Pulmonary

Question 1

aPPT, PTT

Answer 1

Partial prothrombin time-heparin

Range is 20-30 seconds

Therapeutic range is 1.5-2.5 times normal range

Question 2

PT

Answer 2

Protime-Coumadin

Normal range 11-12.5 seconds

Therapeutic range 1.5-2 times normal range

Question 3

INR

Answer 3

International normalized range-Coumadin

Normal range 0.8-1.1

PE 2.5-3 Reoccurring PE 3-4.5

Question 4

Physical assessment of PE

Answer 4

Dyspnea
Pleuritic chest pain on inspiration
Auscultation: crackles or clear, wheezes or rubs
Tachycardia and low grade fever (early sign)
Diaphoresis (shock)
Hypotension
Transient ekg

Question 5

Psychosocial assessment of PE

Answer 5

Anxiety
Restlessness
“Impending doom”
Changes in LOC (decrease in o2)

Question 6

Laboratory assessment of PE

Answer 6

Respiratory alkalosis(low PaCo2)-early
Respiratory acidosis followed by metabolic acidosis-later
Low 02
Need metabolic panel, troponin, BNP, d dimer (will be increased if PE) base line clotting studies

Question 7

Imaging assessment for PE

Answer 7

Pulmonary angiography-main
CT-PA
Chest X-ray

Question 8

PE prevention

Answer 8

PROM or AROM for immobilized patients
TCDB&A post op
Ted hose, SCDs
Prevent compression in popliteal space
Assess need for anticoagulant therapy
Smoking cessation

Question 9

Managing hypotension in PE

Answer 9

IV fluids- isotonic
ECG monitoringCVP helps determine hydration
Monitor output, skin turgor, moisture of mucous membranes

Question 10

Reversal agent for heparin

Answer 10

Protamine sulfate

Question 11

Reversal agent for Coumadin

Answer 11

Vitamin k

Question 12

Minimizing bleeding in PE

Answer 12

Assure proper antidote to drug therapy available
Assess for bleeding every two hours
Check emesis, stools, urine, IV site
Avoid IM injections, blowing nose, rectal strain
Bleeding precautions

Question 13

Minimize anxiety in PE

Answer 13

02
Communication
Drug therapy-anti anxiety meds, pain meds (no NSAIDs)

Question 14

Thoracic trauma

Answer 14

1st approach to all chest injuries

Breathing
Airway
Circulation

Question 15

Pulmonary contusion

Answer 15

OCCURS MOST OFTEN BY DECELERATION DURING CAR CRASHES
Hemorrhage and edema can occur in/between alveoli reducing lung movement and gas exchange
Hypoxia, dyspnea over time, bruising on chest, cough, tachycardia, increased HR
Normal chest X-ray-first
Opacities develop later in X-ray

Question 16

Rib fractures

Answer 16

RESULT FROM BLUNT FORCE TRAUMA TO THE CHEST
Presents with pain on movement and splints affected side
Preexisting lung conditions increased risk for pneumonia

Analgesics for treatment to reduce pain and promote breathing

Question 17

Flail chest

Answer 17

BREATH IN CHEST COLLAPSES, 2 NEIGHBORING RIBS IN 2 OR MORE PLACES CAUSE PARADOXAL CHEST WALL MOVEMENT

Assessment: dyspnea, cyanosis, tachycardia, hypotension, paradoxical chest wall movement

Question 18

Flail chest interventions and management

Answer 18

Humidified o2
Pain management
TCDB
Tracheal suctioning
PEEP
ABGs

Question 19

Pneumothorax

Answer 19

ANY INJURY THAT ALLOWS AIR TO ENTER THE PLEURAL SPACE-BETWEEN THE VISCERAL AND PARIETAL
Lung can’t expand

Caused by blunt chest trauma
Open or closed

Question 20

Pneumothorax assessment findings

Answer 20

Decreased breath sounds
Lack of chest wall movements
Pleuritic pain
Tachypnea
SubQ emphysema-rice krispies under skin

Question 21

Pneumothorax interventions/management

Answer 21

Chest X-ray for diagnosis
Chest tube
Pain control
Continual assessment-respiratory failure

Question 22

Tension pneumothorax

Answer 22

RAPIDLY DEVELOPING COMPLICATION OF BLUNT CHEST TRAUMA RESULTS FROM AIR LEAK IN LUNG OR CHEST WALL
Complete collapse of affected lung
Air entering cavity upon inspiration doesn’t exit during expiration

Causes-chest trauma, PEEP, chest tubes

Question 23

Tension pneumothorax assessment findings

Answer 23

Asymmetry of thorax
Tracheal movement away from midline
DNV
Cyanosis
Hypoxia
Respiratory alkalosis

Question 24

Tension pneumothorax emergency management

Answer 24

Needle thoracostomy with large bore needle
Chest tube
Pain control

Question 25

Hemothorax

Answer 25

BLOOD ACCUMULATING INSTEAD OF AIR
Common after blunt chest trauma or penetrating injuries
Bleeding from injury to lung tissue or fx of ribs or sternum, trauma to heart, great vessels, or intercostal arteries

Question 26

Hemothorax assessment findings

Answer 26

Respiratory distress with decreased breath sounds
Dull percussion
Chest X-ray reveals blood in pleural space

Question 27

Hemothorax management and interventions

Answer 27

Focus on removing blood-improve breathing/prevent infection 
Chest tube to drain pleural cavity
Aggressive pain management 
Frequent vitals and I&Os
Transfusions and fluid replacement
Mechanical vent

Question 28

Chest tubes

Answer 28

Drain air, blood, or fluid from pleural space or thoracic cavity
May or may not be attached to suction

Question 29

Chest tubes placement and care

Answer 29

Insertion site protected with airtight dressing
6 ft of tubing-allows for pt movement
3 chambers/parts-collection, water seal, suction regulator

Question 30

Chest tubes-collection chamber

Answer 30

Collects fluid draining from pt and is checked hourly for 24 hours

More than 200 ml per hour call doc

Question 31

Chest tubes-water seal

Answer 31

Prevents air from reentering the pt pleural space
Air trapped in water creates bubbling, fill with 2cm of water

Bubbling will stop when air is removed from cavity or kink in tubing/problem with the chest tube collection

Question 32

Chest tubes-suction regulator

Answer 32

Suction control, wet or dry suction available

Question 33

Chest tubes management-QSEN

Answer 33

Maintain patency and sterility of the drainage system
Keep manipulation of tubing to a minimum
Frequently check resp assessment of pt and check device
Pain management
TCDB&A
Flutter valve or heimlich for palliative home treatment