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NRSG 200: Med Surg 3 > [Exam 3] Chapter 23 - -Management of Patients with Chest and Lower Respiratory Tract Disorders > Flashcards

[Exam 3] Chapter 23 - -Management of Patients with Chest and Lower Respiratory Tract Disorders Flashcards

1
Q

Pulmonary Edema: What is this?

A

The abnormal accumulation of fluid in the lung tissue and alveolar space or sometimes both.

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2
Q

Pulmonary Edema: How is gas exchange here?

A

Difficult , will be SOB.

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3
Q

Pulmonary Edema: Fluid build up makes it difficult for O2 to do what?

A

Crossover from alveoli to capillary, gas exchange is impaired

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4
Q

Pulmonary Edema: Cardiogenic is often related to what?

A

HF, with fluid backing up into the lungs

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5
Q

Pulmonary Edema Non-Cardiogenic: What causes this?

A

There has been damage to the capillary lining.

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6
Q

Pulmonary Edema Non-Cardiogenic: What can damage to capillary lining be from?

A

Can be direct injury or indirect injury.

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7
Q

Pulmonary Edema Non-Cardiogenic: Direct injury includes what?

A

Chest trauma , smoke inhalaiton, pulmonary infection, aspiration, anyhting thats directly injured to capillary lining around alveoli

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8
Q

Pulmonary Edema Non-Cardiogenic: What are some examples of indirect causes?

A

Sepsis, burns, pancreatitis, something that sets off inflammatory process.

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9
Q

Pulmonary Edema Non-Cardiogenic: What happens to the capillary when injury occurs?

A

It becomes more permeable, meaning proteins and fluids are going to leak into the intersitial space and push on alveoli.

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10
Q

Pulmonary Edema Non-Cardiogenic: What problems occur when fluid accumulates?

A

Causes repsiratory difficulties, we arent able to get adequate gas exchange, and see them require a lot of oxygen

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11
Q

Pulmonary Edema Non-Cardiogenic: How is this treated?

A

You need to manage whatever disease process is causing this issue. If sepsis, treat sepsis. If chest trauma, treat that first.

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12
Q

Pulmonary Edema Non-Cardiogenic: Treatment different between this and Cardiogenic?

A

They are the same. You are wanting to get fluid out of the lungs except Hypoxia may exist even though we are giving them O2.

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13
Q

Pulmonary Edema Non-Cardiogenic: What does PEEP help with?

A

Helps open up the collapsed alveoli to help with gas exchange. Sometimes high PEEP doesn’t help them oxygenate. See decreased Sat levels.

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14
Q

Pulmonary Edema Non-Cardiogenic: What usually is activated here to cause this?

A

Inflammatory process is activated and capillary linings become permeable. Also seen in those with low albumin.

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15
Q

Acute Respiratory Failure: When does this happen?

A

When the patients cannot ventilate . Aren’t able to do gas exchange and cannot get enough oxygenation.

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16
Q

Acute Respiratory Failure: ABG values for acute?

A

pH < 7.35
CO2 > 50
PaO2 < 50

Resembles respiratory acidosis

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17
Q

Acute Respiratory Failure: Why does respiratory acidosis occur?

A

Because ventilaiton is impaired so bad that gas exchange is impaired.

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18
Q

Acute Respiratory Failure: what signs of respiratory acidosis may they show?

A

May be restless, may be fatigued, may have headache , confused, lethargy.

Can’t get enough oxygenation.

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19
Q

Acute Respiratory Failure: Why may symptoms get worse?

A

May happen as their respiratory failure gets worse

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20
Q

Acute Respiratory Failure Tx: How can we treat this?

A

Fix the underlying condition.

If caused by COPD, manage COPD.

May require intubation or ventilation.

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21
Q

Patho of ARDS: What is this?

A

Severe inflammatory process where there’s alveolar damage that leads to pulmonary edema.

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22
Q

Patho of ARDS: How are their oxygen levels?

A

Are hypoxic and are unresponsive to increased oxygen levels and PEEP

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23
Q

Patho of ARDS: Mortality rate for those that go into ARDS?

A

26-58 percent

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24
Q

Patho of ARDS - Causes: THis includes what?

A

Same causes of non-cardiogenic pulmonary edema.

