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N361: Pathophysiology II > Module 8: Disorders of Ventilation and Gas Exchange > Flashcards

Module 8: Disorders of Ventilation and Gas Exchange Flashcards

1
Q

Bronchiectasis

A

Abnormal permanent dilation of the large bronchi

An obstructive issue like COPD - hard to get the air out/CO2 out

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2
Q

Bronchiectasis is associated with…

A

infection and destruction of the bronchial walls

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3
Q

Why does infection occur in bronchiectasis?

A

Usually bronchi are straight, but this weakening can allow outpouching that fills with debris and can become a medium for bacterial growth and lead to lung and bronchial tube infections

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4
Q

Causes for Bronchiectasis

A
  1. local airway obstructions like tumors and foreign bodies
  2. congenital abnormalities
  3. lung infections (tb, fungal, lung abcess etc)
  4. cystic fibrosis
  5. immunodeficiency states
  6. exposure to toxic gases
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5
Q

Where can bronchiectasis occur?

A

It can be localized or generalized

Can be bilateral

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6
Q

Bronchiectasis impacts __ lobes more than __ lobes

A

lower ; upper

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7
Q

As bronchiectasis progresses what things can it develop and progress into?

A

Bronchial obstruction
atelectasis
smooth muscle relaxation
dilation of the airway walls
airway remains patent
infection
inflammation
impaired mucociliary function
pooling of secretions
chronic inflammation
development of new infections

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8
Q

Atelectasis

A

Alveolar collapse (no surfactant to prevent collapse)

“Empty Balloon syndrome”

can lead to complete or partial lung collapse and leads to less oxygenation in the body

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9
Q

Does atelectasis only occur with Bronchiectasis?

A

no it can happen with other things like post surgically

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10
Q

What happens if there is impaired mucociliary function

A

the secretions can pool and not push debris out and this allows a vicious cycle of infection to occur

chronic bronchitis can occur leading to more COPD

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11
Q

Is there a cure for Bronchiectasis?

A

No the only thing to do is detect it early to prevent permanent damage

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12
Q

Manifestations of Bronchiectasis

A

Fever

Recurrent Bronchopulmonary infection

Coughing

Production of copious amounts of foul smelling purulent sputum

Hemoptysis (from damage to the bronchial wall)

Weight Loss

Anemia

Marked Dyspnea and Cyanosis

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13
Q

Foul breath in bronchiectasis may lead to …

A

a bad taste in the mouth and not wanting to eat leading to subsequent weight loss

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14
Q

How does anemia relate to bronchiectasis

A

it could be an underlying factor leading to bronchiectasis or something that the bronchiectasis caused

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15
Q

Bronchiectasis is an ___ disorder by nature

A

obstructive

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16
Q

Why does cyanosis and dyspnea occur in bronchiectasis?

A

There is inability to exchange gasses from atelectasis or mucus

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17
Q

Cystic Fibrosis

A

An autosomal recessive genetic defect affecting the exocrine glands and cells leading to large amounts of thick mucous

These secretions collect and inspissate in ducts

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18
Q

How does Cystic Fibrosis work genetically?

A

Autosomal recessive

1 in 29 carry the gene on chromosome 7

there are 200 different types of defects

most fatal genetic disease in Caucasian newborn (1:2000)

Dx usually around 1 mo to 2 yrs

Not sex linked

Median survival age is 38

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19
Q

___ does not always go with cystic fibrosis but commonly does go with it?

A

Bronchiectasis

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20
Q

Inspissate

A

To thicken by evaporation or absorption of fluid

So this is the mucus in cystic fibrosis getting thick and acting like a sponge thus causing some atelectasis

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21
Q

There is ion channel dysfunction with CF, so what would this mean?

A

there are increased concentrations of sodium and chloride in the sweat of a patient with CF

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22
Q

Absorption Atelectasis

A

Thick secretions in CF causing fluids to be pulled into them - this also pulls fluids/surfactant in the alveoli causing decreased surface tension and collapse

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23
Q

What are the effects of CF on the pulmonary system?

