Module 8: Disorders of Ventilation and Gas Exchange Flashcards
Bronchiectasis
Abnormal permanent dilation of the large bronchi
An obstructive issue like COPD - hard to get the air out/CO2 out
Bronchiectasis is associated with…
infection and destruction of the bronchial walls
Why does infection occur in bronchiectasis?
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
Causes for Bronchiectasis
- local airway obstructions like tumors and foreign bodies
- congenital abnormalities
- lung infections (tb, fungal, lung abcess etc)
- cystic fibrosis
- immunodeficiency states
- exposure to toxic gases
Where can bronchiectasis occur?
It can be localized or generalized
Can be bilateral
Bronchiectasis impacts __ lobes more than __ lobes
lower ; upper
As bronchiectasis progresses what things can it develop and progress into?
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
Atelectasis
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
Does atelectasis only occur with Bronchiectasis?
no it can happen with other things like post surgically
What happens if there is impaired mucociliary function
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
Is there a cure for Bronchiectasis?
No the only thing to do is detect it early to prevent permanent damage
Manifestations of Bronchiectasis
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
Foul breath in bronchiectasis may lead to …
a bad taste in the mouth and not wanting to eat leading to subsequent weight loss
How does anemia relate to bronchiectasis
it could be an underlying factor leading to bronchiectasis or something that the bronchiectasis caused
Bronchiectasis is an ___ disorder by nature
obstructive
Why does cyanosis and dyspnea occur in bronchiectasis?
There is inability to exchange gasses from atelectasis or mucus
Cystic Fibrosis
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
How does Cystic Fibrosis work genetically?
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
___ does not always go with cystic fibrosis but commonly does go with it?
Bronchiectasis
Inspissate
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
There is ion channel dysfunction with CF, so what would this mean?
there are increased concentrations of sodium and chloride in the sweat of a patient with CF
Absorption Atelectasis
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
What are the effects of CF on the pulmonary system?
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
What does the edema of the capillary-alveolar interface impact the body in CF?
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
In CF, Scarring from repeated infection leads to…
bronchial airways being destroyed from not stretching
What happens if you cannot get the bronchi and alveoli to stretch?
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
What effects does CF have on the pancreas?
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
What effects does CF have on the Liver?
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
What effects does CF have on the intestine?
Blocks digestion and absorption
Malabsorption of fats, carbs, and proteins
FTT (Failure to thrive) is a common complication
Poor nutritional status
Why does CF lead to malnutrition, liver failure, and potential diabetes?
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
Portal Vein
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)
Portal Hypertension
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
Effects of CF on the Cardiac System
Cor Pulmonale (R Sided HF)
Effects of CF on the Reproductive System
Male - obstructed vas def –> aspermia
Female - thick mucus secretion in cervix blocking entrance –>sterility
Effects of CF on sweat glands
impaired reabsorption of Na and Cl in sweat ducts
Excessive salt loss in sweat
Heat prostration (exhaustion)
Dehydration
Hyponatremia
Hypochloremia
Effects of CF on Dentition
gingivitis
dental caries
Why does CF lead to cor pulmonale
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
What do normal sweat glands release
isotonic fluids with sodium and chloride in it as salt and water
What do CF sweat glands release
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
How much more is the concentration of salt in CF sweat compared to those without it?
4-5x more
Why do dental issues occur with CF?
The salivary ducts are clogged and cannot make saliva to clear out bacteria and protect teeth
Respiratory manifestations of CF
wheezing
chronic cough
dyspnea
tachypnea
barrel chest
cyanosis
Developmental manifestations of CF
delayed weight gain
retarded bone growth
delayed sexual development
GI manifestations of CF
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
What is neonate meconium ileus?
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
Why does Steatorrhea occur in CF?
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
Why is impaired fat digestion so serious in CF?
we need fat for our myelin sheathes on our nerves
we need fat to get fat soluble vitamins like ADEK
Why should babies never have only skim milk?
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
Rectal prolapse
large intestine coming out of the anus
comes from straining and issues passing stool (especially with CF)
Mucofecal Masses
very hard to pass masses of mucus leading to prolapsed anus, hemorrhoids, and chronic constipation
What ways is CF diagnosed?
