Pneumothorax Flashcards
chest trauma types
blunt trauma
a) Deceleration, acceleration, shearing, and compression injuries
b) Open wound through the pleural space
fivetypes of chest injuries
fractured ribs
flail chest
pneumothorax
hemothorax
chylothorax
emergency management for chest injuries
- Initial interventions
a) Circulation, airway, breathing
b) O2 to keep SpO2>90%
c) IVs and fluid resuscitation
d) Assess injury
e) Dressing to site - On-going monitoring
what is a fractured rib
Can damage pleura and lungs, and surrounding vessels or organs
fractured ribs clinical manifestations
Pain with inspiration, coughing, splinting, shallow respirations
fractured ribs complications
atelectasis
pneumonia
management of fractured ribs
reduce pain
deep breathing and coughing
incentive spirometry
what is flail chest
a) 3 or more adjacent ribs fractured in 2 or more places
b) Paradoxical chest wall movement
manifestations of flail chest
rapid, shallow respirations; tachycardia, crepitus
management of flail chest
O2 as needed
pain management,
stabilize flail segment (mechanical ventilation, surgical fixation)
what is pneumothorax
a) Collection of air in the pleural space.
b) Positive pressure in cavity causes lung to collapse
c) Increased air in pleural space equals reduced lung volume
manifestations of pneumothorax (small and large)
Small pneumothorax – mild tachycardia and dyspnea
Large pneumothorax – respiratory distress, absent breath sounds over affected area
types of pneumothorax
spontaneous
iatrogenic
tension pneumothorax
describe spontaneous pneumothorax
Rupture of blebs (air-filled sacs)
describe latrogenic pneumothorax
Caused by medical procedures
describe tension pneumothorax
accumulation of air in pleural space that cannot escape resulting in increased intrapleural pressure
causes mediastinal shift and hemodynamic instability – decreased venous return and decreased CO
Medical emergency –needle decompression or insertion chest tube
manifestation of tension pneumothorax
severe dyspnea
tachycardia
tracheal deviation
decreased or absent breath sounds on affected side
JVD
cyanosis
diaphoresis
emergency management of pneumothorax
Cover wound with dressing secured on 3 sides
Do not remove impaled object
Chest tube insertion
what is hemothorax and its management
Presence of blood in the pleural space
Management: chest tube insertion, treat hypovolemia as needed
what is chylothorax and its management
Lymphatic fluid in pleural space
Management: chest tube, Octreotide, surgery, pleurodesis
purpose of chest tube. and pleural drainage
to remove air, blood or fluid from pleural space (pleural tube) and reestablish negative pressure
chest tube insertion equipment
chest tube, drainage system, sterile water, insertion tray
pleural drainage devices
flutter (Heimlich) valve
PleurX catheter
Drainage system with suction
what is a flutter (Heimlich) valve
One-way valve that allows air or drainage to collect in vented drainage bag
what is a drainage system with suction and its 4 compartments
Collect fluid, air, or blood from chest cavity
compartments:
1. suction control chamber/dry. suction. regulator (area A)
2. water seal chamber (area B)
3. air leak monitor (area C)
4. collection chamber (area D)
describe Drainage system with suction. compartment: Suction control chamber or dry suction regulator
controls amount of suction
(wet suction – sterile water – 20 cm of suction, gentle bubbling)
(dry suction – dial regulator – no water)
describe Drainage system with suction. compartment: water seal chamber
contains 2 cm of water, acts as one-way valve preventing backflow of air to the pt.
describe Drainage system with suction. compartment: air leak monitor
observe for bubbling air leak during inspiration
describe Drainage system with suction. compartment: collection chamber
collects fluid & air vents to Area B/C
nursing management for chest tubes and. pleural drainage
(1) Set up and insertion
(a) Consent, setup drainage unit (dry or water suction)
(2) Assess vital signs, lung sounds, pain, amount drainage, insertion site , presence of subcutaneous emphysema, presence of air leak
(3) Maintain drainage system
(4) Chest tube dressings (Change according to agency policy and procedure (-petroleum gauze mostly used))
(5) Monitor for complications: re-expansion pulmonary edema, hypotension, subcutaneous emphysema
(6) Troubleshoot Chest tube and drainage system as needed
(7) Chest tube removal
how to maintain a drainage system
(a) Tight, taped connections
(b) Secure chest tube to chest wall
(c) Keep tubing loosely coiled on bed (no dependent loops)
(d) Check frequently for kinks or loops
(e) Observe for: tidaling (fluctuation in the water seal column), bubbling during expiration, air leak, fluid leak
(f) Keep drainage system below the level of chest
(g) Mark and measure drainage (hourly initially)
***Report greater than 200 mL/hr in first hour; and 100 mL/hr thereafter; replace unit when full (>150 mL/hr with mediastinal tubes).