A

Blocks alveolar ventilation

Absorption atelectasis

Chronic inflammation

Edema of capillary-alveolar interface

Bronchial scarring and fibrosis destroying the bronchial airways

Reduced lung compliance

Developing overinflated barrel chest

Increased risk of pneumonia and chronic bronchitis

Bronchiectasis

Increased incidence of nasal polyps and URIs

Digit Clubbing in severe cardiopulmonary disease

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24
Q

What does the edema of the capillary-alveolar interface impact the body in CF?

A

fluid/mucus fathers between cells of the alveoli and blood - building up in the interstitial space - and this leads to increased distance between O2 and CO2 to diffuse (increased diffusion capacity)

This leads to making it harder for CF to oxygenate tissues

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25
Q

In CF, Scarring from repeated infection leads to…

A

bronchial airways being destroyed from not stretching

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26
Q

What happens if you cannot get the bronchi and alveoli to stretch?

A

Usually sucking air down the bronchus will make the diaphragm flatten but if they cannot stretch then you lose a major way of getting air into the lungs leading to reduced lung compliance

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27
Q

What effects does CF have on the pancreas?

A

Pancreatic Ducts Clog

Digestive Enzymes do not reach S intestine

Pancreas gets destroyed - digestion of pancreatic parenchymal tissue occurs

decreased insulin secretion and diabetes can occur

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28
Q

What effects does CF have on the Liver?

A

Small bile duct obstruction

Biliary cirrhosis

Portal HTN (hard knotty liver means greater HTN leading to blood going through collateral vessels not detoxed)

Liver failure

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29
Q

What effects does CF have on the intestine?

A

Blocks digestion and absorption

Malabsorption of fats, carbs, and proteins

FTT (Failure to thrive) is a common complication

Poor nutritional status

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30
Q

Why does CF lead to malnutrition, liver failure, and potential diabetes?

A

There is a block in the common bile duct for the pancreas and liver, the enzymes from the pancreas cannot get through to digest food causing issues with the alpha, beta, and gamma cells potentially leading to diabetes.

The block also makes bile back up leading to not being able to digest fats either, and the backup causes increased pressure in the liver leading to destruction, disease, cirrhosis, and inflammation which will lead to portal hypertension

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31
Q

Portal Vein

A

3-4 inch long vein that branches let and right into the liver

It moves blood from the spleen and GI tract to the liver for detoxification (75% of blood)

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32
Q

Portal Hypertension

A

an issue of pressure buildup and destruction in the liver leading to issues in getting blood through the portal vein

the blood will travel through collateral vessels instead, and bypass the liver, and this causes unfiltered blood to circulate

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33
Q

Effects of CF on the Cardiac System

A

Cor Pulmonale (R Sided HF)

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34
Q

Effects of CF on the Reproductive System

A

Male - obstructed vas def –> aspermia

Female - thick mucus secretion in cervix blocking entrance –>sterility

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35
Q

Effects of CF on sweat glands

A

impaired reabsorption of Na and Cl in sweat ducts

Excessive salt loss in sweat

Heat prostration (exhaustion)

Dehydration

Hyponatremia

Hypochloremia

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36
Q

Effects of CF on Dentition

A

gingivitis

dental caries

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37
Q

Why does CF lead to cor pulmonale

A

The pressure builds up in the lungs, and the right ventricle is not strong enough to move against it and this causes right sided heart failure

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38
Q

What do normal sweat glands release

A

isotonic fluids with sodium and chloride in it as salt and water

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39
Q

What do CF sweat glands release

A

Normal sweat ducts are permeable to Cl, but CF sweat ducts are relatively impermeable to Cl

Cl makes the sweat excessively negatively charged and this attracts Sodium (positive) to come with it leading to blood hyponatremia and hypochloremia

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40
Q

How much more is the concentration of salt in CF sweat compared to those without it?

A

4-5x more

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41
Q

Why do dental issues occur with CF?

A

The salivary ducts are clogged and cannot make saliva to clear out bacteria and protect teeth

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42
Q

Respiratory manifestations of CF

A

wheezing

chronic cough

dyspnea

tachypnea

barrel chest

cyanosis

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43
Q

Developmental manifestations of CF

A

delayed weight gain

retarded bone growth

delayed sexual development

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44
Q

GI manifestations of CF

A

inspissated meconium in fetal gut

meconium ileus

chronic recurrent abdominal pain

GERD

abdominal distention

frequent steatorrhea

vitamin deficiencies (ADEK)

rectal prolapse

inspissated mucofecal masses

chronic constipation

voracious appetite

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45
Q

What is neonate meconium ileus?

