Exam #2

Question 1

Serum Electrolytes

Answer 1

1) potassium: 3.5-5.0
- ICF cation
- increased with poor kidney function
- imbalances cause cardiac issues

2) sodium: 135-145
- ECF Cation
- determines whether water is retained, excreted, or moved
- imbalances cause neuro problems

3) chloride: 96-106
- ECF anion
- works with soidum to maintain osmotic pressure
- increased with poor kidney function
- decreased with excessive vomiting and diarrhea

4) calcium: 8.6-10.2
- ionized calcium: 4.4-5.4 (calcium unbound to albumin)
- transmission of nerve impulses, heart and muscle contractions, blood clotting, formation of teeth and bone
- requires vit D for absorption

5) phosphate (PO4): 3.0-4.5
- balance is intertwined with calcium
- increased ca = decreased PO4
- decreased Ca = increased PO4

• • other tests:
• BUN 6-20: renal fxn, waste removal
• creatinine: 0.6-1.3, muscular breakdown waste
• total protein
• ablumin: liver function, oncotic pressure

Question 2

normal levels, magic 4

Answer 2

• potassium: 3.5-5 (4)
• chloride: 96-106 (104)
• sodium: 134-145 (140)
• PH: 7.35-7.45 (7.40)
• CO2: 35-45 (40)
• HCO3: 22-26 (24)
• hematocrit: normal is 3 x the hemoglobin

Question 3

osmolarity and osmolality

Answer 3

• indicates the water balance of the body
• serum osmo = 285-295
• 295 = hyperosmo = water deficit/concentrated
• urine osmo = 50-1200 (Avg 500-800)
• together are used to determine what is causing a sodium imbalance

Question 4

urine specific gravity

Answer 4

• measures the kidney’s ability to concentrate or dilute urine
• 1.003-1.030
• high is concentrated
• low is dilute or unable to concentrate
• kidney failure often causes a fixed specific gravity (1.010)

Question 5

fluid spacing

Answer 5

• first spacing: normal, balance between ICF and ECF
• second spacing: edema, fluid outside interstitial space
• third spacing: ascites, burn edema, massive amount of fluid shifts and hard to bring back into vessels (thoracentesis needed)

Question 6

IV fluids

Answer 6

• isotonic fluid: NS, D5W, LR - give to hypertonic pt
• hypertonic fluid: 3% NS, d10W - give to hypotonic pt
• hypotonic fluid: 1/2 NS - give to hypertonic pt
• plasma expanders: increase levels of albumin, bring fluid into vascular space and out of interstitial space

Question 7

gerontologic considerations

Answer 7

• percent of body weight made of water is decreased, ~45%, thin skin increased evaporation, lower GFR, lower creatinine clearance, loss of ability to concentrate urine and conserve water, decrease in renin and aldosterone, increase in ADH and ANP
• structural changes in the kidney and decreased renal blood flow
• loss of SQ tissue
• decrease in thirst mechanism
• musculoskeletal changes
• mental status changes
• incontinence

Question 8

ADH, ANP, Aldosterone

Answer 8

• aldosterone = retains sodium
• ADH = retains water
• ANP = secretes sodium

Question 9

F&E Imbalances

Answer 9

• can be life-threatening
• chornic renal and endocrine patients (can’t excrete waste properly and it builds up)
• patients taking medications that affect F&E balance
• TPN
• addisions
• cushings
• loop diuretic

Question 10

Fluid volume excess and deficit

Answer 10

• fluid volume excess
• causes: too much intake, renal failure (decreased urination), heart failure (edema), liver failure
• body compensates by supressing ADH to increase urine output to decrease BP and volume
• signs and symptoms: weight gain, edema, ascites, high BP, bounding pulses, crackles, JVD
• labs: low na and osmo, low sg, low HCT
• fluid volume deficit:
• causes: too little intake, NPO, diabetes, burns, wound drainage, sweating, diarrhea, vomiting, diuretics, hemorrhage, 3rd spacing
• body compensates by increasing thirst, releasing ADH, increasing aldosterone to decrease urine output and raise BP and volume
• S/S: weight loss, dry mucosa, low BP, tenting, elevated temp
• labs: high na and osmo, high specific gravity, high albumin, high CHT, high BUN

