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Pneumothorax Flashcards

1
Q

chest trauma types

A

blunt trauma
a) Deceleration, acceleration, shearing, and compression injuries
b) Open wound through the pleural space

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2
Q

fivetypes of chest injuries

A

fractured ribs
flail chest
pneumothorax
hemothorax
chylothorax

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3
Q

emergency management for chest injuries

A
  1. Initial interventions
    a) Circulation, airway, breathing
    b) O2 to keep SpO2>90%
    c) IVs and fluid resuscitation
    d) Assess injury
    e) Dressing to site
  2. On-going monitoring
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4
Q

what is a fractured rib

A

Can damage pleura and lungs, and surrounding vessels or organs

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5
Q

fractured ribs clinical manifestations

A

Pain with inspiration, coughing, splinting, shallow respirations

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6
Q

fractured ribs complications

A

atelectasis
pneumonia

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7
Q

management of fractured ribs

A

reduce pain
deep breathing and coughing
incentive spirometry

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8
Q

what is flail chest

A

a) 3 or more adjacent ribs fractured in 2 or more places
b) Paradoxical chest wall movement

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9
Q

manifestations of flail chest

A

rapid, shallow respirations; tachycardia, crepitus

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10
Q

management of flail chest

A

O2 as needed
pain management,
stabilize flail segment (mechanical ventilation, surgical fixation)

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11
Q

what is pneumothorax

A

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

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12
Q

manifestations of pneumothorax (small and large)

A

Small pneumothorax – mild tachycardia and dyspnea

Large pneumothorax – respiratory distress, absent breath sounds over affected area

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13
Q

types of pneumothorax

A

spontaneous
iatrogenic
tension pneumothorax

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14
Q

describe spontaneous pneumothorax

A

Rupture of blebs (air-filled sacs)

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15
Q

describe latrogenic pneumothorax

A

Caused by medical procedures

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16
Q

describe tension pneumothorax

A

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

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17
Q

manifestation of tension pneumothorax

A

severe dyspnea
tachycardia
tracheal deviation
decreased or absent breath sounds on affected side
JVD
cyanosis
diaphoresis

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18
Q

emergency management of pneumothorax

A

Cover wound with dressing secured on 3 sides

Do not remove impaled object

Chest tube insertion

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19
Q

what is hemothorax and its management

A

Presence of blood in the pleural space

Management: chest tube insertion, treat hypovolemia as needed

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20
Q

what is chylothorax and its management

A

Lymphatic fluid in pleural space

Management: chest tube, Octreotide, surgery, pleurodesis

21
Q

purpose of chest tube. and pleural drainage

A

to remove air, blood or fluid from pleural space (pleural tube) and reestablish negative pressure

22
Q

chest tube insertion equipment

A

chest tube, drainage system, sterile water, insertion tray

23
Q

pleural drainage devices

A

flutter (Heimlich) valve
PleurX catheter
Drainage system with suction

24
Q

what is a flutter (Heimlich) valve

A

One-way valve that allows air or drainage to collect in vented drainage bag

25
Q

what is a drainage system with suction and its 4 compartments

A

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)

26
Q

describe Drainage system with suction. compartment: Suction control chamber or dry suction regulator

A

controls amount of suction
(wet suction – sterile water – 20 cm of suction, gentle bubbling)
(dry suction – dial regulator – no water)

27
Q

describe Drainage system with suction. compartment: water seal chamber

A

contains 2 cm of water, acts as one-way valve preventing backflow of air to the pt.

28
Q

describe Drainage system with suction. compartment: air leak monitor

A

observe for bubbling air leak during inspiration

29
Q

describe Drainage system with suction. compartment: collection chamber

A

collects fluid & air vents to Area B/C

30
Q

nursing management for chest tubes and. pleural drainage

A

(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

31
Q

how to maintain a drainage system

A

(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

32
Q

chest tube removal

A

(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.

33
Q

complications chest trauma.

A

a) Tension pneumothorax
b) Cardiac tamponade
c) Bleeding
d) Infection
e) Subcutaneous emphysema
f) Unplanned removal of chest tube

34
Q

nursing diagnoses for chest trauma

A

(1) Impaired gas exchange
(2) Acute pain
(3) Decreased cardiac output

35
Q

assessment for chest trauma

A

(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

36
Q

actions for chest trauma

A

(1) Elevate head of bed
(2) Encourage cough and deep breathing
(3) Encourage ROM exercise and early ambulation
(4) Administer prescribed medications

37
Q

teaching for chest trauma

A

(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

38
Q

what are the different kinds of surgical procedures for chest surgery

A
  1. decortication
  2. exploratory thoracotomy
  3. lobectomy
  4. pneumonectomy
  5. segmental resection
  6. wedge resection
  7. other procedures: lung volume reduction surgery, video-assisted thoracic surgery
39
Q

what is decortication

A

Surgical removal or stripping of thick, fibrous tissue membrane from visceral pleura

40
Q

what is exploratory thoracotomy

A

incision into thorax to look for injured or bleeding tissues

41
Q

what is lobectomy

A

Removal one lobe of lung

42
Q

what is pneumonectomy

A

a) Removal of entire lung
b) Position on operative side to promote expansion of remaining lung

43
Q

what is segmental resection

A

Remove 1 or more lung segments

44
Q

what is wedge resection

A

Removal of small wedge shaped section of lung tissue

45
Q

preoperative care for chest surgery

A

Assess cardiovascular status

Teaching: surgical procedure, pain management – splinting, exercises T,C & DB, incentive spirometer, range of motion

46
Q

postoperative care after chest surgery

A

(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

47
Q

what is thoracentesis

A

aspiration of intrapleural fluid

48
Q

preparation for thoracentesis

A

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

49
Q

during and post thoracentesis

A

a. Monitor vital signs, pulse oximetry
b. Assess respiratory status and observe for resp distress
c. Obtain chest x-ray

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