Pneumonia, Shock, Sepsis, Drug Overdose, Aspiration. Trauma. Acute Injury.

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25
Q

Patho of ARDS - Causes: What occurs immediately after acute lung injury?

A

Initiation of inflammatory-immune response

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26
Q

Patho of ARDS - Causes: What three changes occur in the inflammatory-immune response?

A
  1. Increased capillary membrane permeability
  2. Decreased Airway Diameter
  3. Injury to Pulmonary Vasculature
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27
Q

Patho of ARDS - Causes: What happens as capillary membranes have increased permeability?

A

Alveolar flooding with loss of surfactant leading to alveolar collapse

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28
Q

Patho of ARDS - Causes:What happens when there is a decrease in airway diameter?

A

Increase in airway resistance and decreased lung compliance leading to increased work of breathing and hypoxemia

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29
Q

Patho of ARDS - Causes:What happens when there is injury to the pulmonary vasculature?

A

Pulmonary vasoconstriction leading ot decreased cardiac output and alveolar dead space

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30
Q

ARDS - CMs: What will this resemble?

A

Pulmonary Edema

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31
Q

ARDS - CMs: What are some of the signs seen?

A

Rapid onset of dyspnea, not responsive to O2, infilrates, fluid showing on X-Ray, and crackles in lungs.

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32
Q

ARDS - CMs: Later on, what does this lead to?

A

Increased alveolar dead space , meaning alveoli isn’t fuctioning and it’s dead space. Lungs difficult to ventilate.

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33
Q

ARDS - CMs: What will we hear in lungs?

A

A lot of crackles throughout the lungs,

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34
Q

ARDS - CMs: What sign may we physically see with the patient?

A

Intercostal retractions, where patient is really struggling to breathe.

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35
Q

ARDS - CMs: How can you differeniate between HF and Lung Issues?

A

BNP

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36
Q

ARDS - CMs: If BNP is elevated, what does this show

A

Shows that the left ventricle is stretching and its a heart failure issue.

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37
Q

Mx of ARDS: Mx is similar to what?

A

Pulmonary Edema, and you have to treat whatever is causing it.

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38
Q

Mx of ARDS: WHy is PEEP useful?

A

Helps improve oxygenation and increases the fuctional residual capacity and really opens up the alveoli and helping prevent them from collapsing.

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39
Q

Mx of ARDS: How does the increased PEEP pressure in the thoracic cavity affect the heart?

A

Less room for heart to contract. CO usually decreases a long with blood pressure.

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40
Q

Mx of ARDS: As PEEP goes up, what happens to blood pressure?

A

May go down.

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41
Q

Mx of ARDS: What is the PaO2 usually kept at?

A

Above 60 because it is hard to oxygenate them and keep their SAT above 90.

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42
Q

Mx of ARDS - Nutritional Support: How will they receive this?

A

Through internal feedings.

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43
Q

Mx of ARDS - Pharmacologic Therapy: What treatment may be done?

A

Patients may be on neuromuscular blocking agents and paralytics just so they can accept the breath from the ventilator. Also sedated.

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44
Q

Mx of ARDS - Pharmacologic Therapy: What other medicatiosn will they be on if not paralyzed?

A

SEdatives or analgesic to help improve their ventilation.

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45
Q

Mx of ARDS - Pharmacologic Therapy: How does Nitric Oxide help?

A

Helps improve the VQ ratio, which is the ventilation to perfusion. Helps vasodilate and with oxygenation.

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46
Q

Mx of ARDS - Pharmacologic Therapy: What will they be given since blood pressure may be dropping?

A

May be put on vasopressors or inotropes or steroids that may help with inflammation

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47
Q

Mx of ARDS - General Supporitve Care: What is one of the most important things to do?

A

Frequent position changes . Usually prone position (abdomen and chest). because they can breathe better and expand lungs more fully.

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48
Q

Mx of ARDS - General Supporitve Care: Being in the prone position helps the lungs how?

A

Helps their lungs drain better as well as letting them get a better breath

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49
Q

Mx of ARDS - Ventilator Consideations: What does this mean?

A

It means patients may be fighting the ventilator and not accepting the breaths that the ventilators are giving them.

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50
Q

Mx of ARDS - Ventilator Consideations: What is a Roto-Prone Bed?