Question 11

sodium 135-145

Answer 11

• major ECF cation
• sodium level reflects the ratio of sodium to water
• regulated by kidneys, ADH, aldosterone
• GI tract absorbs sodium from food, expel sodium through urine and sweat
• imbalances are typically associated with fluid volume problems
• foods high in sodum: processed meats, condiments, dairy

Question 12

hypernatremia

Answer 12

• > 145
• water loss or sodium gain
• Hypovolemia: decreased total body weight and Na with a relatively greater decrease in TBW; GI losses, burns, osmotic diuresis, loop diuretics, infection
• hypervolemia: increased Na with normal or increased TBW; endocirine problems, too much salt intake, renal failure
• euvolemic: decreased TBW with near-normal total body Na: Diabetes insipitus, increased insensible loss
• hyperosmolarity: shift of water out of the cells leading to cellular dehydration (shrinking) and subseuqent brain injury
• neurologic issue or relates to what is causing the hypernatremia
• s/s = altereled mental status, lethargy, seizures, increased HR, decreased BP
• treatment: treat underlying cause, dieuretics, sodium restriction, seizure precautions
• treat underlying vuase, seizure precautions
• if pt has decreased water: treat with water replacement, give isotonic/hypotonic fluids
• ir pt has increased sodium: salt free IV fluids, diuretics, decreased sodium intake, isotonic/hypotonic fluids (D5W, 0.9% NS, LR, 45NS), give diuretics

Question 13

hyponatremia

Answer 13

• water excess or loss of sodium
• caused by hypervolemic: dilutional form of hyponatremia, occurs when there is an increase in total body water but a relatively smaller increase in total serium sodium = CHF, cirrhosis, renal failure
• caused by hypovolemic:loss of both salt and water = GI loss, 3rd spacing, diuretics, addisions disease, NG tube, diarrhea
• caused by euvolemic: dilutional form of hyponatremia, occurs when the total serium sodium is normal or near nomrla but the total body water is increased without clinically evident edema = SIADH, diuretics, hypothyroid, psychogenic polydipsia
• S/S: confusion, headaches, seizures, abd cramps, neuro issues
• TX: 3% NS (hypertonic solution, increases sodium content in vascular fluid); if fluid excess issue then give diuretics, fluid restriction; SIADH treatment with lithium or declomycin

Question 14

potassium 3.5-5.0

Answer 14

• major ICF cation
• sodium-potassium pump is a major controller
• moves into cells during formation of new tissues and leaves the cell during itssue death
• sourceo of potassium: diet
• primary rout of loss of potassium: kidneys
• foods with potassium: avocado, fish, banana, OJ, raisins, dried fruits, meat, milk, fruits, veggies, salt substitutes

Question 15

hyperkalemia

Answer 15

• increased cell excitability, takes less stimuli to excite, cellular action potential may discharge spontaneosly
• causes: kidney failure, salt or potassium supplements, cell destruction, acidosis, hypoxia, catabolic state, potassium-sparing diruetics, hemolyuzed blood, adrenal insufficiency
• can get false high iresutls if specimen not handleded properly
• S/S of increased serum K+ = diarrhea, abd cramping, nausesa
  Muscle weakness
  Urine, oliguria, anuria
  Respiratory distress
  Decreased cardiac contractility
  ECG canges
  Reflexes, hyperreflexia, areflexia
• ECG: flattened P wave, widening of QRS, peaked T wave
• TX: cardiac monitor, kayexelate, calcium gluconate (reverses cardiac membrane excitabikity), glucose and insulin IV (drives K+ back into the cell), Na BIcarb,

