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Med/Serg > Problems of lung expansion > Flashcards

Problems of lung expansion Flashcards

1
Q

What is a pneumothorax

A

air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.

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2
Q

Examples of spontaneous pneumothorax (closed pneumothorax)

A

COPD, cystic fibrosis, bad case of pneumonia

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3
Q

Examples of traumatic pneumothorax

A

stab, fractured rib, subclavian line put in

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4
Q

What is an open pneumothorax

A

opening in chest cavity that air can go through (outside wound present)

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5
Q

What is a closed pneumothorax?

A

Air in pleural space without any outside wound

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6
Q

What is tension pneumothorax?

A

pressure buildup from air moving in pleural space and not being able to get out

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7
Q

S+S of tension pneumothorax?

A

sudden chest pain over shoulder
restless/agitated
trachea deviates to opposite side

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8
Q

Systems that tension pneumothorax affects?

A

respiratory (cyanosis, hypoxemia) + cardio system (tachy cardic)

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9
Q

What is hydrothorax?

A

fluid in the pleural cavity

  • non-specific serous fluid (pleural effusion)
  • lymph (chylothorax)
  • blood (hemothorax)
  • pus (empyema)
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10
Q

Clinical manifestations?

A
  • 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
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11
Q

Diagnostic tests

A
  • chest CT
  • Chest ultrasound
  • thoracentesis (drain fluid with large boar needle)
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12
Q

Indications for chest tubes

Goals of Chest Tubes as a therapy

A
  • 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.
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13
Q

Your role for insertion

A
  • 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
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14
Q

your role after tube insertion

A
  • 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.
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15
Q

how to increase 02 after tube insertion?

A

position in high fowlers, encourage coughing, increase fluid intake, use incentive spirometer

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16
Q

What is cardiac tamponade

A

compression of the heart by an accumulation of fluid in the pericardial sac

17
Q

What is the collection chamber

A
  • This chamber allows monitoring of volume, rate and nature of the drainage
  • Measure output per hospital policy
  • Most systems are considered “full” at 2500ccs
18
Q

Water seal chamber assessment

A

-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

19
Q

What does the suction control chamber do?`

A
  • 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
20
Q

Patient assessments?

A
  • 02 sat
  • breath sound auscultation
  • assess pt q2-4h
  • cardio + LOC assessment
  • pain
21
Q

Chest tube maintenance?

A

check for:

  • kinks
  • dependent loops
  • verify extra tubing is coiled
  • verify tube is placed below patient’s chest
22
Q

How to mark drainage during shift?

A

mark line at end of shift with sharpie on collection container

23
Q

how to spot an air leak in collection system?

A

watch for tidying in the water seal chamber

bubbling will be seen if air is leaving the chest (tube should be clamped if seen)

24
Q

preventing infection on dressing

A
  • Occlusive dressing using sterile technique

- ensure dressing stays dry

25
Q

Don’t for chest tubes?

A
  • tube should not be milked as it creates negative pressure

- should not clamp the tube

26
Q

Complications of chest tubes?

A

bleeding/infection @ site

-subcutaneous emphysema (may need to maneuver tube)

27
Q

Disconnection with Contamination steps to take?

A 
-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.

28
Q

Accidental D/C of Tube steps to take?

A
  • 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.
29
Q

nursing care after tube removal?

A
  • monitor to verify no fluid discharge
  • repeat x-ray
  • re-evaluate tube site
30
Q

what is pleural effusion?

A

excess fluid buildup around the lung

31
Q

what is a hemothorax?

A

collection of blood in the space between the chest wall and the lung (the pleural cavity)

32
Q

what is a chylothorax?

A

type of pleural effusion. It results from lymph accumulating in the pleural cavity

33
Q

what is a thoracentesis?

A

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

34
Q

Rationale for using vaseline gauze on pleural dressing?

A

an air- and water-tight dressing. Provides a total seal without absorbent properties

Med/Serg (10 decks)

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