(h) No milking or stripping chest tubes
(i) Clamping chest tube only clamped briefly to change drainage unit
(j) Avoid overturning unit
(k) Breakage of unit – place distal end of chest tube in 2 cm in sterile water in sterile container; replace unit
chest tube removal
(a) When removed
(b) Pre-medicate prior to removal.
(c) Have client Valsalva maneuver during removal
(e) Apply occlusive dressing (if needed)
(f) Monitor for respiratory distress.
complications chest trauma.
a) Tension pneumothorax
b) Cardiac tamponade
c) Bleeding
d) Infection
e) Subcutaneous emphysema
f) Unplanned removal of chest tube
nursing diagnoses for chest trauma
(1) Impaired gas exchange
(2) Acute pain
(3) Decreased cardiac output
assessment for chest trauma
(1) Vital signs, oxygen saturation
(2) Level of consciousness
(3) Respiratory effort
(4) Chest tube – type, amount & color of drainage, water seal
chamber (air leak), presence or absence of subcutaneous emphysema, dressing
(5) Pain
(6) ABGs
actions for chest trauma
(1) Elevate head of bed
(2) Encourage cough and deep breathing
(3) Encourage ROM exercise and early ambulation
(4) Administer prescribed medications
teaching for chest trauma
(1) Use of pain medications
(2) Importance of coughing and deep breathing, using incentive spirometer, splint with pillow when coughing
(3) Health promotion - Motor vehicle safety – use seat belts, avoid distracted driving, no drinking and driving
what are the different kinds of surgical procedures for chest surgery
- decortication
- exploratory thoracotomy
- lobectomy
- pneumonectomy
- segmental resection
- wedge resection
- other procedures: lung volume reduction surgery, video-assisted thoracic surgery
what is decortication
Surgical removal or stripping of thick, fibrous tissue membrane from visceral pleura
what is exploratory thoracotomy
incision into thorax to look for injured or bleeding tissues
what is lobectomy
Removal one lobe of lung
what is pneumonectomy
a) Removal of entire lung
b) Position on operative side to promote expansion of remaining lung
what is segmental resection
Remove 1 or more lung segments
what is wedge resection
Removal of small wedge shaped section of lung tissue
preoperative care for chest surgery
Assess cardiovascular status
Teaching: surgical procedure, pain management – splinting, exercises T,C & DB, incentive spirometer, range of motion
postoperative care after chest surgery
(A) Pain management – PCA, epidural, nerve blocks
(B) Assess vital signs pulse oximetry
(C) Assess respiratory status
(D) Prevent/detect infection – temperature, incision care
(E) Monitor for complications – hemorrhage, atelectasis, hypoxia, dysrhythmias, infection
(F) Early mobilization
(1) Range of motion, up in chair, ambulation
(2) Lobectomy or wedge resection positioning; Turn to either side (side-back-side)
(3) Pneumonectomy positioning; Supine or operative side only
(G) Manage chest tube system
(1) Pneumonectomy – usually no chest tube. If chest tube, NO SUCTION
(H) Teaching
(1) Breathing exercises
(2) Smoking cessation
(3) Medications
what is thoracentesis
aspiration of intrapleural fluid
preparation for thoracentesis
a. Verify consent
b. Position – sit on side bed and lean forward
c. Fluid is withdrawn with needle and syringe
d. Collect fluid sample for analysis
e. Usually not withdraw more than 1000-1200 mL at a time
during and post thoracentesis
a. Monitor vital signs, pulse oximetry
b. Assess respiratory status and observe for resp distress
c. Obtain chest x-ray