Question 16

hypokalemia

Answer 16

• decreased excitabikity of cells, esp in nerves and muscles making them less responsive to stimuli
• causes: vomiting, NG suction, diarrhea, medications, metabokic alkolosis, rapid cell building, insulin thearpy, low na, mag levelisl, stress
• S/S: dysrhythmias, weakness, N/V, paralytic ileus, constipation, low BP, weak pulse, muscle weakness and paralysis, increaed digoxin toxicity, diuresis
• ECG: impaired repolarization: peaked T wave, QRS prolonged, flattened T wave, emergence of U wave
• tx: cardiac monitor, food high in potassium (fruit juice, citrus fruits, dried fruits, abanas, nuts, veggies), watch for DIG TOXICITY, magnesium, potassium IV

Question 17

potassium administration

Answer 17

• must have urine output > 600ml/day
• never give IV push or undiluted
• must be on cardiac monitor
• assess IV site often
• give no more than 40 meq in a 50-100ml bolus
• run no faster than 20meq/hr
• give no more than 40 meq/l in IV maintenance fluids

Question 18

calcium 8.5-12.0

Answer 18

• stored in bones, but we need vit d to absorb it
• regulated by parathyroid hormone, calcitonin, vitamin D
• affects transmission of nerve impulses, heart and muscle contractions, blood clotting, forming of teeth and vone
• free ionized calcium vs bound attached to albumin
• calcium and phosphorous have an inverse relationship

Question 19

hypercalcemia

Answer 19

• causes: hyperparathyroidism, malignancy, vit D or calcium overdose, prolonged immobolization, renal failure, use of thiazide diuretics, ionized calcium can be high or low if acidotic and alkolytic
• S/S: reduces excitability of muscles and nerves = lethargy, confusion, depressed reflexes, severe muscle weakness, fractures, kidney stones, constipation, faster clotting times (Risk of DVT)
• TX: promotion of excretion of calcium with a diuretic, isotonic IV fluids (dilute the blood), drink 3000-4000ml/day, weight bearing activity (drives calcium into bone), bisphosphonates (inhibit osteoclasts break down), no antacids (have calcium), dialysis/cardiac monitoring

Question 20

hypocalcemia

Answer 20

• causes: removal of parathyroid gland, acute pancreatitis, multpiple blood transfusions, alkalosis, immobility, lactose intolerance, malabsorption syndromes, decreased vit d intake, renal failure, drugs, increased phosphorus, post menopausal women
• S/S: tetany, trousseay’s sign, chvostek’s sign, stridor, numbness/tingling around the mouth/extremities, cardiac symptoms, leg or foot cramps, abd cramps/diarrhea, possibly brittle bones
• TX: oral/IV calcium supplements, diet high in calcium (borccoli, dairy, spinach, with vit d supplements), very closely observe those who have had thyroid or neck surgery

Question 21

phosphate imbalances

Answer 21

• normal 3-4.5
• hyperphosphatemia: caused by renal failure, tumor lysis syndrome; S/S = calcium deposits in joints, skin, kidneys; TX = fix hypocalcemia
• hypophosphatemia: caused by malnutrition, malabsorptopn syndrome, alcohol abuse, too many antacids; S/S: CNS depression, confusion, muscle weakness, dysrhythmias, fractures; TX: neutra-phos, decrease calcium intake, IV phsophate, stop antacids and calcium supplements

Question 22

magnesium imbalances

Answer 22

• normal is 1.3-2.1
• hypermagnesemia: caused by increased intake (maalox) with chornic kidney disease; S/S: lethargy, n/v, loss of deep tendon reflexes, respiratory or cardiac arrests; TX: avoid magnesium-containing drugs, increased fluid intake, may need dialysis
• hypomagnesemia: caused by prolonged fasting or starvation, chornic alcoholism, diuretics; S/S: confusion, hyperactive DTRs, tremors, seizures, cardiac dysrhythmias; TX: oral supplements, increased green veggies, nuts, banannas, oranges, PB, chocolate, IV magnesium