Sweat Test
Genetic Screening
CXR
Stool Sample
Sweat Test
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
What value of Cl- is indicative of CF
> 60 mEq/L
What sort of genetic tests can be done to check for CF?
recombinant DNA
amniocentesis
What may a CXR look for in a patient with suspected CF
Hyperinflation - from barrel chest dev
Widespread consolidation - from fibrotic changes and scarring
Blebs
Bronchiectasis
RUL involvement and pulmonary infiltrates
What is the most common location of pulmonary infiltrates?
R Upper Lobe
Blebs
lung blister filled with fluid
What is absent in the stool of someone with CF?
The digestive enzymes trypsin and chymotrypsin
What is normal fecal fat levels compared to CF fecal fat levels?
Normal -4g
CF - 15-30g
When do CF patients take pancreatic enzymes and why?
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
CF is Autosomal ___
recessive
What are the odds for children between 2 heterozygous parents for CF?
25% of CF
50% of carrier
25% of no disease or carrier
(total 75% chance of no disease)
What is the chances for a person to have CF if the parents are Homozygous dominant and recessive respectively?
100% chance of being a carrier
What are the odds for children between someone with CF and a heterozygous carrier?
50% chance of carrier
50% chance of CF
Pulmonary arteries carry…
deoxygenated blood from the heart to the lungs (unlike normal arteries)
Pulmonary veins carry
oxygenated blood from the lungs to the heart (unlike normal veins)
Pulmonary Hypertension
Increased blood pressure in pulmonary circulation/artery
Normal Systemic BP
120/90
Normal Pulmonary BP
25/10
Pulmonary HTN BP
> 30/>12
Primary Pulmonary HTN
Idiopathic HTN
We do not know the reason but it is 7% of the time familial autosomal dominant with variable expression
Secondary Pulmonary HTN
Can be from:
Alveolar hypoventilation
COPD
Chronic Bronchitis
Emphysema
CF
Other causes
S/S of Pulmonary HTN
Murmurs and S3/S4
Dyspnea
JVD
Chest Pain
palpitations
dizziness
syncope
cough
LE edema
What is the major pulmonary mechanism that is unique to the system and also causes pulmonary HTN ultimately?
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
Why do the lung vessels vasoconstrict with low pH, high CO2, and low O2?
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
How does the pulmonary vasoconstriction cause problems?
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
What is the pathway of blood backup causing pulmonary HTN edema?
blood backing up in superior vena cava –> jugular veins –> body –> lower extremity edema
S3 is …
pathonomic for heart failure
S4 is …
always before S1 and is always a bad thing
What ways can we diagnose Pulmonary HTN?
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
Pulmonary hypertension is autosomal ___
dominant
Cor Pulmonale
Disturbance in pulmonary circulation resulting in R ventricular dysfunction
*Lung problem causes R sided heart failure (think about the vasoconstriction in PHTN)
Acute cor Pulmonale
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
Chronic cor pulmonale
Hypertrophy and dilation of the R ventricle from diseases of the pulmonary parenchyma and/or the vascular system
ex: CF
Manifestations of Cor Pulmonale
cough with or without sputum
dyspnea especially with exertion
JVD
S3 and tricuspid regurgitation
atypical chest pain
rhonchi and wheezing
hepatomegaly and ascites
cyanosis
What are some Pulmonary tree issues causing cor pulmonale
COPD
pulmonary fibrosis
pulmonary resection
granulomatous diseases like sarcoidosis, RA, and SLE
bronchiectasis
CF
malignancy
*chronic hypoxia at high altitudes
What are some pulmonary vessel problems causing cor pulmonale
primary Pulmonary HTN
pulmonary embolism
pulmonary vascular disease secondary to systemic illness
IV drug abuse
injuries to vessels
What are some thoracic cage problems leading to cor pulmonale
obesity
kyphoscoliosis
neuromuscular diseases
sleep apnea
Pulmonary Fibrosis
restrictive lung disease from things that cause lung scarring
Sarcoidosis
granuloma formation in the lungs (non cancerous inflammation) which causes scarring and can go on to calcify
Kyphoscoliosis
bend in the back and a twist in the spine leading to no expansion of the thoracic cage
Why can chronic hypoxia at high altitudes cause cor pulmonale?
