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Nursing of Adults I > Other Respiratory to Know: Tracheostomy Care, Chest Tubes, Chest Surgeries > Flashcards

Other Respiratory to Know: Tracheostomy Care, Chest Tubes, Chest Surgeries Flashcards

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1
Q

Flutter/Heimlich valve: Drainage bag must be __________ to atmosphere to prevent tension pneumothorax

A

vented

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2
Q

Pleural Drainage: this is the third compartment which is wet or dry and controls suction from the regulator

A

suction control chamber

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3
Q

removal of the tracheostomy from the trachea is called

A

decannulation

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4
Q

four criteria for decannulation of tracheostomy

A
  1. hemodynamic stability
  2. stable, intact respiratory drive
  3. be able to adequately exchange air
  4. independently expectorate secretions
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5
Q

this size chest tube drains fluid

A

medium (24F to 36F)

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6
Q

approach to a thoracotomy that involves posterolateral or anterolateral incisions and is mainly used for the lungs

A

lateral thoracotomy

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7
Q

Wet suction chest drainage: Dial the wall suction regulator until there is ____________________________ in the suction control chamber

A

continuous, gentle bubbling

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8
Q

In patients with long-term tracheostomy, the tube is changed ____________ after the first tube change and every ________________ thereafter. (time periods)

A

1 month, 1-3 months

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9
Q

Patients with tracheostomies should receive _________________ air to help keep secretions thin, decrease formation of mucous plugs, and promote comfort

A

humidified

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10
Q

Flutter/Heimlich valve: During (inspiration, expiration), the pressure in the chest decreases and the valve closes

A

inspiration

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11
Q

Caring for the patient with a tracheostomy: Supervise the LPN/VN: Provide tracheostomy care using ____________ technique

A

sterile

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12
Q

Chest Surgery: incision into thorax for surgery on organs other than the lungs

A

thoracotomy (not involving lungs)

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13
Q

Nursing management of chest tubes: Mark and measure drainage: Report greater than _____ mL/hr in first hour and ______ mL/hr thereafter; _________ when full.

A

200, 100, replace

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14
Q

Try to avoid suctioning through the newly created tracheostomy in the first ____________ after the procedure, which may worsen discomfort and promote bleeding

A

few hours

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15
Q

Nursing management of chest tubes: Do not _______ or _______ chest tubes

A

milk, strip

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16
Q

type of chest tube dressing typically used

A

petroleum gauze

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17
Q

after a tracheostomy is inserted, this is done immediately

A

cuff is inflated

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18
Q

Caring for the patient with a tracheostomy: Clean around the stoma with ________________ and apply a ______________ dressing around the tracheostomy tube site.

A

normal saline, sterile precut

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19
Q

Because an inflated tracheostomy cuff exerts pressure on the tracheal mucosa, inflate the cuff with the _________ amount of air needed to obtain an airway seal.

A

least

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20
Q

Nursing management of chest tubes: Keep chest drainage (below, above) chest

A

below

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21
Q

three complications that can occur with chest tubes

A

reexpansion pulmonary edema
hypotension
severe subcutaneous emphysema

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22
Q

this type of chest tube has a curly end designed to keep it in place and has a size of 10F to 14F

A

pigtail tubes

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23
Q

Caring for the patient with a tracheostomy: Collaborate with the Dietician: Recommend a diet to promote ____________ and decrease ___________ risk.

A

nutrition, aspiration

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24
Q

Chest tube insertion: The area is cleansed with ____________, and a __________________ is injected. A small ___________ is made over the rib, and the chest tube is inserted. The chest tube is then __________ in place, and a(n) ______________ dressing is used to cover the wound.

A

antiseptic, local anesthetic, incision, sutured, occlusive

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25
Q

Change tracheostomy tapes after the first ___________ and then as needed.

A

24 hours

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26
Q

Caring for the patient with a tracheostomy: Provide tracheostomy care per _______________

A

agency guidelines

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27
Q

Caring for the patient with a tracheostomy: _______________ the tracheostomy as needed.

A

Suction

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28
Q

Caring for the patient with a tracheostomy: Collaborate with the respiratory therapist: Assist with ______________

A

decannulation

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29
Q

this type of suction control chamber determines the amount of suction with a dial on the chest tube drainage device

A

dry suction control chamber

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30
Q

this size chest tube drains blood

A

large (36F to 40F)

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31
Q

Nursing management of chest tubes: Assess the following related to drainage: __________, site ______________, and subcutaneous ______________

A

amount, infection, emphysema

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32
Q

Chest Surgery: removal of small, localized lesion that occupies only part of a lung segment

A

wedge resection

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33
Q

Keep this readily available at the bedside of a tracheostomy patient

A

replacement tube of equal or smaller size

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34
Q

normal water fluctuation within the water-seal chamber is called

A

tidaling

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35
Q

purpose of performing a chest X-ray 30-60 minutes after removal of chest tubes

A

check for pneumothorax or fluid accumulation

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36
Q

Chest Surgery: removal or stripping of thick, fibrous membrane from visceral pleural; allows for improved lung expansion

A

decortication

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37
Q

Caring for the patient with a tracheostomy: Collaborate with the respiratory therapist: Ensure equipment is available for _________________ and tracheostomy care.