Question 23

medications issues with F&E imbalances

Answer 23

• loop diuretics: cause a loss of potassium
• thiazide diuretics: potentiate digoin, cause loss of potassium
• potassium sparing diuretics: spironolactone, decreased clearance of digoxin and lithium, too much potassium could be harmful
• electrolytes: potassium is most common, have to have good urine output, should not exceed 40meq/L in IV fluids
• kayexelate: binds with potassium to remove it from the body, liquid or powder can be given as an enema, antacids can decease the effectivemenss of this med

Question 24

arterial blood gases

Answer 24

• PH 7.35-7.45
• CO2 45-35
• HCO3 22-26
• PaO2 80-100
• SaO2 95-100

Question 25

acidosis

Answer 25

• labs: low PH, low bicarb, high CO2, high K
• makes drugs ineffective
• decreases force of cardiac contraction
• decreases vascular response to catecholemines
• causes increased release of O2 molecule from Hgb

Question 26

respiratory acidosis

Answer 26

• CAUSE: retention of CO2, respiratory dression, inadequate chest expansion, airway obstruction, CNS depression
• TX: patent airway, oxygen, turn cough deep breath, semi-fowler’s postiion, suction, incentive spriometer, decreased use of sedatives, bronchodilators, ventiolator

Question 27

metabolic acidosis

Answer 27

• CAUSED: acide excess, acid retention, bicarb deficet
• TX: identify and treat cuased (DKA, seizures, renal failure, diarrhea, dehydration), insulin for DKA, IV fluids for dehydration, IV bicarb, antiemetics for vomiting, antidiarrheals

Question 28

anion gap

Answer 28

• 10-14 = presence of metabilic acidosis from loss of bicarb

- > 14 = metabolic acidosis with increased ketones or lactici acid

Question 29

alkalosis

Answer 29

• labs: low ca, low K, high PH, high bicarb, low CO2

- interferes with tissue oxygenation and normal neuromuscular function

Question 30

respiratory alkalosis

Answer 30

• CAUSE: loss of acids, hyperventilation, CNS stimulation, hypoxemia
• TX: breath into paper bag, oxygen rebreather mask, antianxiety meds, relaxation techniques, reduce stimulation, treat pain/fever

Question 31

metabolic alkalosis

Answer 31

• CAUSE: increased bicarbs, increased loss of acids
• TX: most difficult to treat and slow to resolve, antiemetics, fluids, diaxmox can stimulate bicarb excretion through kidneys, no antacids or IV bicarb

Question 32

how to answer acid/base questions

Answer 32

- identify metabolic problem first:
~ DKA or hihg glucose = acidosis
~ vomiting or NG suction = alkalosis
~ diuretics = alkalosis
- identify respiratory alkalosis next:
~ hyperventilation = alkalosis
- whatever is left is respiratory acidosis:
 too sedated, immobility, lung problems

Question 33

artificial airways

Answer 33

• endotracheal tube: inserted into trachea via nose or mouth, performed at bedside
• tracheotomy: inserterd into trachea via a stoma in the neck, surgical procedures

Question 34

endotracheal tube ETT

Answer 34

• guide wire
• radio opaque line ( confirms placement with xray)
• depth markings
• cuff (seals air form leaking around the tube, keeps saliva from going into lungs)
• pilot balloon with 1 way valve (makes sure ETT in in place with balloon)
• universal adapter (connects to ventilator)
• adult size is usually 7-9mm

Question 35

ETT procedure

Answer 35

• obtain consent
• explain they will not be bale to speak
• have ambu bag, 02, suction, and IV access available
• remove pt dentures
• preoxygenate with 100% 02 for 3-5 minutes
• give premeds if not comatose
• monitor 02 sat throughout the procedures
• place supine with head extended and neck flexed
• each attempt should be less than 30 seconds
• watch for change in VS, hypoxia, dysrhythmias, aspiration

Question 36

after ETT intubation

Answer 36

• inflate the cuff and confirm placement with end titdal co2
• auscultate breathsounds
• observe for summetric movement