A

an emergency situations where the infant cannot pass their meconium leading to bowel obstruction that becomes toxic and requires immediate surgical intervention

Can occur in CF

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46
Q

Why does Steatorrhea occur in CF?

A

They have no bile breaking down fat, so the stool becomes large, greasy, and bulky since fat is coming through

It is pale since bile usually gives the brown color and malodorous

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47
Q

Why is impaired fat digestion so serious in CF?

A

we need fat for our myelin sheathes on our nerves

we need fat to get fat soluble vitamins like ADEK

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48
Q

Why should babies never have only skim milk?

A

a lack of fat in the diet can cause impairments in cognition and development because of impaired development of the CNS that still occurs post partum

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49
Q

Rectal prolapse

A

large intestine coming out of the anus

comes from straining and issues passing stool (especially with CF)

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50
Q

Mucofecal Masses

A

very hard to pass masses of mucus leading to prolapsed anus, hemorrhoids, and chronic constipation

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51
Q

What ways is CF diagnosed?

A

Sweat Test

Genetic Screening

CXR

Stool Sample

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52
Q

Sweat Test

A

test done between 1 month old and 20 years old to check for CF

If there is failure of the ion channels there will be too much Cl- in the sweat

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53
Q

What value of Cl- is indicative of CF

A

> 60 mEq/L

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54
Q

What sort of genetic tests can be done to check for CF?

A

recombinant DNA

amniocentesis

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55
Q

What may a CXR look for in a patient with suspected CF

A

Hyperinflation - from barrel chest dev

Widespread consolidation - from fibrotic changes and scarring

Blebs

Bronchiectasis

RUL involvement and pulmonary infiltrates

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56
Q

What is the most common location of pulmonary infiltrates?

A

R Upper Lobe

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57
Q

Blebs

A

lung blister filled with fluid

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58
Q

What is absent in the stool of someone with CF?

A

The digestive enzymes trypsin and chymotrypsin

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59
Q

What is normal fecal fat levels compared to CF fecal fat levels?

A

Normal -4g

CF - 15-30g

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60
Q

When do CF patients take pancreatic enzymes and why?

A

They need to take the enzymes with food to prevent malabsorption

This is because the enzymes and food must reach the duodenum at the same time

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61
Q

CF is Autosomal ___

A

recessive

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62
Q

What are the odds for children between 2 heterozygous parents for CF?

A

25% of CF
50% of carrier
25% of no disease or carrier

(total 75% chance of no disease)

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63
Q

What is the chances for a person to have CF if the parents are Homozygous dominant and recessive respectively?

A

100% chance of being a carrier

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64
Q

What are the odds for children between someone with CF and a heterozygous carrier?

A

50% chance of carrier
50% chance of CF

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65
Q

Pulmonary arteries carry…

A

deoxygenated blood from the heart to the lungs (unlike normal arteries)

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66
Q

Pulmonary veins carry

A

oxygenated blood from the lungs to the heart (unlike normal veins)

67
Q

Pulmonary Hypertension

A

Increased blood pressure in pulmonary circulation/artery

68
Q

Normal Systemic BP

A

120/90

69
Q

Normal Pulmonary BP

A

25/10

70
Q

Pulmonary HTN BP

A

> 30/>12

71
Q

Primary Pulmonary HTN

A

Idiopathic HTN

We do not know the reason but it is 7% of the time familial autosomal dominant with variable expression

72
Q

Secondary Pulmonary HTN

A

Can be from:

Alveolar hypoventilation

COPD

Chronic Bronchitis

Emphysema

CF

Other causes

73
Q

S/S of Pulmonary HTN

A

Murmurs and S3/S4

Dyspnea

JVD

Chest Pain

palpitations

dizziness

syncope

cough

LE edema

74
Q

What is the major pulmonary mechanism that is unique to the system and also causes pulmonary HTN ultimately?

A

Normally, low pH, High CO2, and low O2 causes vasodilation in systemic vessels

But in the lungs, low pH, high CO2, and low O2 causes vasoconstriction which causes pressure in the lungs to rise

75
Q

Why do the lung vessels vasoconstrict with low pH, high CO2, and low O2?