A

It flips them over and rotates them gently. Improves oxygenation and increases sat levels in ABG quickly.

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51
Q

Ventilation-Perfusion Ratios: What is the V here?

A

Alveolar Perfusion

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52
Q

Ventilation-Perfusion Ratios: What is the Q here?

A

Pulmonary Blood Flow

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53
Q

Ventilation-Perfusion Ratios: What is important to consider with ventilaiton and perfusion?

A

That we are achieving ideal O2 and CO2 exchange.

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54
Q

Ventilation-Perfusion Ratios: What is a VQ ration?

A

Ventilation-Perfusion Ratio

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55
Q

Ventilation-Perfusion Ratios: What can cause a change in VQ ratio?

A

When theres hypoxia.

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56
Q

Ventilation-Perfusion Ratios: What is an example of a 1:1 ratio Ventilation-Perfusion Ratios: for VQ ration?

A

When you have an equal amount of CO2 and O2 entering and exiting the body

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57
Q

Ventilation-Perfusion Ratios: What would occur if there were a shunt present?

A

Perfusion would exceed ventilation . Blood is going through there but there is a blocokage in alveolus. So no gas exchange occurs.

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58
Q

Ventilation-Perfusion Ratios: What are some examples of no gas exchange occurs because there is a blockage?

A

Pneumonia, Atelectsis, Mucuous Plug so no gas exchange occurs

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59
Q

Ventilation-Perfusion Ratios: What occurs when there is dead-space within the capillary?

A

Ventillation exceeds perfusion and the alveoli don’t have adequate blood supply for gas exchange to occur.

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60
Q

Ventilation-Perfusion Ratios: Example of there being more ventillation than perfusion so the body don’t have adequate blood supply?

A

Pulmonary Embolism , Cardiogenic Shock,

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61
Q

Ventilation-Perfusion Ratios: What is the silent unit?

A

There is a blockade in the alveoli and also a blockage in the blood flow. Absnece of ventilation perfusion

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62
Q

Ventilation-Perfusion Ratios: What would be some examples of when alveoli and blood flow is blocked

A

Pneumo, Severe Respiratory Distress

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63
Q

Ventilation-Perfusion Ratios: What is the goal with VQ Ratios?

A

We want an equal amount of CO2 and O2 to be exchanged.

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64
Q

How does PEEP affect the overall problem of ARDS?

A

Alveoli is normally closed with with PEEP, it improves:

Oxygenation
Increased Fuctional Residual Capacity
Reverse Alveolar Collapse

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65
Q

Review Questions - ARDS: How does PEEP reverse alveolar collapse?

A

Prevent collapse and open collapsed

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66
Q

Review Questions - ARDS: Why may systemic hypotension occur in patients with ARDS receiving PEEP?

A

Systemic hypotension may occur due to hypovolemia secondary to leakage of fluids into the intersitialspaces and depressed cardiac output from high levels of PEEP

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67
Q

Pulmonary Hypertension: What is this?

A

Increased vascular resistance thats caused by a congenital heart defect, portal hypertension, COPD/PE. Just increased pressure in lungs.

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68
Q

Pulmonary Hypertension CMs: What does this result in?

A

Dyspnea biggest sign, increased pulmonary artery pressure bc of increased pressure in lungs.

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69
Q

Pulmonary Hypertension Assess/Diagnostic Finding: What Diagnostics could tell us this?

A

From Increased PA Pressure from right-sided heart cath.

Decreased lung compliance,

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70
Q

Pulmonary Hypertension Medical Mx: How is this treated medication wise?

A

Smooth muscle relaxers like Viagra or Cilalis.

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71
Q

Pulmonary Hypertension Medical Mx: Paitents with severe pulmonary hypertension may see what issues?

A

It can cause heart issues and may see a lung transplant done. Even heart transplant as well.

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72
Q

Pulmonary Hypertension Medical Mx: What is the best way to help manage pulmonary hypertension?

A

Early diagnosing.

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73
Q

Pulmonary Hypertension Medical Mx: Pulmonary Hypertension causes what to hapen to blood vesssels?

A

Causes them to become constricted

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74
Q

Pulmonary Embolism: What is this?

