Chest Tubes & Pulmonary Disorders

Question 0

Describe Kussmaul’s Breathing.

Answer 0

Air hunger - marked by increase in depth and rate of breathing.

Question 1

Define Cheyne-Stokes breathing.

Answer 1

Periodic breathing characterized by rhythmic waxing and waning of the depth of respirations.

Question 2

Define Rhonchi

Answer 2

Rhonchi - Low-pitched, coarse, loud, moaning/snoring sounds heard primarily on expiration, that arise from the large airways (i.e., trachea or bronchi).

Question 3

What is the implication of a chest drainage tube that is clamped, kinked or has pressure applied to it?

Answer 3

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.

Question 4

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?

Answer 4

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.

Question 5

Distinguish between the 3 following types of Pneumothoraxes:

1) Simple Pneumothorax
2) Traumatic Pneumothorax
3) Tension Pneumothorax

Answer 5

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) .

Question 6

Describe Subcutaneous Emphysema.

Answer 6

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.

Question 7

When is it ok to clamp the drainage tubing momentarily? What does clamping the tube put the patient at risk for?

Answer 7

1) When checking for air leaks
2) When changing the draining apparatus
* Clamping puts the patient at risk for a Tension Pneumothorax

Question 8

Differentiate between the 3 following terms:

1) Hemothorax
2) Hydrothorax
3) Empyema
4) Fibrothorax

Answer 8

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

Question 9

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

Answer 9

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

Question 10

Define Fremitus

Answer 10

Fremitus is a vocal vibration detected on palpation, it is often presenting patients with pneumonia.

Question 11

What is the difference between Hypoxia and Hypoxemia?

Answer 11

1) Hypoxia - Deceesed oxygen supply to the tissues.

2) Hypoxemia - Dcrease of oxygen content in arterial blood.

Question 12

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

Answer 12

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.

Question 13

What are the 5 mentioned complications of Severe Acute Asthma?

Answer 13

1) Rib fractures
2) Pneumothorax
3) Pneumomediastimun
4) Atelectasis
5) Pneumonia

Question 14

What is Pulsus Paradoxus?

Answer 14

Pulsus Paradoxus (a sign of Asthma) is an abnormally large decrease in systolic BP and pulse wave amplitude during inspiration.

Question 15

What types of Tx should the nurse administer to treat Acute Asthma?

Answer 15

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 ).

Question 16

Which Short-acting Bronchodilators are used to treat Asthma?

Answer 16

1) SABA - Albuterol, Levalbuterol, and Terbutaline

2) Cholinergic Antagonists - Atrovent

Question 17

Which Long-acting Bronchodilators are used to treat Asthma?

Answer 17

1) LABA - Salmeterol, Formeterol.
2) Leukotrine Modifiers - Singulair, Accolate, Zyflo
3) Mast Cell Stabalizers - Cromolyn Sodium Inhalation
4) Xanthines - Theophyline

Question 18

Which Corticosteroids are used to treat Asthma?

Answer 18

1) Long-term: Flovent Discus, Flonase, Pulmicort, Aerobid.

2) Short-term: Prednisone, Methlyprednisone

Question 19

What are the 3 most common identified causes of COPD?

Answer 19

1) Smoking
2) Primary Alpha-1 Antitrypsin deficiency (genetic disorder)
3) Recurrent infections

Question 20

What are the 6 main causes for a High Pressure Alarm on the Ventilator?

Answer 20

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

Question 21

What are the 2 main causes for a Low Pressure Alarm on the Ventilator?

Answer 21

1) Disconnection or leak in the ventilator or in the client’s airway cuff occurs.
2) The client stops spontaneous breathing

Question 22

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.

Answer 22

Describe the difference between Ventilation and Respiration?

Question 23

What is the difference between Hypoxemic Respiratory Failure and Hypercapneic Respiratory Failure?

Answer 23

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).

Question 24

Differentiate between the following ventilation modes:

1) Assist Control
2) Synchronized Intermittent Mandatory Ventilation
3) High Frequency Oscillation Ventilation
4) Pressure Support Ventilation

Answer 24

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.

Question 25

What are the indications for the use of PEEP on the ventilator?

Answer 25

1) to ⬆ PaO2 and FRC without compromising CO or causing pulmonary barotrauma.
2) To allow a reduction of FiO2 to non-toxic levels.

Question 26

What is Minute Volume and how is it calculated?

Answer 26

Minute Volume is the total amount of air (volume) inspired in a minute. MV = TV x RR

Question 27

Ventilator Associated Pneumonia (VAP) care includes which nursing interventions?

Answer 27

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 .

Question 28

Which two mentioned meds are used for paralyzing PTs on ventilators who are sedated?

Answer 28

1) Verconium

2) Atacurium

Question 29

Describe the 3 types of weaning ventilator methods?

Answer 29

1) Rapid Weaning - SIMV > CPAP > Extubation
2) AS > SIMV > CPAP > Extubation
3) AC > CPAP > AC > CPAP

Question 30

What are two main clinical manifestations of ADVANCED COPD.

Answer 30

1) Hyperinflated chest (barrel chest)

2) Flattened diaphragm

Question 31

In which types of patients are bronchodilators contraindicated?

Answer 31

1) PTs with hypersensitivity
2) PTs with PUD
3) PTs with cardiac disorders
4) PTs with hyperthyroidism
5) PTs with Siezure disorders