A

Normally, if something causes alveoli not to work well, the body will vasoconstrict this area to shunt blood toward working alveoli - it is a protective mechanism

76
Q

How does the pulmonary vasoconstriction cause problems?

A

With a lung disease, the majority of alveoli are not working so the vasoconstriction is not helping much but is causing increased pressure which is too strong against the right ventricle

this can lead to cor pulmonale and inability to pump

77
Q

What is the pathway of blood backup causing pulmonary HTN edema?

A

blood backing up in superior vena cava –> jugular veins –> body –> lower extremity edema

78
Q

S3 is …

A

pathonomic for heart failure

79
Q

S4 is …

A

always before S1 and is always a bad thing

80
Q

What ways can we diagnose Pulmonary HTN?

A

EKG - R ventricular hypertrophy and R axis deviation

PFT and ABG - arterial hypoxemia, reduced diffusion capacity

V/Q Scan - rules out pulmonary embolism

CXR - enlarged central pulm arteries

Echo doppler - R ventricular enlargement and overload

Cardiac Cath - R cath to measure pulm artery pressure

Pulmonary angiography - if VQ scan shows a need for it

81
Q

Pulmonary hypertension is autosomal ___

A

dominant

82
Q

Cor Pulmonale

A

Disturbance in pulmonary circulation resulting in R ventricular dysfunction

*Lung problem causes R sided heart failure (think about the vasoconstriction in PHTN)

83
Q

Acute cor Pulmonale

A

Acute dilation of the R ventricle secondary to pulmonary HTN (usually d/t pulmonary embolisms) - it can cause expansion to the point that the right ventricle explodes

emergency

84
Q

Chronic cor pulmonale

A

Hypertrophy and dilation of the R ventricle from diseases of the pulmonary parenchyma and/or the vascular system

ex: CF

85
Q

Manifestations of Cor Pulmonale

A

cough with or without sputum

dyspnea especially with exertion

JVD

S3 and tricuspid regurgitation

atypical chest pain

rhonchi and wheezing

hepatomegaly and ascites

cyanosis

86
Q

What are some Pulmonary tree issues causing cor pulmonale

A

COPD

pulmonary fibrosis

pulmonary resection

granulomatous diseases like sarcoidosis, RA, and SLE

bronchiectasis

CF

malignancy

*chronic hypoxia at high altitudes

87
Q

What are some pulmonary vessel problems causing cor pulmonale

A

primary Pulmonary HTN

pulmonary embolism

pulmonary vascular disease secondary to systemic illness

IV drug abuse

injuries to vessels

88
Q

What are some thoracic cage problems leading to cor pulmonale

A

obesity

kyphoscoliosis

neuromuscular diseases

sleep apnea

89
Q

Pulmonary Fibrosis

A

restrictive lung disease from things that cause lung scarring

90
Q

Sarcoidosis

A

granuloma formation in the lungs (non cancerous inflammation) which causes scarring and can go on to calcify

91
Q

Kyphoscoliosis

A

bend in the back and a twist in the spine leading to no expansion of the thoracic cage

92
Q

Why can chronic hypoxia at high altitudes cause cor pulmonale?

A

It may have high Hct making the heart pump harder and the increased pressure in the pulm artery will cause r sided heart failure

93
Q

Treatments for Pulmonary Hypertension and Cor Pulmonale

A
  1. low flow O2 tx
  2. bronchodilators on a routine schedule
  3. diuretics for fluid removal (monitor lytes)
  4. vasodilators - but needs cardiac monitoring
  5. avoidance of sedatives and depressants
  6. cardiac cath
94
Q

What should be avoided with Cor Pulmonale and Pulmonary HTN?

A

Sedatives and respiratory depressants

95
Q

What O2 can be given for treatment of Cor Pulmonale an Pulmonary HTN

A

low flow - we want to see arterial O2 > 60 mmHg on an ABG

96
Q

Why give diuretics in cor pulmonale and pulmonary HTN?

A

to prevent fluid buildup and heart failure (but they will need nutrients and lytes if they are taking these)

97
Q

How can the active ingredient in Viagra (Sildenafil) help with cor pulmonale and pulmonary HTN?

