Problems of lung expansion Flashcards
What is a pneumothorax
air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.
Examples of spontaneous pneumothorax (closed pneumothorax)
COPD, cystic fibrosis, bad case of pneumonia
Examples of traumatic pneumothorax
stab, fractured rib, subclavian line put in
What is an open pneumothorax
opening in chest cavity that air can go through (outside wound present)
What is a closed pneumothorax?
Air in pleural space without any outside wound
What is tension pneumothorax?
pressure buildup from air moving in pleural space and not being able to get out
S+S of tension pneumothorax?
sudden chest pain over shoulder
restless/agitated
trachea deviates to opposite side
Systems that tension pneumothorax affects?
respiratory (cyanosis, hypoxemia) + cardio system (tachy cardic)
What is hydrothorax?
fluid in the pleural cavity
- non-specific serous fluid (pleural effusion)
- lymph (chylothorax)
- blood (hemothorax)
- pus (empyema)
Clinical manifestations?
- respiratory distress with shallow rapid respirations, dyspnea, decreased 02 sat.
- chest pain when breathing deeply
- cough (with or without hemoptysis)
- asymmetrical chest movement
- no or diminished breath sounds over affected area
Diagnostic tests
- chest CT
- Chest ultrasound
- thoracentesis (drain fluid with large boar needle)
Indications for chest tubes
Goals of Chest Tubes as a therapy
- Removal of air and/or fluid
- Preventing drained air and/or fluid from returning to the pleural space
- Restoration of negative pressure within the pleural space to re-expand the lung.
Your role for insertion
- Educate patient and family
- Ensure comfort - Administer pain meds
- Set up chest drainage unit
- Assists with insertion PRN
- Verify occlusive dressing is intact
- Tape all connections from CT to drainage system to prevent air leaks
- Assess the patient and document appropriately
your role after tube insertion
- Ongoing clinical monitoring of the patient
- Assessment and management of the chest drainage system
- Monitor for complications
- Identify and treat real and potential clinical problems related chest drainage system.
how to increase 02 after tube insertion?
position in high fowlers, encourage coughing, increase fluid intake, use incentive spirometer
What is cardiac tamponade
compression of the heart by an accumulation of fluid in the pericardial sac
What is the collection chamber
- This chamber allows monitoring of volume, rate and nature of the drainage
- Measure output per hospital policy
- Most systems are considered “full” at 2500ccs
Water seal chamber assessment
-Water creates a one-way valve that prevents air or fluid from returning to the patient’s chest
-Monitor this chamber for:
air leaks (bubbling)
-tidaling (fluctuations in fluid level)
increased negative pressure
What does the suction control chamber do?`
- Regulates the suction level acceptable for thoracic drainage
- Suction increases drainage rate
- Suction is controlled by water level
- Regulate wall suction until gentle bubbles appear (or “Floater”)
- Pressure around 80 mmHg
Patient assessments?
- 02 sat
- breath sound auscultation
- assess pt q2-4h
- cardio + LOC assessment
- pain
Chest tube maintenance?
check for:
- kinks
- dependent loops
- verify extra tubing is coiled
- verify tube is placed below patient’s chest
How to mark drainage during shift?
mark line at end of shift with sharpie on collection container
how to spot an air leak in collection system?
watch for tidying in the water seal chamber
bubbling will be seen if air is leaving the chest (tube should be clamped if seen)
preventing infection on dressing
- Occlusive dressing using sterile technique
- ensure dressing stays dry
Don’t for chest tubes?
- tube should not be milked as it creates negative pressure
- should not clamp the tube
Complications of chest tubes?
bleeding/infection @ site
-subcutaneous emphysema (may need to maneuver tube)
Disconnection with Contamination steps to take?
-Submerge the tube 2 to 4 cm below the surface of a 250-mL bottle of sterile water or saline solution until a new CDU is set up.
-This establishes a water seal,
allows air to escape, and
prevents air re-entry.
Accidental D/C of Tube steps to take?
- Instruct the patient to perform the Valsalva maneuver.
- At end-expiration immediately cover the insertion site with a dry sterile dressing, and occlusive tape.
- Call the physician and prepare for re-inserting of the chest tube.
- Sit patient in high-Fowlers and place on oxygen.
- Assess for tension pneumothorax.
nursing care after tube removal?
- monitor to verify no fluid discharge
- repeat x-ray
- re-evaluate tube site
what is pleural effusion?
excess fluid buildup around the lung
what is a hemothorax?
collection of blood in the space between the chest wall and the lung (the pleural cavity)
what is a chylothorax?
type of pleural effusion. It results from lymph accumulating in the pleural cavity
what is a thoracentesis?
removal of excess fluid in pleural cavity with the use of a needle. used when there is not an excess amount of fluid.
fluid may also be sent for a biopsy to determine the cause of the accumulation of fluid
Rationale for using vaseline gauze on pleural dressing?
an air- and water-tight dressing. Provides a total seal without absorbent properties
