Gas Exchange/Chest Tubes/Drains/Trachs

Question 1

Pulmonary disease is classified by

Answer 1

alteration in the lung or heart

Question 2

Understanding the pathophysiology of common ____________ problems can greatly affect the outcome of each individuals during gas exchange.

Answer 2

respiratory

Question 3

Lungs characteristics

Answer 3

large surface area constantly exposed to the external environment

Question 4

Lung disease is greatly influenced by what a pt is exposed to

Answer 4

environmental, occupation, personal, social habits

Question 5

S/S of pulmonary alterations

Answer 5

cough
dyspnea
chest pain
abnormal sputum
hemoptysis
altered breathing patterns
cyanosis
fever

Question 6

Dyspnea is described as
with s/s

Answer 6

subjective sensation of uncomfortable breathing
the feeling of being unable to get enough air described as air hunger, sob, labored breathing- causes disturbance of gas exchange, increase work of breathing, dz that damages lung tissue, pulmonary congestion r/t heart dz
s/s of dyspnea nostril flaring accessory muscles use, retraction more common in children

Question 7

Hemoptysis

Answer 7

coughing up blood or bloody secretions from lungs

Question 8

Cyanosis

Answer 8

bluish discoloration of skin and mucous membranes

Question 9

Cough

Answer 9

protective reflex cleanse the lower airways by an explosive expiration

Question 10

Chest pain can be described as

Answer 10

sharp or stabbing when breathing could be pleural

Question 11

What is a symptom of severe or later sign of hypoxia

Answer 11

cyanosis

Question 12

Orthopnea

Answer 12

dyspnea when lying down often sleeps propped up

Question 13

Hypoventilation

Answer 13

inadequate alveolar ventilation r/t metabolic demands

Question 14

Hypercapnia

Answer 14

retaining CO2

Question 15

Hyperventilation

Answer 15

alveolar ventilation exceeding metabolic demands

Question 16

Hypocapnia

Answer 16

a state of reduced carbon dioxide in the blood

Question 17

Hypercapnia

Answer 17

breathing may be the normal cause- decreased drive to breathe – drug, CNS ( brain spine) obstruction, increased work of breathing

Question 18

Clubbing

Answer 18

bulbous enlargement of the end of a finger or toe

Question 19

What sign is related to chronic hypoxemia?

Answer 19

clubbing

Question 20

Hypoxemia

Answer 20

abnormally low concentration of oxygen in the blood

Question 21

Hypoxia

Answer 21

deficiency in the amount of oxygen reaching the tissues

Question 22

Aspiration

Answer 22

passage of fluid or solid particles into the lung

Question 23

Atelectasis

Answer 23

collapse of alveoli

Question 24

Hypoxia dx

Answer 24

ABGs
Pulmonary function
Hgb and Hct
Clinical S/S
Hx
Pulse Ox below 90%

Question 25

Hypoxia Complications

Answer 25

**cellular death in target** tissue with body-wide effects - **heart and brain** are most affected

Question 26

Hypoxia Risk factors

Answer 26

Chronic or acute hypoxia inflammation problems immobility in elderly

Question 27

Nursing Interventions for Hypoxia

Answer 27

maintain fluids, suction, TCDB Position in semi to high fowlers O2, expectorants, ambulation

Question 28

Tracheostomy is a medical procedure that is permeant or temporary?

Answer 28

Both

Question 29

Tracheostomy involves creating an opening into the

Answer 29

neck and place a tube in pt's windpipe

Question 30

The incision is made into

Answer 30

the trachea below the larynx

Question 31

What is needed at the bedside if the trachea comes out?

Answer 31

Obfuscator and a smaller trach

Question 32

Why is a tracheostomy performed?

Answer 32

- **ventilation** - airway **obstruction or blockage** - airway protection - **secretions**

Question 33

Risks associated with tracheostomy performed

Answer 33

thyroid gland damage **erosion of trachea** collapse lung scar tissue in trachea

Question 34

JP Drains

Answer 34

used after surgery - if blood clots, then okay to milk or strip -compress with negative pressure for suction

Question 35

What type of fluid will appear in JP Drains?

Answer 35

serosanguinous

Question 36

What do you do if clots appear in the JP Drain tubes?

Answer 36

milk or strip

Question 37

When showering with a Drain, what should you do?

Answer 37

Hold or clip to an area to prevent falling out

Question 38

Colostomy

Answer 38

intestine (still living/pink) stoma **left side** stool hard strangulation = med emergency rash can form if in contact with poop

Question 39

Ileostomy

Answer 39

right-sided a lot of fluid and gas (empty out more) will look watery

Question 40

Reasons for a chest tube

Answer 40

Pneumothorax Hemothorax

Question 41

Pneumothorax

Answer 41

air in pleural space - keeps lungs from expanding

Question 42

Hemothorax

Answer 42

blood in the pleural space - possible conjunction with pneumothorax

Question 43

Tension pneumothorax causes

Answer 43

tracheal deviation

Question 44

T/F: Never clamp the chest tube unless cracked or emergency.

Answer 44

True

Question 45

If there is more than _____ mL of liquid in an hour out of chest tubes. - Then what should be the next step?

Answer 45

100 mL call HCP

Question 46

If the chest tube comes out, then what should the nurse do?