A

suctioning

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38
Q

Cleaning stoma: Remove dried secretions from stoma using ________________ soaked in __________ or _________. Gently ______ area around the stoma dry. Clean under the ______________ using cotton swabs.

A

4X4-inch gauze pad, sterile water, saline, pat, tracheostomy flange (faceplate)

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39
Q

chest tube placement is confirmed with this

A

chest X-ray

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40
Q

chest tubes may be placed in these three hospital locations

A

emergency department, operating room, bedside

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41
Q

Cleaning non-disposable inner cannula: Step 2: Rinse cannula in _________ solution. Remove from solution and _________ to dry. Insert inner cannula into outer cannula with the curved part ________, and lock in place.

A

sterile, shake, down

42
Q

Chest Surgery: video-assisted technique with a rigid scope with a distal lens inserted into pleura and image shown on a monitor screen

A

video-assisted thoracic surgery (VATS)

43
Q

four methods that confirm correct tracheostomy tube placement

A
  1. auscultation of chest
  2. EtCO2 capnography
  3. video-assisted confirmation for percutaneous tracheostomy
  4. passage of suction catheter through tracheostomy tube
44
Q

Inserting a chest tube into the pleural space can reestablish _____________ pressure, __________ the pleural space, and allow for _______________.

A

negative, drain, lung expansion

45
Q

Caring for the patient with a tracheostomy: Collaborate with the Dietician: Assess risk for ______________

A

aspiration

46
Q

Nursing management of chest tubes: Encourage and teach patient regarding _________ breathing, ____________________, and __________ exercises.

A

deep, incentive spirometry, ROM

47
Q

Measure cuff inflation pressure with a cuff manometer at least every _________

A

8 hours

48
Q

five purposes of a tracheostomy tube

A
  1. establish patent airway
  2. bypass upper airway obstruction
  3. simplify removal of excretions
  4. permit long-term mechanical ventilation
  5. facilitate weaning
49
Q

To prepare for chest tube insertion, elevate head of bed up to __________ degrees with arm ______________________.

A

45, raised above head

50
Q

Nursing management of chest tubes: Assess patient for ______________, ______________, and ______.

A

vital signs, lung sounds, pain

51
Q

Caring for the patient with a tracheostomy: Before cleaning the stoma/cannula, position patient in ________________ position.

A

semi-Fowler’s

52
Q

Nursing management of chest tubes: If chest drainage unit breaks, place distal end of chest tube in _______________ in sterile container, then __________ unit.

A

2 cm water, replace

53
Q

Caring for the patient with a tracheostomy: Collaborate with Physical and Occupational Therapy: Help facilitate any _____________ for patients going home with a tracheostomy

A

adaptation

54
Q

Caring for the patient with a tracheostomy: Maintain appropriate cuff inflation pressure at ____________ cm H2O (_______ mmHg)

A

20-30, 15-22

55
Q

After removing chest tubes, this type of dressing is applied

A

airtight and occlusive

56
Q

after removing chest tubes, monitor patient for this

A

respiratory distress

57
Q

clamping chest tubes is not indicated during transport or disconnection due to risk for this

A

tension pneumothorax

58
Q

a surgical incision into the chest to gain access to the heart, lungs, esophagus, thoracic aorta, or anterior spine

A

thoracotomy

59
Q

this size chest tube drains air

A

small (12F to 24F)

60
Q

Caring for the patient with a tracheostomy: Collaborate with the respiratory therapist: Measure ____________ pressures

A

tracheal cuff

61
Q

Caring for the patient with a tracheostomy: Collaborate with Speech Language Pathology: Develop plan to avoid ____________

A

aspiration

62
Q

Dry suction chest drainage. If ordered to decrease suction, turn the dial _______ and ________ the high-negativity vent. Assess for a ______ in the water level of the water-seal chamber

A

down, depress, rise

63
Q

if tidaling stops suddenly, assess the chest tube immediately for this

A

occlusion

64
Q

Chest Surgery: removal of one lobe of lung

A

lobectomy

65
Q

Chest Surgery: involves reducing lung volume by multiple wedge excisions or VATS

A

open surgical procedure for lung volume reduction surgery

66
Q

Caring for the patient with a tracheostomy: Collaborate with the respiratory therapist: If accidental dislodgement occurs, ______________ the tracheostomy tube or ventilate the patient with a __________ device

A

replace, bag-valve-mask (BVM)

67
Q

Tie the tracheostomy tapes or Velcro straps securely with room for ________ between the tapes and the skin.

