COPD/pneumothorax/chest drainage systems Flashcards
what is the main cause of COPD?
smoking
what two conditions compromise COPD?
chronic bronchitis/ emphysema
chronic bronchitis
excessive production of mucous in bronchi and presence of chronic productive cough for 3 months - 2 successive years
emphysema
hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowed airways, loss of lung elasticity
what is the most common cause of COPD exacerbations?
infection
clinical manifestations of COPD
cough, sputum production, dyspnea, smoker, decreased breath sounds, accessory muscle use, wheezes, hypoxemia, o2 sats less than 88%, polycythemia
complications of COPD
cor pulmonae (R side hypertrophy of heart), acute exacerbations and respiratory failure, depression, anxiety
collaborative care for COPD
- 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
nursing management of COPD - health promotion
- smoking cessation,
- exercise (pursed lip breathing),
- energy conservation strategies
- sexual activity
- sleep
types of pneumothorx
- 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
clinical manifestations of pneumothorax
tachycardia, dyspnea, respiratory distress (air hungry), decreased o2 sats, chest pain, mediastina displacement (shift to unaffected side)
collaborative care for pneumothorax
aspiration of pleural space, insert chest tube and connect to water-seal drainage
where do rib fractures commonly occur
ribs 5-10 (less protected)
treatment of rib fractures
anesthesia and nerve blocks
what can the symptoms of rib fractures lead to?
atelectasis
flail chest
multiple rib fractures causing chest instability - moves paradoxically preventing adequate ventilation
treatment of flail chest
o2 therapy, pain control, IV crystalloid admin
what influences a lung to collapse?
if intrapleural pressure becomes equal to atmospheric pressure
chest tube insertion procedure
- client sitting or lying down
- local anesthesia admin
- air and fluid removed with catheters, chest tube inserted
compartments of drainage system
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)
two types of suction control
wet and dry
nursing management
- 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
if tidaling doesn’t occur…
- tube is blocked or lung has re expanded
if bubbling increases…
there may be a leak in the tube
what manoeuvre do you use to remove a chest tube?
valsalva manœuvre (deep breath and bear down)