Question 37

nursing care for ETT pts

Answer 37

• maintain correct tube placement: check pilot balloon, check breath sounds q2-4 hrs
• maintain proper cuff inflation at 20-25mmhg: measure and records q 8 hours, perform mouth care and suction above cuff first
• monitor oxygentation and ventilation
• maintain tube patency: only suction if visible secretions, suspected aspiration, sudden onset of resp distress, closed suctioning (sterile with bag), open suctioning, adequately hydrate pt, no NS in ETT!
• provide oral care and maintain skin integrity: reposition tape q 24 hours, moisten lips q2-4, perform oral care 2 x day, change tubing q 24 hours, rinse equipment with NS after each use,

Question 38

mechanical ventilation

Answer 38

• goals: increase o2 and ventilation, decrease work of breathing
• indicated for: apnea, acute respiratory failure, severe hypoxia, res[iratory muscle fatigue, resp support after surgery, during anesthesia/heavy sedation

Question 39

types of mechanical ventilation

Answer 39

• negative pressure: noninvasive, doesnt require an artifical airway, involves chanbers that encase the chest or body, works by changing pressure within the chest cavity, used for pts at home with neuromuscular disease, CNS disesae, spinal cord injury
• positive pressure: most commonly used, pushes air into the lungs to expand the chest, different types

Question 40

ventilator settings

Answer 40

• trigger: what cuase the vent to deliver a breath
• tidal volume: volume the pt receives with each breath (controls CO2)
• rate: breaths per minute (controls CO2)
• RR x TV: minute ventilation (increased Minute vent = decreased CO2)
• FiO2: fraction of inspired O2
• sighs: volumes of air that are 1 1/2 - 2 times the set tidal colume, given 6-10 x hr
• flow: how fast the vent fives each breath
• tidal volume delivered slow long time for inhalation and less time for exhaladtion
• PIP: peak inspiratory pressure (how much pressure it takes to push air into lungs)
• PEEP: how much pressure in lungs after exhalation, keeps alveoli open

Question 41

Positive inspiratory pressure PIP

Answer 41

• peak is 25-30
• reading the pressure needed to deliver a set tidal volume, highest pressure reached during inspiration
• reflects changes in resistance of the lungs and the ventilator
• set high pressure alarms to prevent barotrauma

Question 42

positive end expiratory pressure PEEP

Answer 42

• positive pressure is applied during exhalation
• increases oxygenation by opening the alveoli
• used with ARDS and pulmonary edema
• usually at pressure of 5-15

Question 43

continuous positive airway pressure CPAP

Answer 43

• similar to PEEP, but the pressure is delivered continuously during spontaneous breathing
• commonly used to treat obstructive sleep apnea
• can be done invasively or noninvasively
• increases the WOB so be cautious in pts with CV compromise
• usually 5-15

Question 44

bilevel positive airway pressure BIPAP

Answer 44

• provides 2 levels of pressure support - higher inspiratory pressure and lower expieratory pressure along with oxygen
• non-invasive
• used with acute resp failure in pts with COPD and heart failure and sleep apnea
• can also be used after extubation
• easier to breath out than CPAP

Question 45

other ways to improve ventilation

Answer 45

• high frequency oscillatory ventilation - kids, ARDS
• nitric oxide: causes pulmonary vasodilation, ARDS
• prone positioning: used to improve oygenation with ARDS or acute lung injury
• extracorporeal membrane pxygenation: form cadiac bypass, used for severe respiraotry failure, used more in kids

Question 46

complications of mechanical ventilation

Answer 46

• CV: decreased CO and BP, fluid retention, hihg PEEP, RR, TV (leads to r sided HF), crackles, pulmomary htn
• pulmonary: barotrauma or volutrauama
• acid base imbalance if vent is set wrong
• alveolar hypoventilation or hypoventilation
• o2 txicity: high FIo2, causes free radicals that cause damage
• autopeep: air starts to stack up in lungs and doesnt come out correctly
• ventilator-associated pneumonia:
• psychosocial: unable to speak, eat, move, breath normal
• alarms, ventilator dependence