Answer 46

Place a gauze pad and have it taped on 3 sides for air to escape and catch secretions

Question 47

If tube becomes detached from the drainage system, then

Answer 47

place in sterile water

Question 48

What should you never do with a chest tube?

Answer 48

strip or milk the line avoid clamping or dependent loops

Question 49

What is the purpose of a chest tube?

Answer 49

restore negative pressure

Question 50

Air in pleural space chest tubes are located

Answer 50

top of the lungs

Question 51

Blood/fluid in pleural space chest tubes are located

Answer 51

bottom of the lungs

Question 52

If the patient has a pneumothorax, what side should they lay on?

Answer 52

lay on their good side

Question 53

If the patient has a hemothorax, what side should they lay on?

Answer 53

lay on their bad side

Question 54

Where should the drainage system of a chest tube be placed related to the patient?

Answer 54

below the pt

Question 55

Subcutaneous emphysema

Answer 55

swelling with air starts at the insertion site and spreads up to the face, neck, and chest which causes a crackling feeling under fingertips - sounds like rice krispies

Question 56

What should the nurse encourage the patient to do if a patient has a chest tube? Select all that apply. - TCDB - ROM exercises - ICS - Milk and stretch-out tubing

Answer 56

TCDB ROM exercises ICS

Question 57

What position should a patient with a chest tube?

Answer 57

45 degree or semi-fowlers

Question 58

S/S of pneumothorax

Answer 58

P- pleuritic pain T - Trachea deviation H- hyper resonance O-onset sudden R- reduced breath sounds A- absent fremitus X- x-ray shows collapse

Question 59

The nurse is caring for a client with a chest tube. During report handoff, the incoming nurse notes that the fluid in the tube is moving up the tube with inspiration, and down the tube with expiration. Which of the following actions is most appropriate for the nurses in this situation? A. Notify the provider B. Continue with the report, as this is a normal finding C. Increase the suction because it is too low to be effective D. Place the chest tube on the bedside table in order to stop the fluid from moving up and down

Answer 59

B. Continue with report, as this is a normal finding This finding is referred to as tidaling, and is a normal occurrence with a chest tube system with inspiration and expiration. If the nurse notes that there is no tidaling, then either the client's lung has completely re-expanded, or there’s an occlusion in the tubing, such as a clot.

Question 60

The provider writes an order for a client to have a chest tube removed. Which of the following are appropriate reasons to discontinue a chest tube? Select all that apply. A. Improved respiratory status B. Symmetrical rise and fall of the chest C. Bilateral breath sounds D. Oxygen saturation above 90%

Answer 60

A. Improved respiratory status Chest tubes may be removed when the client has an improvement in respiratory status, as this indicates that the reason for placing the chest tube has improved. B. Symmetrical rise and fall of the chest When the chest rises and falls symmetrically, this indicates that the hemothorax or pneumothorax has resolved. C. Bilateral breath sounds When breath sounds can be heard on both sides, the client's lung has expanded on the affected side.

Question 61

A nurse is preparing for a focused assessment of the chest and lungs of a client. Which position is best for the nurse to place this client? A. Sitting B. Dorsal recumbent position C. Sim's position D. Knee-chest position

Answer 61

A. Sitting In order to have the most access to a client's chest and lungs when performing a focused respiratory assessment, the nurse should assist the client to a sitting position if the client is able. All other positions listed may still allow the nurse to assess the chest, but the best access is the sitting position.

Question 62

The nurse is assessing a client’s thorax and lungs and lightly palpates the skin over the anterior chest. Which of the following conditions, if present, will the nurse discover with this assessment? A. Subcutaneous emphysema B. Pneumonia C. Cystic fibrosis D. Status asthmatica

Answer 62

A. Subcutaneous emphysema When a client has a tension pneumothorax, air becomes trapped in the tissues. This is called subcutaneous emphysema or crepitus and feels like "rice crispies" under the skin. This  is felt by lightly palpating the chest with two fingers.

Question 63

A patient has developed a pneumothorax and requires a chest tube. The nurse knows that the chest tube will be inserted where? A. 8th or 9th intercostal space B. 2nd intercostal space C. In conjunction with the endotracheal tube D. At the sternoclavicular junction

Answer 63

B. 2nd intercostal space When a client has air in the pleural space, the chest tube is placed in the 2nd intercostal space.

Question 64

A patient has had a chest tube for three days. The nurse assesses the client’s respiratory status and chest tube unit during shift assessment. Which of the following would indicate that the client is ready to have the chest tube removed? A. There is little to no drainage B. The client has only mild respiratory distress C. The water seal has fluctuations D. There is a minimal air leak

Answer 64

A. There is little to no drainage Certain criteria must be met before a client's chest tube can be removed. Criteria include little to no drainage from the tube, absence of respiratory distress, bilateral breath sounds, no fluctuations in the water seal, and no air leak.

Question 65

What color should a stoma be?

Answer 65

pink/red

Question 66

If a stoma is purple, what is happening?

Answer 66

strangulation

Question 67

What discharge teaching is needed for ileostomy?

Answer 67

record mL (gas and liquid) emptied and keep more fluids going

Question 68

Tracheostomy needs to happen with the cuff/balloon

Answer 68

deflated to prevent erosion usually when doing care

Question 69

Can a tracheotomy be performed at the bedside?

Answer 69

yes

Question 70

What keeps air from going up into the chest tube?

Answer 70

Closed water seal in the chamber