A

It can help stop and treat the vasoconstriction that occurs

98
Q

Pleura

A

Lining that covers the lungs and thoracic cavity
has visceral (near/on lung) and parietal (encapsulates chests wall) and there is fluid inbetween

99
Q

Pleural Effusion

A

Fluid build up in the pleural space itself (not the lung tissues)

2 types - exudative or transudative

100
Q

Transudative Pleural Effusion

A

Pleural effusions with LOW protein in them

101
Q

What is the most common causes for transudative pleural effusions?

A

increased pulmonary venous pressure from HF with buildup of back pressure (most common)

alveoli and pleura become filled with fluid “squished” out of capillaries from increased pressure

Other: low serum albumin (loss of osmotic pressure)

102
Q

Exudative Pleural Effusion

A

Pleural effusions with HIGH protein levels and cellular contents like debris, inflammation elements, pneumonia, cancer, dead cells, and pus in them

May be high in fibrin

103
Q

What are common causes for exudative pleural effusions?

A

inflammatory (pneumonia, Tb) or malignant process

gross bloody effusion: malignancy or chest trauma (stab/gunshot)

cellular contents: WBCs or cancer cells

Presence of air: bronchopleural fistula d/t Tb, pyogenic pneumonia, lung abscess, or malignancy (air @ apex; fluid @ base)

Fluid: usually pus (empyema)

high fibrin content results in pleural adhesions - restricts ventilation

chylothorax - d/t lymphatic obstruction - lymphoma or malignancies with lymphatic metastases

104
Q

Capillary Dynamics

A

at the arterial end the push hydrostatic pressure is greater than osmotic with the osmotic pull being greater at the venous end

105
Q

Manifestations of Pleural Effusions

A

always caused by some underlying disease, but varies on presentation based on rapidity of collection and volume

  1. Pain - most common sx
  2. Dyspnea - effusion compresses thenormal lung
  3. Tachypnea
  4. Cough; Hemoptysis
  5. Breath sounds are reduced, absent, or bronchial
  6. Mediastinal shift
106
Q

What is the pain like in a pleural effusion

A

sharp, stabbing, intensified by respiration

pleural friction rub occurs especially if it is exudative d/t fibrosis

107
Q

Respirophasic

A

can hear a sound while they breath

108
Q

How to tell a pericardial effusion from a pleural effusion?

A

if they hold their breath and it continues it is pericardial but if it stops its pleural

109
Q

Diagnoses and Treatments for Pleural Effusion

A
  1. Thoracentesis (repeated to prevent fibrosis or offer symptomatic relief)
  2. cone Biopsy
  3. treatment of underlying issue
  4. Chest tube (cont. drainage) (esp. emphysema)
  5. Decortication or peeling of the pleural layers may be needed if fibrous adhesions have occurred

6.Pleurodesis

110
Q

Cone Biopsy

A

to check for pleural effusion

it extracts a small portion of pleural tissue when tuberculosis or malignancy is suspected

tells etiologic factors

111
Q

Pleurodesis

A

pulmonary vessel sclerosis

need to IV give bleomycin or tetracycline instilled in a chest tube so the capillaries do not leak

it deliberately scars the pleural lining to prevent recurrence, and is only used in late stage diseases or when there is thoracentesis daily

The pleural lining would then be attached to the chest wall to prevent collapse

112
Q

Decortication

A

scraping off infection on the pleural layer to prevent scarring

but there is still a risk of these layers scarring again

113
Q

Pneumothorax

A

Pneumo = air

it is the rapid accumulation of intrapleural air and collapse of the lung

114
Q

What is normal pressure in the pleural space?

A

A pressure that is always negative!!!

-4mmHg on expiration and -10 mmHg on inspiration

115
Q

What causes pneumothorax

A

caused by any opening into the pleural space through the visceral pleura, chest wall, or mediastinum

116
Q

Types of Pneumothorax

A

Spontaneous (unexpected)

Closed (leak closes quickly)

Tension (LETHAL)

open (penetrating injury)

Hydro (accompanied by transudate)

Hemo (accompanied by blood)

117
Q

Spontaneous Pneumothorax

A

pneumothorax caused by rupture of blebs (coalesced alveoli)

can be primary/congenital or secondary to emphysema

air gains access to the pleural cavity through a defect in the bronchus or alveoli

118
Q

Primary symptom of Spontaneous Pneumothorax

A

chest pain or shoulder pain worse with inspiration or cough

119
Q

Other symptoms of Spontaneous Pneumothorax

A

Dyspnea- from pain and lung collapse

decreased respiratory excursions and asymmetry

Decreased breath and voice sounds

120
Q

In what groups does primary spontaneous pneumothorax tend to occur?