A

This is a blockage in the lung artery that originated from venous system form right side of heart so gas exchange will be impaired. Could be absent in the area where blood clot is at.

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75
Q

Pulmonary Embolism: What is the patho of this?

A

Occurs when blood clots (emboli) become lodged in a lung artery , blocking blood flow to lung tissue

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76
Q

Pulmonary Embolism - RFs: What can cause us to be at risk?

A

Smoking, HF, Immobility, DVT, Sometimes people are more liekly for this. Afib.

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77
Q

Pulmonary Embolism - CMs: What signs will they have?

A

They will have dyspnea, chest pain, anxious, tachycardic, hemoptysis (coughing up of blood), they can;t breathe.

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78
Q

Pulmonary Embolism - Assessment/Diagnostics: What may initially be drawn?

A

D-Dimer, which shows potentially clots being formed.

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79
Q

Pulmonary Embolism - Assessment/Diagnostics: Why may a VQ scan be done?

A

Looks at ventilation and perfusion.

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80
Q

Pulmonary Embolism - Assessment/Diagnostics: What is most often does?

A

CTA, which is a chest CT. Looks at vessels within lungs and so it will show if there is a PE present.

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81
Q

Pulmonary Embolism - Assessment/Diagnostics: What is the last diagnostic that may be done?

A

Pulmonary Angiography, which is similar to heart cath. Catheter threaded up to see if there is a blockage within the lung.

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82
Q

Pulmonary Embolism - Prevention: What can be done to prevent this for hospital pts.

A

Patients can wear SCDs in hospital.

Lovenox injection

Anticoagulants. Reduce venous stasis.

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83
Q

Mx of PE - Pharmacologic Therapy: What must we do if someone is coming in with a present PE?

A

It is considered an emergency. We need to make sure patient is put on O2, NC, and IV is stated. Start EKG and draw labs and do CTA or VQ scan and manage anxieety.

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84
Q

Mx of PE - Pharmacologic Therapy: What will they be started on?

A

Anticoagulants and it could be Lovenox, heparin drip, or may be on a oral anticoagulant like eliquis, protaxa, or zeltoro.

85
Q

Mx of PE - Pharmacologic Therapy: What may be done if it is big?

A

May need to do thrombolytics TPA.

86
Q

Mx of PE - Pharmacologic Therapy: When wouldn’t you want to give a thrombolytic?

A

Contraindicated if those patients just recently had a CVA and were given a thrombolytic. If they’re already at a risk for bleeding.

87
Q

Mx of PE - Surgical Mx: What will this consist of?

A

Embolectomy, which is when they go in and remove the blood clot.

88
Q

Mx of PE - Surgical Mx: What is the EKos procedure?

A

They take a catheter and thread it up to where the blood clot is and just directly instill a thrombolytic to help dissolve the clot.

89
Q

Mx of PE - Surgical Mx: What is an IVC Filter?

A

Inferior Vena Cava Filter. Can be placed in the IVC that allows blood to pass through but collects any emboli that are coming from lower extremity to the pelvis area.

90
Q

Mx of PE - Nursing Mx: what is the number one thing we want to do?

A

Help reduce the risk of patient developing PE. Encourage them to walk, don’t cross legs because blood can pool.

91
Q

Mx of PE - Nursing Mx: What should we assess for?

A

DVTs, pain in the legs, monitor treatments that we have done .

92
Q

Mx of PE - Nursing Mx: What should we monitor for if we gave them a thrombolytic”?

A

Want to make sure we assess vital signs, keep on bed rest, avoid invasive procedures.

93
Q

Mx of PE - Nursing Mx: What can be done to continue to monitor them?

A

They won’t be sent to labs every 4 hours. They instead will have a line placed in them. so we can monitor them and draw blood

94
Q

Mx of PE - Nursing Mx: Blood will be drawn to assess for what?

A

INR and aPTT time.

95
Q

Mx of PE - Nursing Mx: What can we help with?

A

Help monitor their pain, monitor their respiratory rate, give them o2 as necessary

96
Q

Mx of PE - Nursing Mx: How can we promote breathing?

A

Making sure they use IS and deep breathing techniques

97
Q

Mx of PE - Nursing Mx: What is a big complication to monitor for?

A

Right sided heart failure.

98
Q

Mx of PE - Nursing Mx: What are some signs that the patient may have right sided ehart failure?

