COPD/pneumothorax/chest drainage systems

Question 1

what is the main cause of COPD?

Answer 1

smoking

Question 2

what two conditions compromise COPD?

Answer 2

chronic bronchitis/ emphysema

Question 3

chronic bronchitis

Answer 3

excessive production of mucous in bronchi and presence of chronic productive cough for 3 months - 2 successive years

Question 4

emphysema

Answer 4

hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowed airways, loss of lung elasticity

Question 5

what is the most common cause of COPD exacerbations?

Answer 5

infection

Question 6

clinical manifestations of COPD

Answer 6

cough, sputum production, dyspnea, smoker, decreased breath sounds, accessory muscle use, wheezes, hypoxemia, o2 sats less than 88%, polycythemia

Question 7

complications of COPD

Answer 7

cor pulmonae (R side hypertrophy of heart), acute exacerbations and respiratory failure, depression, anxiety

Question 8

collaborative care for COPD

Answer 8

• bronchodilators, smoking cessations, oral steroids, humidified o2 therapy (sats above 90%)
• pulmonary rehabilitation
• nutritional therapy - rest 30 mins before eating, bronchodilators before meals, high calorie high protein diet

Question 9

nursing management of COPD - health promotion

Answer 9

• smoking cessation,
• exercise (pursed lip breathing),
• energy conservation strategies
• sexual activity
• sleep

Question 10

types of pneumothorx

Answer 10

• closed: no associated external wound (mech vent.)
• open: sucking chest wound present
• tension: severe pressures in chest cavity (one way valve for air)
• hemothorax: accumulation of blood in pleural space
• chylothorax: lymph fluid in the pleural space

Question 11

clinical manifestations of pneumothorax

Answer 11

tachycardia, dyspnea, respiratory distress (air hungry), decreased o2 sats, chest pain, mediastina displacement (shift to unaffected side)

Question 12

collaborative care for pneumothorax

Answer 12

aspiration of pleural space, insert chest tube and connect to water-seal drainage

Question 13

where do rib fractures commonly occur

Answer 13

ribs 5-10 (less protected)

Question 14

treatment of rib fractures

Answer 14

anesthesia and nerve blocks

Question 15

what can the symptoms of rib fractures lead to?

Answer 15

atelectasis

Question 16

flail chest

Answer 16

multiple rib fractures causing chest instability - moves paradoxically preventing adequate ventilation

Question 17

treatment of flail chest

Answer 17

o2 therapy, pain control, IV crystalloid admin

Question 18

what influences a lung to collapse?

Answer 18

if intrapleural pressure becomes equal to atmospheric pressure

Question 19

chest tube insertion procedure

Answer 19

1. client sitting or lying down
2. local anesthesia admin
3. air and fluid removed with catheters, chest tube inserted

Question 20

compartments of drainage system

Answer 20

first comp. (collection chamber) - fluid collected from chest cavity
second com. (water-seal chamber) - air filtered through 2 cm of water (to avoid back flow)
third comp. (suction control chamber) - controlled suction to system (filled with 20 cm of water)

Question 21

two types of suction control

Answer 21

wet and dry

Question 22

nursing management

Answer 22

• keep tubing straight, all connection tight (taped??)
• add sterile water to suction control and water-seal chambers by adding sterile water
• mark time of measurement and fluid level
• never empty a drainage system (dispose of)
• encourage deep breathing

Question 23

if tidaling doesn’t occur…

Answer 23

• tube is blocked or lung has re expanded

Question 24

if bubbling increases…

Answer 24

there may be a leak in the tube

Question 25

what manoeuvre do you use to remove a chest tube?

Answer 25

valsalva manœuvre (deep breath and bear down)