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

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

vented

How well did you know this?

Not at all

Perfectly

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

suction control chamber

How well did you know this?

Not at all

Perfectly

removal of the tracheostomy from the trachea is called

decannulation

How well did you know this?

Not at all

Perfectly

four criteria for decannulation of tracheostomy

hemodynamic stability
stable, intact respiratory drive
be able to adequately exchange air
independently expectorate secretions

How well did you know this?

Not at all

Perfectly

this size chest tube drains fluid

medium (24F to 36F)

How well did you know this?

Not at all

Perfectly

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

lateral thoracotomy

How well did you know this?

Not at all

Perfectly

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

continuous, gentle bubbling

How well did you know this?

Not at all

Perfectly

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

1 month, 1-3 months

How well did you know this?

Not at all

Perfectly

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

humidified

How well did you know this?

Not at all

Perfectly

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

inspiration

How well did you know this?

Not at all

Perfectly

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

sterile

How well did you know this?

Not at all

Perfectly

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

thoracotomy (not involving lungs)

How well did you know this?

Not at all

Perfectly

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

200, 100, replace

How well did you know this?

Not at all

Perfectly

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

few hours

How well did you know this?

Not at all

Perfectly

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

milk, strip

How well did you know this?

Not at all

Perfectly

type of chest tube dressing typically used

petroleum gauze

How well did you know this?

Not at all

Perfectly

after a tracheostomy is inserted, this is done immediately

cuff is inflated

How well did you know this?

Not at all

Perfectly

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

normal saline, sterile precut

How well did you know this?

Not at all

Perfectly

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.

least

How well did you know this?

Not at all

Perfectly

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

below

How well did you know this?

Not at all

Perfectly

three complications that can occur with chest tubes

reexpansion pulmonary edema
hypotension
severe subcutaneous emphysema

How well did you know this?

Not at all

Perfectly

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

pigtail tubes

How well did you know this?

Not at all

Perfectly

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

nutrition, aspiration

How well did you know this?

Not at all

Perfectly

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.

antiseptic, local anesthetic, incision, sutured, occlusive

How well did you know this?

Not at all

Perfectly

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

24 hours

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

agency guidelines

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

Suction

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

decannulation

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

dry suction control chamber

this size chest tube drains blood

large (36F to 40F)

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

amount, infection, emphysema

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

wedge resection

Keep this readily available at the bedside of a tracheostomy patient

replacement tube of equal or smaller size

normal water fluctuation within the water-seal chamber is called

tidaling

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

check for pneumothorax or fluid accumulation

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

decortication

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

suctioning

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

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

chest tube placement is confirmed with this

chest X-ray

chest tubes may be placed in these three hospital locations

emergency department, operating room, bedside

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.

sterile, shake, down

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

video-assisted thoracic surgery (VATS)

four methods that confirm correct tracheostomy tube placement

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

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

negative, drain, lung expansion

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

aspiration

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

deep, incentive spirometry, ROM

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

8 hours

five purposes of a tracheostomy tube

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

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

45, raised above head

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

vital signs, lung sounds, pain

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

semi-Fowler's

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

2 cm water, replace

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

adaptation

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

20-30, 15-22

After removing chest tubes, this type of dressing is applied

airtight and occlusive

after removing chest tubes, monitor patient for this

respiratory distress

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

tension pneumothorax

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

thoracotomy

this size chest tube drains air

small (12F to 24F)

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

tracheal cuff

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

aspiration

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

down, depress, rise

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

occlusion

Chest Surgery: removal of one lobe of lung

lobectomy

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

open surgical procedure for lung volume reduction surgery

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

replace, bag-valve-mask (BVM)

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

2 fingers

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

water-seal chamber

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

range of motion, mobility

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

once, inflammation, infection

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

Valsalva (bears down)

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

swallowing, aspiration

two advantages of flutter/Heimlich valve

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

only two times when temporary clamping of chest tubes is indicated

change drainage apparatus check for air leaks

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

wet suction control chamber

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)

suctioning

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

expiration

When changing tracheostomy tapes, use _________ technique

2-person

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

-20

pain medication is given __________ minutes before removal of chest tubes

30-60

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.

no, high, large

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

bronchoscopy procedure for lung volume reduction surgery

standard insertion site of chest tube

midaxillary

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

12-24 hours

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

inlet nozzle

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

20, 12F, 40F

Chest Surgery: removal of the entire lung

pneumonectomy

Chest Surgery: removal of one or more lung segments

segmental resection

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

collection chamber

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

outlet nozzle

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

subcutaneous emphysema

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

median sternotomy

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

respiratory status

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

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

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 ___________.

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

wet suction chest drainage is typically kept at this amount

20 cm H2O

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

swallowing, aspiration

use of Flutter or Heimlich valve

remove air from pleural space

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

hemodynamic, analgesia, sedatives, tolerance, SpO2

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

sterile, tube brush, pipe cleaners

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

exploratory thoracotomy

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

reexpanded, minimal