It may have high Hct making the heart pump harder and the increased pressure in the pulm artery will cause r sided heart failure
Treatments for Pulmonary Hypertension and Cor Pulmonale
- low flow O2 tx
- bronchodilators on a routine schedule
- diuretics for fluid removal (monitor lytes)
- vasodilators - but needs cardiac monitoring
- avoidance of sedatives and depressants
- cardiac cath
What should be avoided with Cor Pulmonale and Pulmonary HTN?
Sedatives and respiratory depressants
What O2 can be given for treatment of Cor Pulmonale an Pulmonary HTN
low flow - we want to see arterial O2 > 60 mmHg on an ABG
Why give diuretics in cor pulmonale and pulmonary HTN?
to prevent fluid buildup and heart failure (but they will need nutrients and lytes if they are taking these)
How can the active ingredient in Viagra (Sildenafil) help with cor pulmonale and pulmonary HTN?
It can help stop and treat the vasoconstriction that occurs
Pleura
Lining that covers the lungs and thoracic cavity has visceral (near/on lung) and parietal (encapsulates chests wall) and there is fluid inbetween
Pleural Effusion
Fluid build up in the pleural space itself (not the lung tissues)
2 types - exudative or transudative
Transudative Pleural Effusion
Pleural effusions with LOW protein in them
What is the most common causes for transudative pleural effusions?
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)
Exudative Pleural Effusion
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
What are common causes for exudative pleural effusions?
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
Capillary Dynamics
at the arterial end the push hydrostatic pressure is greater than osmotic with the osmotic pull being greater at the venous end
Manifestations of Pleural Effusions
always caused by some underlying disease, but varies on presentation based on rapidity of collection and volume
- Pain - most common sx
- Dyspnea - effusion compresses thenormal lung
- Tachypnea
- Cough; Hemoptysis
- Breath sounds are reduced, absent, or bronchial
- Mediastinal shift
What is the pain like in a pleural effusion
sharp, stabbing, intensified by respiration
pleural friction rub occurs especially if it is exudative d/t fibrosis
Respirophasic
can hear a sound while they breath
How to tell a pericardial effusion from a pleural effusion?
if they hold their breath and it continues it is pericardial but if it stops its pleural
Diagnoses and Treatments for Pleural Effusion
- Thoracentesis (repeated to prevent fibrosis or offer symptomatic relief)
- cone Biopsy
- treatment of underlying issue
- Chest tube (cont. drainage) (esp. emphysema)
- Decortication or peeling of the pleural layers may be needed if fibrous adhesions have occurred
- Pleurodesis
Cone Biopsy
to check for pleural effusion
it extracts a small portion of pleural tissue when tuberculosis or malignancy is suspected
tells etiologic factors
Pleurodesis
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
Decortication
scraping off infection on the pleural layer to prevent scarring
but there is still a risk of these layers scarring again
Pneumothorax
Pneumo = air
it is the rapid accumulation of intrapleural air and collapse of the lung
What is normal pressure in the pleural space?
A pressure that is always negative!!!
-4mmHg on expiration and -10 mmHg on inspiration
What causes pneumothorax
caused by any opening into the pleural space through the visceral pleura, chest wall, or mediastinum
Types of Pneumothorax
Spontaneous (unexpected)
Closed (leak closes quickly)
Tension (LETHAL)
open (penetrating injury)
Hydro (accompanied by transudate)
Hemo (accompanied by blood)
Spontaneous Pneumothorax
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
Primary symptom of Spontaneous Pneumothorax
chest pain or shoulder pain worse with inspiration or cough
Other symptoms of Spontaneous Pneumothorax
Dyspnea- from pain and lung collapse
decreased respiratory excursions and asymmetry
Decreased breath and voice sounds
In what groups does primary spontaneous pneumothorax tend to occur?
may occur in otherwise healthy, young adults age 20-40
it is congenital with a familial tendency and is seen more often in males
Closed Pneumothorax
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
Which interferes with respiration more, closed or spontaneous pneumothorax?