Question 47

acute respiratory failure

Answer 47

• no a disease but a symptom of an underlying pathology
• occurs when 02 and/or co2 can not be exchanged adequatly
• hypoxemia: decreased pa02 and sa02
• hypercapnia: icnreased paco2
• very impr to always assess clinical findings in the context of the patient’s baseline

Question 48

classification of respiratory failure

Answer 48

• hypoxemic: oxygenation failure

~ Pa02 45 and PH

Question 49

hypoxemic failure, pathophys

Answer 49

• oxygenation failure

- PaO2

Question 50

hypercapnic failure, pathophys

Answer 50

• ventilatory failure
• imbalance btw ventilatory supply and demand
• perfusion is normal but ventilation is inadequate
• thoracic pressure does not allow for enough air movement in/out of the lungs
• co2>45 in otherwise healthy lungs
• causes: airway and alveoli issues: asthma, COPD, CF; CNS: opioid overdose, CVA, severe head injury; chest wall problems: flair chest, kyphoscoliosis, morbid obesity; neuromuscular conditions: guillian barree, MD, MG, MS

Question 51

hypoxemia and hypoxia

Answer 51

• hypoxemia: pao2

Question 52

s/s hypoxemia and hypoxia

Answer 52

• rapid or slow RR

- pursed lip breathing: increases expiratory rate, increases breath off CO2, increases SP02

Question 53

resp nursing diagnoses

Answer 53

• impaired gas exchange
• ineffective airway clearance
• ineffective breathing pattern

Question 54

nursing care for resp issues

Answer 54

• o2 therapy
• mobilication of secretions
• positive pressure ventilation: helps decreased WOB, bipap or cpap

Question 55

drug therapy for resp issues

Answer 55

• relief of bronchospasm: short acting bronchodilators (albuterol) given with o2 q 15-30
• reduction of airway inflammation: IV corticosteroids (methylprednisolone)
• reduction of pulmonary congestion: IV diuretics, tridil for heart failure
• tx of pulmonary infection: abx (vanco, rocephin)
• reduction of anxiety, pain, agitation: propofol, ativan, versed, fentanly, morphine, vecuronium – give sedation vacations

Question 56

Acute respiratory distress syndrome ARDS

Answer 56

• sudden, progressive form of acute resp failure
• alveoli fill with fluid cuasing severe dyspnea, refractory hypoxemia, reduced lung compliance, pulmonary infiltrates
• mortality rates is high (50-60)
• most common casuse is sepsis

Question 57

ARDS pa02/fio2 ratio

Answer 57

• normal pa02/fi02 ratio = 85-100/.21 RA
• P/F ratio > 400 = normal
• Acute lung injury: p/f is 200-300
• ARDS: p/f is

Question 58

ARDS Phases

Answer 58

1) injury (exudative) phase
~ occurs 1-7 days after initial problem (any insult to the lung that can caused massive swelling and edema)
~ intrapulmonary shunt develops because the fluid filled alveoli no longer allows through the thin membrane the ability for 02/co2 exchange
~ surfactant no longer works causing atelectasis
~ necrotic cells, protein, and fibrin line the alveoli
~ hypoventilation, decreased CO, hypozemia
~ decreased lung compliance results in increased pt WOB
~ hypoxemia and stimulation of

2) reparative (proliferative) phase
~ occurs 1-2 weeks after initial problem
~ influx of monocytes, neutrophils, lymphocytes, and fibroblast proliferation
~ inflammatory process causes dense, fibrous tissue
~ pulmonary htn, worsening hypoxemia

3) fibrotic (chornic or late) phase
~ occurs 2-3 weeks after initial problem
~ diffuse scarring, fibrosis, continue hypoxemia
~ lung is completely remolded by collagenous/fibrous tissues
~ surface area for gas exchange is significantly reduced becauase the interstitum is fibrotic
~ pulm htn results from pulm vasc destruction and fibrosis