A

2 fingers

68
Q

Pleural Drainage: this is the second compartment which contains 2 cm of water which acts as a one-way valve in which air goes in and bubbles out but cannot go back into the patient

A

water-seal chamber

69
Q

Caring for the patient with a tracheostomy: Collaborate with Physical and Occupational Therapy: Develop a plan for active ____________________ and early __________.

A

range of motion, mobility

70
Q

Caring for the patient with a tracheostomy: Assess tracheostomy site and confirm patency at least ________ per shift for any signs of _______________ or ______________

A

once, inflammation, infection

71
Q

During chest tube removal, the patient holds their breath or uses this maneuver

A

Valsalva (bears down)

72
Q

For long-term tracheostomy patients, evaluate _____________ ability and risk for ___________ because the inflated cuff may result in problems.

A

swallowing, aspiration

73
Q

two advantages of flutter/Heimlich valve

A
  1. increased patient mobility
  2. patients can go home with it
74
Q

only two times when temporary clamping of chest tubes is indicated

A

change drainage apparatus
check for air leaks

75
Q

this type of suction control chamber uses a column of water to control the amount of suction from the wall regulator

A

wet suction control chamber

76
Q

Caring for the patient with a tracheostomy: Supervise the LPN/VN: Determine the need for this, perform this, and assess after performing this (this refers to one thing)

A

suctioning

77
Q

Flutter/Heimlich valve: During (inspiration, expiration), intrathoracic pressure increases and the valve opens

A

expiration

78
Q

When changing tracheostomy tapes, use _________ technique

A

2-person

79
Q

suction pressure on a dry system is usually set to _____ cm H2O

A

-20

80
Q

pain medication is given __________ minutes before removal of chest tubes

A

30-60

81
Q

Wet suction chest drainage: If there is no bubbling in the suction control chamber, 1. there is ____ suction, 2. suction is not ______ enough, or 3. the pleural air leak is so ________ that suction is not high enough to evacuate it.

A

no, high, large

82
Q

Chest Surgery: used to place one-way valves in airways leading to diseased parts of the lung

A

bronchoscopy procedure for lung volume reduction surgery

83
Q

standard insertion site of chest tube

A

midaxillary

84
Q

Caring for the patient with a tracheostomy: Perform sterile dressing changes every __________ (time period)

A

12-24 hours

85
Q

this nozzle of a flutter/Heimlich valve allows air to pass in the valve through the chest drainage tube

A

inlet nozzle

86
Q

Chest tubes are _____ inches long and vary in size from ______ to _______.

A

20, 12F, 40F

87
Q

Chest Surgery: removal of the entire lung

A

pneumonectomy

88
Q

Chest Surgery: removal of one or more lung segments

A

segmental resection

89
Q

Pleural Drainage: this is the first compartment which collects fluid and air and vents collected air to the second compartment

A

collection chamber

90
Q

this nozzle of a flutter/Heimlich valve allows air to pass to the environment or collecting device during expiration

A

outlet nozzle

91
Q

this can occur from air leaking into the tissue surrounding the chest tube insertion site; a “crackling” sensation is felt when palpating the skin

A

subcutaneous emphysema

92
Q

approach to a thoracotomy that involves splitting the sternum and is mainly used for the heart

A

median sternotomy

93
Q

Caring for the patient with a tracheostomy: Supervise the LPN/VN: Notify the RN of any changes in ________________

A

respiratory status

94
Q

three pieces of equipment to have if a tracheostomy is to be done at the bedside

A

bag-valve-mask (BVM)
suction
emergency resuscitation equipment

95
Q

After a tracheostomy procedure, monitor ______________, including _________. Obtain a ____________. Note and record the ventilator settings, including ________, _______, and __________. Observe for ______________ and amount of __________ on the dressing at the insertion site. Notify the HCP of persistent ___________.

A

vital signs, SpO2, chest X-ray, mode, FIO2, PEEP, complications, blood, bleeding

96
Q

wet suction chest drainage is typically kept at this amount

A

20 cm H2O

97
Q

Caring for the patient with a tracheostomy: Collaborate with Speech Language Pathology: Assess _____________ ability and risk for ____________

A

swallowing, aspiration

98
Q

use of Flutter or Heimlich valve

A

remove air from pleural space

99
Q

during a tracheostomy, monitor __________________ status, observe response to ____________ and/or _____________, note ________________ to procedure, and observe ________

A

hemodynamic, analgesia, sedatives, tolerance, SpO2

100
Q

Cleaning non-disposable inner cannula: Step 1: Immerse inner cannula in __________ solution and clean inside and outside using _____________ or ______________.

A

sterile, tube brush, pipe cleaners

101
Q

Chest Surgery: incision into thoracic cavity to look for injured or bleeding tissues

A

exploratory thoracotomy

102
Q

removal of chest tubes is indicated when lungs have ______________ and drainage is _________

A

reexpanded, minimal

Nursing of Adults I (21 decks)

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