A

JVD, may be getting edematous,

99
Q

Mx of PE - Nursing Mx: If patient has right sided heart failure from this, what may they eventually have?

A

May eventually go into cardiogenic shock from that

100
Q

Mx of PE - Nursing Mx: Discharge education includes what?

A

If going home on anticoagulant, assess for signs of bleeding

If going home on warfarin , need ot have labs done to monitor if warfarin is being effective.

101
Q

Mx of PE - Nursing Mx: What will they teach the patients?

A

How to prevent a DVT from forming to prevent a PE from occuring again.

102
Q

Care of the Patient with Lung Cancer: What are the two major types of lung cancer

A

Small cell lung cancer and non-small lung cancer.

103
Q

Lung Cancer: How common is Small Cell?

A

15% of tumors

104
Q

Lung Cancer: Small cell is due to what?

A

Cigarette smoking

105
Q

Lung Cancer: How severe is small cell LC?

A

This is the most aggressive form of lung cancer

106
Q

Lung Cancer: What is the problem with small cell LC for treatment?

A

It often metastasizes so that is why chemo is most often the treatment that is done.

107
Q

Lung Cancer - Non Small Cell LC: How commonn is this?

A

Accounts for 85% of tumors

108
Q

Lung Cancer - Non Small Cell LC: Where is this usually located?

A

This is typically localized

109
Q

Lung Cancer - Non Small Cell LC: What is the treatment for this usually?

A

Surgery

110
Q

Lung Cancer - Risk Factors: What does this include?

A

Smoking, Secondhand Smoke, Environmental Exposure, Pollutants, Radon, Asbestos, Nickel, Oil, Radiation

111
Q

Lung Cancer - CMs: How will symptoms first be?

A

They will be asymptomatic until late

112
Q

Lung Cancer - CMs: What will be some of the first signs developed?

A

May develop cough, dyspnea, hemoptysis, pneumitis, respiratory infections that won’t go away, hoarseness, dysphagia.

113
Q

Lung Cancer - CMs: Where may this travel before this can be diagnosed?

A

May travel to the brain, bone, or liver before it can be diagnosed.

114
Q

Lung Cancer - Assessment/Diagnostic: How is this usually diagnosed?

A 
Chest X-Ray shows potential lesion
Chest CT
Broncoscope (Have a camera and will go down to visualize the bronchioles.)
Fine Needle Aspiration Biopsy
Wedge Biopsy  (Take Wedge of Tumor out)
115
Q

Lung Cancer - Assessment/Diagnostic: What will occur during a PET scan?

A

They go in to see if lung cancer is anywhere else within the body.

116
Q

Lung Cancer - Surgery: When is this preferred?

A

For the non-small cell lung cancer because its often localized.

117
Q

Lung Cancer - Radiation: What will this do?

A

Can reduce the tumor to make an inoperable tumor now operable. Also reduces symptoms of superior vena cava syndrome

118
Q

Lung Cancer - Radiation: What are some side effects of this?

A

May see esophagitis because tumor may be very close to esophagus

Pneumitis

Fatigue

119
Q

Lung Cancer - Chemotherapy: How will chemo impact these patients?

A

Will have GI SE like N/V, Stomatitis, Mucostitis,

120
Q

Lung Cancer - Chemotherapy: What type of patient will receive this?

A

Small cell LC patients because its more aggressive and metastasizes.

121
Q

Lung Cancer - Chemotherapy: What neurological changes may occur?

A

Chemo brain may occur.

122
Q

Lung Cancer - Chemotherapy: What SE can occur on Cardio Pulmonary side?

A

HF, Pulmonary Fibrosis.

123
Q

Lung Cancer - Chemotherapy: What is this doing to our cells?

A

Causing anemia, neutropenic, thrombocytopenia (more likely to bleed),

124
Q

Lung Cancer - Chemotherapy: What renal issues may occur?

A

Nephrotitis, Electrolyte Imbalance,

125
Q

Lung Cancer - Palliative Care: When is this done?

A

This is end of life care. Will occur near the end of the patient’s life.

126
Q

Lung Cancer - Palliative Care: What will occur during this?

A

Keeping patient comfortable for this last parts of their life.