Open
Closed interferes less because the opposite lung is unaffected
Up to 30% of closed pneumothorax may be treated without what?
chest tube insertion and just watched for resolution (may be small enough to heal on its own)
Tension Pneumothorax
valve like opening in the visceral pleura permits entry of air during inspiration but closes during expiration
Why is tension pneumothorax a medical emergency?
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
Tension Pneumothorax does what to the trachea?
makes it do a mediastinal shift and tracheal deviation away from the side of pneumothorax
Tension pneumothorax must be …
dealt with immediately or it can result in death within minutes
Mediastinal shift
when the trachea deviates and is pulled over away from a pleural effusion or tension pneumothorax
Open Pneumothorax
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
What things will occur with an open chest wound in open pneumothorax?
- affected lung DOES NOT EXPAND ON INSPIRATION because there is no negative pressure that can be created around it
- Positive pressure develops in the trachea on EXPIRATION and effected lung will EXPAND to some degree
- Air in the trachea is rebreathed by unaffected lung on next inspiration
- Paradoxical breathing
Paradoxical Breathing
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
Hemopneumothorax
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
Hydropneumothorax
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
What do we need to do before infusing IV fluid into a catheter in the subclavian vein
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
Thoracotomy Tube/ Chest Tube
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
Where is a chest tube inserted
between the ribs through the intercostal muscles into the intrapleural space
Between the 6th and 7th ICS for fluid
Trocar
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)
Chest Tube Pleurovac / Thoraclex Collector
A device with 3 chambers:
- collection chamber for bleeding and fluid to gather
- a water seal chamber allows bubbling and air
- suction control chamber for suctioning with 20 cm of water in it if ordered
What is important to do q 4 hours with the chest tube pleurovac
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
Underwaterseal or Water Seal Chamber
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
What does a rolling boil mean in a water seal chamber?
there must be a leak somewhere between the PATIENT AND CHEST TUBE
What does no bubbling mean in a water seal chamber?
there must be a leak somewhere between the CHEST WALL AND CHEST TUBE
A pleurovac or thoraclex must be …
below the level of the chest tube at all times
How is fluid drainage facilitated with a chest tube?
by using a semi fowlers position or turning toward the side of the tube
Avoid what when using a pleurovac or thoraclex
dependent loops of tubing especially when fluid is being evacuated (turns gravity into an opposing force)
Never do what with the pleurovac?
DO NOT MILK TUBINGF (changes pressure in the lungs)
How should dressings over a chest tube be done?
You apply it on top and reinforce but you NEVER TAKE IT OFF as its a pressure dressing
If soiled call the MD
Check for what things while doing care of a patient with a chest tube?
respiratory distress
kinks in tubing
chest tube connections
leaking of air into subcutaneous tissue around the insertion site
If air is leaking out of a chest tube you may …
feel subcutaneous emphysema or crepitus
How should mobility during care of the patient with a chest tube be handled?
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
How should clamping of a chest tube be done?
NEVER clamp unless you are changing a full colletion device or system has been opened by damage and CHANGE IT QUICKLY
If the patient with a chest tube has an air leak, clamping will cause?
tension pneumothorax
How is suctioning done for a chest tube?
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
When does fluid drainage for chest tubes usually stop?
in 3-4 days
What is the amount of suction usually ordered by the physician?
20 cm of H2O
Chest tube drainage is recorded how often?
at least every shift, or maybe even sooner
How long are chest tubes usually in for?
Only about a few days to a week (only 3 days in babies)
How is chest tube removal done?
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
What must the nurse do after a chest tube removal?
Check VS and breath sounds q15 minutes 4 times over the next hour
Developmental Psych impacts of resp disorders
loss of self esteem
fear of dying
physical changes d/t disease or tx
Economic psych impacts of resp disorders
disruption or loss of employment
cost of hospitalization and home care
Occupational/Recreation psych impacts of resp disorders
restrictions in work activity
changes in leisure activities
Social psych impacts of resp disorders
changes in sexual function
social isolation
changes in role performance
