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XIO > fund 51 chest tube management > Flashcards

fund 51 chest tube management Flashcards

1
Q

community acquired pneumonia

A

community or ≤48 hours after hospital admission or institutionalization of patients

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2
Q

health care associated pneumonia

A

Hospitalization for ≥2 days in an acute care facility within 90 days of infection

*Residence in a nursing home or long-term care facility

*Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection

*Hemodialysis treatment at a hospital or clinic

*Home infusion therapy or home wound care

*Family member with infection due to multidrug-resistant bacteria

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3
Q

hospital acquired pneumonia

A

Pneumonia occurring ≥48 hours after hospital admission that did not appear to be incubating at the time of admission

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4
Q

ventilator associated pneumonia

A

A type of HAP that develops ≥48 hours after endotracheal tube intubation

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5
Q

VAP (being vapid until you’re 96)

A

VAP occurring within 96 hours of the onset of mechanical ventilation is usually due to antibiotic-sensitive bacteria that colonize the patient prior to hospital admission, whereas VAP developing after 96 hours of ventilatory support is more often associated with MDROs.

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6
Q

pneumona tactile fremitis and percussion

A

increased tactile and dull percussion (fluid is dull)

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7
Q

thorocentisis (just single bottle small, double big)

A

Thoracentesis – insertion of a needle into the pleural space to drain fluid or air
Single bottle system is used to drain air or small amounts of fluid from the pleural space
Two chamber system work as a single bottle chest drainage system, but it decreases the workload of breathing

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8
Q

chest drainage systems have

A

A suction source
A collection chamber for pleural drainage
And a mechanism to prevent air from reentering the chest with inhalation. Used in removal of air and fluid from the pleural space and re-expansion of the lungs. Wet (water seal) or dry suction control

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9
Q

normal amount of suction is

A

20 mL, might be orders for something different.

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10
Q

chest drain nursing management -

A

Know indication(s) & supplies
Chest drainage system set up, chest tube (type & size)
Patent IV access

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11
Q

types of chest tubes (CHD had a chest tube)

A

Types of plastic (PVC or silicone)
Coated or non coated
Heparin
Decreased friction

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12
Q

nursing responsiblities

A

assess VS, breath sounds, SaO2, IV access, give 204 L o2 via nasal cannula, HOB up 30 degrees, assess LOC, orientation, anxiety, cyanosis, restlessness, watch ECG for PAC or PVCS, monitor chest x-ray, ABGs

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13
Q

chest tube insertion - supplies - types of gauze

A

Tube sutures in place
Sterile, occlusive dressing
Petrolatum – Dry gauze -
Prepare drainage system in advance
Physical assessment of breath sounds and improved ventilation
CXR to confirm placement
Supplies

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14
Q

chest tube nursing care - check for what type of emphsyema?

A

Check for sub-Q emphysema
Examine chest tube site (occlusive, securement, leaks)
Monitor water seal, chamber (tidaling, air leak)
Monitor collection chamber
Mark level on CDU
Drainage amount & characteristics
Encourage C & DB with splinting
Administer pain meds
Don’t strip the tubing
Emergency supplies in place

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15
Q

maintain drainage system how?

A

below chest level

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16
Q

occlusive dressing when?

A

at all times and change per unit policy

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17
Q

monitor how often? (4 chambers in the chest)

A

at least every 4 hours

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18
Q

chest tube removal (seal the suction)

A

Switch from suction to water seal
Resolution of pneumothorax
Patient advocate
Preemptive analgesia, supplies (suture removal, sterile gloves, PPE, occlusive dressing, order CXR, positioning
Assist physician
Immediate application of occlusive dressing
Physical assessment of breath sounds, RRED, oxygenation, comfort, pain

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19
Q

correct tracheal cuff pressure

A

22

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20
Q

When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for how long? (Plugged up for 5 min)

A

5 - 20 min

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21
Q

70% and the FEV1 is 65%

A

COPD II

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22
Q

take pancreatic enzyme with

A

meals

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23
Q

70% and the FEV1 is 85%

A

COPD I

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24
Q

emergent supplies for chest tube drainage

A

clamps, occlusive dressing (to prevent infection), suction, replacement drainage system

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25
Q

get baseline…

A

respiratory & VS assessment and continuous monitoring during procedure
Facilitate provision of analgesia (IV & local)

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26
Q

assess pt for what?

A

Assess for pain, SQ air, breathing effort, output, leaks, oxygenation.

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27
Q

how often to monitor chest drain?

A

monitor every hour after, then every 4 will get a repeat chest xray.

28
Q

Pleural tubes (type of chest tube)

A

Pleural tubes allow for the removal of air or body fluids and re-expansion of the lung and restoration of normal negative pressure in the pleural space

29
Q

how much fluid draining before you can remove chest tube (the chest tube cost 100 mL)

A

< 100 mL of pleural drainage in the past 24 hours

30
Q

how often to assess respiratory status? (respiratory an even 2)

A

Assess respiratory status q 2 hrs.