127
Q

Nursing Care of Patient with Cancer - Mxing Symptoms: What symptoms may we have to manage?

A

Manage their pain, difficulty breathing,

128
Q

Nursing Care of Patient with Cancer - Mxing Symptoms: How can we relieve breathing problems?

A

Helping with airway clearance, may need these patients bronchodilators or supplemental O2.

129
Q

Nursing Care of Patient with Cancer - Mxing Symptoms: How can we reduce fatigue?

A

Making sure to cluster care together

130
Q

Nursing Care of Patient with Cancer - Mxing Symptoms: How can we provide psychological suppport?

A

Emotional Support

Managing Pain

131
Q

Chest Trauma - Blunt Trauma: Why is this difficult to identify?

A

Often times, the symptoms may be generalized or vague.

132
Q

Chest Trauma - Blunt Trauma: This is most often caused by what?

A

Motor vehicle crashes, falls, bicycle crashes,

133
Q

Chest Trauma - Blunt Trauma: How bad can the injuries be?

A

Can be life threatening

134
Q

Chest Trauma - Blunt Trauma: What are some changes that can occur in the body due to this?

A

Hypoxemia, Hypovolemia, Cardiac Failure

135
Q

Chest Trauma - Blunt Trauma: Why may hypoxemia be seen?

A

Because there is a disruption of the airway

136
Q

Chest Trauma - Blunt Trauma: Why would hypovolemia be seen?

A

May come from fluid loss or ruptured vessels. May be bleeding out.

137
Q

Chest Trauma - Blunt Trauma: Why can cardiac tamponade occur?

A

They are bleeding within their chest due to the trauma

138
Q

Chest Trauma - Blunt Trauma: Time is critical, so we should think about what?

A

ABCs. Airway, Breathing, Circulation

139
Q

Chest Trauma - Blunt Trauma: What will the initial airway assessment consist of?

A

Airway patency, pneumothorax , cardiac tamponade

140
Q

Blunt Trauma - Types: What are the different types that can occur?

A

Sternal/Rib Fractures
Flail Chet
Pulmonary Contusion

141
Q

Blunt Trauma - Types: These often occur from what?

A

Motor vechicle crash, direct blow from stering wheel

142
Q

Blunt Trauma - Types: When rib fracture, what must we consider behind them?

A

Can poke whatever is behind it, like the lungs.

143
Q

Blunt Trauma - Types: If patients first three ribs are fractured, you want to be concerned with what

A

Subclavian Vein and any arteries in the upper extremity

144
Q

Blunt Trauma - Types: When the lower half of the ribs break, what must you be concerned with?

A

Spleen may be ruptured.

145
Q

Blunt Trauma - CMs: What signs will they have?

A

CP, Tenderness, Ecchymosis, Bruising, Possible Chest Wall Deformity.

146
Q

Blunt Trauma - Assess: What do we want ot assess for ,with what diagnostic?

A

Lung sounds, chest xray, evaluate heart, (consider organs behind ribs)

147
Q

Blunt Trauma - Assess: What are you trying to evaluate for?

A

Chest injury by performing the chest xray

148
Q

Blunt Trauma - Mx: How will this be most likely managed?

A

Splinting/Chest Binder.

149
Q

Blunt Trauma - Mx: What can we do when splinting?

A

We can hold a pillow up that can be held against them when moving

150
Q

Blunt Trauma - Mx: What must we be aware of with a chest binder?

A

It will be extremely painful, and patient will need pain medication.

151
Q

Blunt Trauma - Mx: How can we monitor for associated injuries?

A

By making sure that nothing was punctured and that the organs are okay

152
Q

Blunt Trauma - Mx: How long will it take for ribs to heal

A

3-6 weeks on their own so don’t need surgery

153
Q

Blunt Trauma - Flail Chest: What is this the result of?

A

3 or more adjacent ribs that are fractured

154
Q

Blunt Trauma - Flail Chest: What has happened to the chest wall?

A

It has lost stability and it can cause respiratory impairment

155
Q

Blunt Trauma - Flail Chest: What can be done to try to protect these patients?

A

They may be intubated to prevent injury from getting worse.

156
Q

Blunt Trauma - Pulmonary Contusion: This is often associated with what

A

flail chest

157
Q

Blunt Trauma - Pulmonary Contusion: What does this mimic?