A

may occur in otherwise healthy, young adults age 20-40

it is congenital with a familial tendency and is seen more often in males

121
Q

Closed Pneumothorax

A

Communication between the tracheobronchial tree or diseased lung tissue closes immediately leaving lung only partially collapsed

closed pleural space - leak in visceral pleura usually closes quickly when lung is partially collapsed

Symptoms get worse with pulmonary function already being compromised by emphysema or another disease

122
Q

Which interferes with respiration more, closed or spontaneous pneumothorax?

A

Open

Closed interferes less because the opposite lung is unaffected

123
Q

Up to 30% of closed pneumothorax may be treated without what?

A

chest tube insertion and just watched for resolution (may be small enough to heal on its own)

124
Q

Tension Pneumothorax

A

valve like opening in the visceral pleura permits entry of air during inspiration but closes during expiration

125
Q

Why is tension pneumothorax a medical emergency?

A

air accumulates under excessive positive pressure (usually its negative in there) completely collapsing the lung and compressing all contents of the mediastinum (other lung, aorta, vena cavas, heart, trachea)

prevents respiration leading to cyanosis, shock, and death

126
Q

Tension Pneumothorax does what to the trachea?

A

makes it do a mediastinal shift and tracheal deviation away from the side of pneumothorax

127
Q

Tension pneumothorax must be …

A

dealt with immediately or it can result in death within minutes

128
Q

Mediastinal shift

A

when the trachea deviates and is pulled over away from a pleural effusion or tension pneumothorax

129
Q

Open Pneumothorax

A

open, penetrating chest injuries or when opening in the visceral pleura is very large and remains open despite complete collapse of the lung

ex: gun shot, accident, stabbing

continuous air movement from outside to alveoli and pleural space

130
Q

What things will occur with an open chest wound in open pneumothorax?

A
  1. affected lung DOES NOT EXPAND ON INSPIRATION because there is no negative pressure that can be created around it
  2. Positive pressure develops in the trachea on EXPIRATION and effected lung will EXPAND to some degree
  3. Air in the trachea is rebreathed by unaffected lung on next inspiration
  4. Paradoxical breathing
131
Q

Paradoxical Breathing

A

rising of the chest wall on expiration and fall on inspiration on affected side

normally the diaphragm would drop when inspiring and invert on expiration, but the hole in the chest makes it so that the air coming in will fill the with are while the injured lung gets sucked in and then on expiration the affected lung will expand slightly from air trapped in the trachea

Also called see saw breathing

132
Q

Hemopneumothorax

A

blood and air get into the cavity with blood settling at the bottom

often seen in chest trauma or surgery where the blood vessels are cut

may need a chests tube

may need 2 different chest tubes depending on what is collected

133
Q

Hydropneumothorax

A

water and air (accompanied by transudate - low protein)

air moves to the top and fluid settles at the base

can be caused by healthcare with a misplaced intravenous catheter in the subclavian vein which punctures the pleura and infuses IV fluid into it

134
Q

What do we need to do before infusing IV fluid into a catheter in the subclavian vein

A

a chest x ray to check that it is in the right place and will not infuse it into the wrong place and cause a hydropneumothorax

135
Q

Thoracotomy Tube/ Chest Tube

A

A tube that removes air or fluid from the intrapleural space and helps re expand the lung (maybe in some disease process or trauma)

also used after chest surgery when pneumo and hemo thorax iatrogenically caused by cutting blood vessels and opening chest wall and pleura occurs

136
Q

Where is a chest tube inserted

A

between the ribs through the intercostal muscles into the intrapleural space

Between the 6th and 7th ICS for fluid

137
Q

Trocar

A

the part of the chest tube that is inserted

it has small openings

When there is two things that need to be removed you may have a Y shaped one or more than one trocar (the lower would be for fluid and the upper would be for air)

138
Q

Chest Tube Pleurovac / Thoraclex Collector

A

A device with 3 chambers:

  1. collection chamber for bleeding and fluid to gather
  2. a water seal chamber allows bubbling and air
  3. suction control chamber for suctioning with 20 cm of water in it if ordered
139
Q

What is important to do q 4 hours with the chest tube pleurovac

A

Since each chamber is graduated to measure, and it is very important to do so, every 4 hours there will need to be a mark of initial and time on the actual vac/clex and then charting done of the output over time

140
Q

Underwaterseal or Water Seal Chamber

A

2nd chamber of the pleurovac - in all chest drainage systems

Allows bubbling of air through it, but air cannot return to the intrapleural space through it - bubbling stops backup

the tiddaling in the water chamber is based on breathing action through full expansion

141
Q

What does a rolling boil mean in a water seal chamber?

A

there must be a leak somewhere between the PATIENT AND CHEST TUBE

142
Q

What does no bubbling mean in a water seal chamber?

A

there must be a leak somewhere between the CHEST WALL AND CHEST TUBE

143
Q

A pleurovac or thoraclex must be …

A

below the level of the chest tube at all times

144
Q

How is fluid drainage facilitated with a chest tube?

A

by using a semi fowlers position or turning toward the side of the tube

145
Q

Avoid what when using a pleurovac or thoraclex

A

dependent loops of tubing especially when fluid is being evacuated (turns gravity into an opposing force)

146
Q

Never do what with the pleurovac?

A

DO NOT MILK TUBINGF (changes pressure in the lungs)

147
Q

How should dressings over a chest tube be done?

A

You apply it on top and reinforce but you NEVER TAKE IT OFF as its a pressure dressing

If soiled call the MD

148
Q

Check for what things while doing care of a patient with a chest tube?

A

respiratory distress

kinks in tubing

chest tube connections

leaking of air into subcutaneous tissue around the insertion site

149
Q

If air is leaking out of a chest tube you may …

A

feel subcutaneous emphysema or crepitus

150
Q

How should mobility during care of the patient with a chest tube be handled?

A

encourage full ROM on affected side of shoulder and arm to prevent froze shoulder

deep breathing and coughing essential to re expanding the lungs and preventing atelectasis

deep inspiration expands lungs and pushes air and fluid in the tube

Patient can ambulate and carry the tube with them

151
Q

How should clamping of a chest tube be done?

A

NEVER clamp unless you are changing a full colletion device or system has been opened by damage and CHANGE IT QUICKLY

152
Q

If the patient with a chest tube has an air leak, clamping will cause?

A

tension pneumothorax

153
Q

How is suctioning done for a chest tube?

A

Amount will be ordered by the physician

It is done via a section of the vac/clex and a gentle cont. bubbling in the suction chamber is all that is needed

The device will regulate pressure and the wall unit can be set (between 80-120 mmHg)

You must check fluid levels in the suction chamber and water seal, check and record the amount of drainage frequently, and check VS and make assessments if large amounts of bloody drainage suddenly occur

154
Q

When does fluid drainage for chest tubes usually stop?

A

in 3-4 days

155
Q

What is the amount of suction usually ordered by the physician?

A

20 cm of H2O

156
Q

Chest tube drainage is recorded how often?

A

at least every shift, or maybe even sooner

157
Q

How long are chest tubes usually in for?

A

Only about a few days to a week (only 3 days in babies)

158
Q

How is chest tube removal done?

A

A CXR is done first to make sure lung is re-expanded, it is ALWAYS done by an MD, PA, or NP, and pain medications ALWAYS given before removal

The suture is clipped, the patient takes deep breaths and bears down and then regular gauze and wide occlusive adhesive tape to prevent air entry is immediately put over the site

Another CXR may be ordered to confirm pneumothorax did not reoccur

159
Q

What must the nurse do after a chest tube removal?

A

Check VS and breath sounds q15 minutes 4 times over the next hour

160
Q

Developmental Psych impacts of resp disorders

A

loss of self esteem

fear of dying

physical changes d/t disease or tx

161
Q

Economic psych impacts of resp disorders

A

disruption or loss of employment

cost of hospitalization and home care

162
Q

Occupational/Recreation psych impacts of resp disorders

A

restrictions in work activity

changes in leisure activities

163
Q

Social psych impacts of resp disorders

A

changes in sexual function

social isolation

changes in role performance

N361: Pathophysiology II (20 decks)

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