Question 59

ARDS S/S

Answer 59

• hypoxemia despite increased fi02 is hallmark symptom
• initial presentaiton is subtle
• mental status change
• tachypnea, retractions, tachy, diaphoresis, change in LOC, diffuse crackles
• PAWP is NOT increased
• profound resp distress as is progresses requiring intubation or PPV
• CXR with whiteout
• lung consolidation and infiltrates spread through out lungs leaving few recongnizable air spaces
• severe hypoxemia, hypercapnia, metabokic acidosis, manifestiation of target organ dysfunction will rapidly occur

Question 60

ARDS nursing care

Answer 60

• o2 therapy: keep it losest possible
• pos pressure ventilation
• positioning: prone
• continous lateral rotation therapy
• kinetic therapy

Question 61

chest trauma

Answer 61

• blunt: chest strikes or is stuck by an object - can cause deceleration, acceleration, shearing, compression, of thoracic fractures
• penetrating: open injury in which a foreign body impales or passes through the body tissues

Question 62

pneumothorax

Answer 62

• air in the pleural space causing a partial or complete collapse of the lung: increasing intrathoracic pressure and decreaing lung capacity
• caused by an injury to the chest wall or a hole in the lung
• causes complete or partal lung collapse: should be suspected after any blunt trauma
• air is coming in 2 ways: down the trachea and throug the hole in the chest wall, surface tension between the lung and the chest is interrupted
• if small then minor dyspnea and tachy
• if large then resp distress
• shallow, rapid respirations, dyspnea, air hunger, 02 hunger, dsats
• chest pain w or w/o cough, hemoptysis
• no breath sounds over the affected area
• CXR shows air/fluid in pleural space, reduction in lung volume
• if tracehal deviation occurs, emergency
• TX: if stable and small no tx needed, chest tube to water seal draining, pleurectomy, pleurodesis

Question 63

tension pneumothorax

Answer 63

• air enters but doesn’t leave the pleural space
• increased intrapleural pressure builds up so much that it stops the return of blood to the heart
• the good lung gets compressed when everything shifts to the unaffected side
• venous return decreases, cardiac o utput falls
• air can enter on inspiration but cannot escape
• S/S: dyspnea, tachy, tracheal deviation, decreased/absent breath sounds on affected side, neck vein distention, diaphoresis
• TX: open - cover with vented dressing open on one side

Question 64

types of pneumothorax

Answer 64

• tension
• open - opening in chest wall, stab, gunshot, vented dressing
• closed - no external wound, most common form is spontanous pneumothorax, with no apparent antecedent event
• hemothorax - blood in intrapleural space, cuased by chest trauma, lung malignancy, chest tube, water seal
• chylothorax - lymph fluid in pleural space due to leak in thoracic duct, milky white fluid high in lipids, 50% cases heal with conservative tx,
• pleurodosis - talc, doxycycline
• primary spontaneous pneumo
• secondary - copd, lung infection
• iatrogenic - caused by clincal issues, surgery

Question 65

flail chest

Answer 65

• occurs when there is a fracture of 2 or more ribs in 2 or more locations
• chest wall cant provide enough support for ventilation
• s/s: pardoxic chest movement, tachy, bruised chest, dyspnea, pain
• tx: o2, pain conrol, monitor abgs, intubation

Question 66

chest tubes

Answer 66

• drain placed in the pleural space, collection container below chest level, water seal,
• tube is placed depending on whether the problem is i with air or blood
• flutter valve is one way valve and opens for expiration
• insertion: have pt do the valsalva and exhale, dont let them talk or cough, help them stay stil and keep calm
• suction chamber, air chamber wiht water seal, fluids collection chamber
• tidaling: bubbles = leak

Question 67

chest tube parts

Answer 67

• drainage system has 3 chambers: tube from pt onnceted to collection chamber, 2nd chamber is water seal to prevent air form going back into pt, 3rd chamber is where suction is applied
• removal: give pain meds before 15 mins, have pt valsalva and bear down, immdeiately cover site with petroleum jelly dressing, obstain chest xray