A

ARDS, because there is direct injury to lungs. Increased respiratory and decreased breath sounds,

158
Q

Blunt Trauma - Pulmonary Contusion: What are the signs of this?

A

Increased RR, Decreased breath sounds, increased HR, Chest Pain

159
Q

Blunt Trauma - Pulmonary Contusion: What may occur with hemoptysis?

A

They be be unable to clear their cough

160
Q

Blunt Trauma - Pulmonary Contusion: What must we make sure to do here?

A

Maintain their airway , giving them oxygen and controlling their pain.

161
Q

Chest Trauma - Penetrating TRauma: What is this?

A

Any organ within chest cavity that is susceptible to injury.

162
Q

Chest Trauma - Penetrating TRauma: What should you monitor for here?

A

Hemorrhagic shock

163
Q

Chest Trauma - Penetrating TRauma: How will this be treated?

A

With a chest tube

164
Q

Chest Trauma - Complicatiosn of all trauma: What is the major one?

A

Pneumothorax, which is a collapsed lung. Pleura area is broke and air enters teh spac and collapses the ling

165
Q

Chest Trauma - Pneumothorax: What are the three different types?

A

Spontaneous or Simple
Traumatic
Tension Pneumothorax

166
Q

Chest Trauma - Pneumothorax: What is a simpl e one?

A

Air enters through a litle blob on the lung surface and if it ruptures, the lung will collapse

167
Q

Chest Trauma - Pneumothorax: What is a traumatic one?

A

Air escapes from the lung itself from blunt trauma , ribs fractures and punctured into lung or central line placements.

168
Q

Chest Trauma - Pneumothorax: Why may central line placements cause a traumatic one?

A

If physician misses vessels, they may puncture into this pleural space.

169
Q

Chest Trauma - Pneumothorax: What is tension pneumothorax?

A

Air is trapped inside the lung. Can be seen after blunt trauma or car accidents. Air enters and lungs collapse

170
Q

Chest Trauma - Pneumothorax: How will these patients appear?

A

Their lungs collapsed so they’ll be SOB, pain, no lung sounds.

171
Q

Chest Trauma - Pneumothorax: Simple, air enters through what

A

A Bleb

172
Q

Chest Trauma - Pneumothorax: What occurs in traumatic?

A

Air escapes form lung itself or air from wound in chest wal linto pleural space.

173
Q

Chest Trauma - Pneumothorax: What must be done if a traumatic open pneumothorax occurs?

A

Emergency interventions. Stop the flow of air through opening in the chest wall is the life saving measure

174
Q

Chest Trauma - Pneumothorax: What happens to air in a tension one?

A

Air drawn into pleural space and trapped. Pressure in chest increased with each breath

175
Q

Chest Trauma - Pneumothorax: How does the trachea move with these?

A

It will move to the unaffected side.

176
Q

Chest Trauma - Pneumothorax: What should you do if you see a tracheal shift?

A

You should be listening to the patients lung sounds see if they have potential pneumo.

177
Q

Chest Trauma - Pneumothorax, CMs: This is dependent on what?

A

Size and cause of the pneumothorax.

178
Q

Chest Trauma - Pneumothorax, CMs: What are some common signs that all patients will have?

A

Pain, SOB, Absent Lung Sounds

179
Q

Chest Trauma - Pneumothorax, CMs: What specific sign will occur with tension pneumothorax?

A

Trachea shifted away from the affected side because pressure is pushing it away

180
Q

Chest Trauma - Pneumothorax, Medical Mx: Thoracentesis can occur, which is what?

A

If lung collapsed because fluid is building up, they will do this to remove that fluid

181
Q

Chest Trauma - Pneumothorax, Medical Mx: What is a thoracotomy?

A

This occurs if there is more than 1500 mL of fluid aspirated initially and will take a initial look to see what is going on

182
Q

Chest Trauma - Pneumothorax, Medical Mx: Thoracotomy is used why ?

A

For the physician to gain acecss to the pleural space in the chest. to get the fluid or blood drained and helping the lung expand.

183
Q

Chest Trauma - Pneumothorax, Medical Mx: What do you most often seen done for this?

A

a chest tube is put into place.