31
Q

how long after chest tube removal should you do an xray? (not right after, but 4..)

A

CXR about 4 hours post removal

32
Q

what setting should the wall suction be on?

A

Monitor suction chamber (20 mm H20, bubbling, wall suction on low

33
Q

how often to change positions and ambulate?

A

Change position q 2hrs. and ambulate if possible

34
Q

COPD avoid what foods?

A

carbs

35
Q

you can do nasotracheal suctioning for COPD even if

A

they pt doesn’t have any tubes attached

36
Q

pleural effusion breath sounds (drowning and can’t hear my breath)

A

decreased breath sounds

37
Q

pursed lip breathing is done to (to purse is to prevent)

A

prevent air trapping

38
Q

Obstructive lung disease is apparent when an FEV1/FVC ratio is (obstructive lung disease at 70)

A

less than 70%.

39
Q

restrictive lung disease is FEV1/FVC ratio is

A

greater than 80%

40
Q

restrictive lung disease - what about pulmonary function tests?

A

pulmonary function tests can be normal

41
Q

late respiration problems, pts start to get

A

bradypnea and bradycardia

42
Q

how long before you get symptoms from hypoxia?

A

3 min

43
Q

how to diagnosis hypoxia

A

blood gases, serial blood gases, pulse oximeter, base line pulmonary function, hemoglobin and hematocrit, (if they’re anemic don’t have enough rbcs)

44
Q

transudative (the straw is trans)

A

change in hydrostatic pressure, decrease is oncotic (end stage liver disease)

45
Q

heart failure sounds like (failing to breathe) you heard this at Kentfield

A

hemothorax - usually not bilateral. Decreased or absent breath sounds

46
Q

pneumothorax is sudden or not?

A

always sudden

47
Q

pulmonary embolus - what decreases first? (emboss lowers my CO2)

A

CO2 will go down at first, they will get tired, they will hyperventilate, its diffusion not ventilation. PO2 will go down.

48
Q

ARDS - happens with what? (tu swims)

A

]lungs become really stiff, happens from massive trauma - blood transfusions, fluids, infections in lungs, bypass,

49
Q

how to treat ARDS

A

positive pressure

50
Q

symptoms of hypoxia - RAT - (hypoxia is a rat on the test)

A

restlessness, anxiety, tachycardia, tachypnea. IN late, bradycardia and pulmonary arrest.

51
Q

bronchectisis usually die bc

A

they have antibiotic resistant strain

52
Q

tidal volume ex

A

tidal volume - 500 mL
inspiratory reserve - 3100 mL
expiratory reserve 1200 mL
residual volume - 1200 mL
inspiratory capacity - reserve plus tidal volume = 3600
vital capacity - 4800 ml (inspiratory reserve + tidal volume + expiratory reserve)
total lung capacity - 6000
functional residual capacity - (at end expiration)

53
Q

C in COPD is for

A

chronic air trapping and Lung hyperinflation

54
Q

emphysema PINK

A

emphasymia - pink puffer
P - huffing and puffing puffed out cheeks and pursed lips
I - increased chest
N - no chronic cough ,or minimal cough
K - keep on tripoding to get air exchange

55
Q

emphysemia - lung sounds (HIGH air trapping is…)

A

hyper resonance when percussing lungs = HIGH air trapping and HIGH-per resonance
distended neck veins

56
Q

chronic bronchitis BLUE

A

B - big and blue skin (obese = big)
L - long term chronic cough (cough earliest indicator of chronic bronchitis)
U - unusal lung sounds - crackles AND wheezes
E - edema - peripherally. and cor pulmone - happens when ppl can’t pump blood into fibrotic lungs - causes hypertension as blood backs up into right ventricle and then into body, which become bloated
R = right sided heart failure rocks the body with fluids

57
Q

COPD grade I

A

mild <70%, greater or equal to 80%

58
Q

COPD grade II

A

moderate - < 70%, 50 - 79%

59
Q

COPD grade III

A

severe <70%, 30-49%

60
Q

COPD IV

A

very severe <70, 30%

61
Q

chrome use for

A

moderate asthma, not severe

62
Q

pleural effusion - lung and breath sounds (leather for my pp)

A

pleural effusion - Lung fields dull to percussion, absent breath sounds, and a pleural friction rub 


63
Q

pleural friction rub heard with what disorders? (leather for my ppl)

A

pleural effusion and pneumonia and lung abcess

64
Q

emphsymia - long inspiration or expiration?

A

expiration

65
Q

asthma sounds

A

wheezing on expiration BUT it’s harder to inhale

66
Q

VQ ratio

A

the amount of air that reaches the avleoli per minute/the amount of blood that reaches the alveoli per minute.

67
Q

chest tube placement- air or pneumothorax is

A

2nd intercostal, hemothorax btwn 5th and 6th

XIO (372 decks)

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