184
Q

Chest Trauma - Pneumothorax, Medical Mx: Chest tube helps with what?

A

Helps the lung reinflate

185
Q

Chest Trauma - Pneumothorax, Medical Mx: What is a big complication of chest tubes?

A

Sub Q emphysema

186
Q

Chest Trauma - Pneumothorax, Medical Mx: What is SubQ Emphysema

A

Crepitus , small air leaks and will feel it on the skin. Will feel like rice krispies.

187
Q

Pneumothorax, Chest Drainage: What is this used for?

A

Used to treat spontaneous and traumatic pneumothorax .

188
Q

Pneumothorax, Chest Drainage: This is used postoperatively why?

A

To re-expand the lung and remove excess air, fluid, and blood.

189
Q

Pneumothorax, Chest Drainage: What are the different types of drainage systems?

A

Traditional Water SEal
Dry Suction Water Seal
Dry Suction

190
Q

Pneumothorax, Chest Drainage: The type used is dependent on what?

A

What the physician orders and the current situation going on with the patient

191
Q

Pneumothorax, Chest Drainage: What must the nurse do here?

A

Monitor the chest tube

192
Q

Pneumothorax, Chest Drainage: How can the chest tube be monitored?

A

Make sure that the chest tube is working properly.

193
Q

Pneumothorax, Chest Tube Drainage System: Where does this system sit inside the body?

A

Sits inside the pleural space to help remove an fluid or air to help the lung re-expand fully.

194
Q

Pneumothorax, Chest Tube Drainage System - Heimlich Valve: What is this?

A

A smaller form of a chest tube . Will go higher in 2nd intercostal space and will help the lung expand . Used for simple pneumo.

195
Q

Patient Undergoing Thoracic Surgery - Types: What is a Pneumonectomy?

A

The removal of the entire lung. Mainly seen for cancer. Will be posteiror lateral or internal lateral appraoch.

196
Q

Patient Undergoing Thoracic Surgery - Types: What is a lobectomy

A

Removal of a lung lobe

197
Q

Patient Undergoing Thoracic Surgery - Types: what can cause a lobectomy?

A

This can be from cancer or can be the blebs that are on the patients lungs causing pneumos.

198
Q

Patient Undergoing Thoracic Surgery - Types: What is a segmentectomy?

A

There is just one lesion and its only in one segment of the lung. Will remove that one specific segment

199
Q

Patient Undergoing Thoracic Surgery - Types: What is a wedge resection?

A

Theres a small nodule. Will be used for diagnostic purposes to see if it is cancerous.

200
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: What potential problems can occur?

A

Respirator Distress, Dsyrhythmias, Atelectasis/Pneumothorax, Blood Loss and Hemorrhage, Pulmonary Edema

201
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: What nursing diagnosis may they have?

A

Impaired Gas Exchange
Ineffective Airway Clearance
Acute Pain
Anxiety

202
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: What must we prep these patients for post-surgery?

A

They may end up with chest tubes to help with any fluids that may be building up to make sure its drained and lung stays expanded.

203
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: What should we do aftersurgery when patient is coughing?

A

Supporting the incision. Nurses hand should be on the anterior and posterior side.

204
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: What exercises should the patient be taught and why?

A

Arm and shoulder exercises because the muscles are transected during these surgeries involving the thoracic area.

205
Q

Patient Undergoing Thoracic Surgery - Problems/Complications: How soon should the patient start their exercises?

A

Within 8-12 hours of their surgery. It helps them heal better and get function back.

206
Q

Patient Undergoing Thoracic Surgery - Pt Teaching and Home Care Consideration: What can we teach to ensure they breathe great?

A

Breathing and coughing techniques

Positioning

207
Q

Patient Undergoing Thoracic Surgery - Pt Teaching and Home Care Consideration: What should the patient e taught to do?

A

Promotemobility and arm and shoulder exercises

208
Q

Patient Undergoing Thoracic Surgery - Pt Teaching and Home Care Consideration: What should the nurse address?

A

Pain/Discomfort
Diet
Prevention of Infection
Signs to Report

209
Q

Patient Undergoing Thoracic Surgery - Pt Teaching and Home Care Consideration: What are some signs of infection to report?

A

Redness, drainage, fever

NRSG 200: Med Surg 3 (46 decks)

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