Quiz 2 Flashcards
What is pneumothorax?
accumulation of air in the pleural space causing partial or all of the lung to collapse
What is spontaneous pneumothorax? What are the two types?
air in the intrapleural space
no preceding trauma or underlying disease
primary: tall white slender males age 10-30 at higher risk
secondary: anyone can get it, patients with long term emphysema at risk
What is iatrogenic pneuomothorax?
caused by medical procedures
air in the pleural space
What is traumatic pneumothorax?
air in pleural cavity, can enter and leave
can lead to hemothorax and hemopneumothorax
penetrating
- can lead to tension pneumothorax
- due to penetrating wound
- GSWs and stab wounds
blunt
- car accident
What is hemothorax?
blood in pleural space from injury to chest wall, diaphragm, lung, blood vessels, or mediastinum
What is hemopneumothorax?
blood and air in the pleural space
What is chylothorax?
- lymphatic fluid in the pleural space
- seen in children often
risk factors
- post op thoracic sx
- congenital abnormalities of thoracic cavity
- empyema
What is tension pneumothorax?
- caused by trauma or disease
- air enters in the pleural space but can’t leave from penetrating injury
- leads to mediastinum shifts (CXR) and tracheal deviation and JVD
- heart becomes compressed–cardiogenic shock–death
What are the clinical manifestations of pneumothorax?
pleural pain
tachycardia
flared chest
dyspnea
respiratory distress
absent breath sounds
hyperresonance or dullness (trapped air)
subcutaneous emphysema
decreased cardiac output
What is subcutaneous emphysema?
- crepitus
- air accumulating in SQ tissue
- trapped usually in upper chest
What diagnostic studies are there for pneumothorax?
ABG - PaO2 < 80 mmHg
CXR - confirms
thoracentesis
What should a nurse tell a patient who is about to have a thoracentesis? What will the nurse do after?
pre- pt will feel pressure, but no pain
post- monitor status (VS, O2, inj. site)
What is the treatment for pneumothorax?
- spontaneous resolution
- urgent needle decompression (tension pneumothorax)
- thoracentesis
- chest tube (primary tx)
- pleurodesis (rx chemically destroys area that keeps rupturing–sealed)
What medications can be given for pneumothorax? Why?
Why should they be used cautiously?
benzodiazepines (lorazepam or midazolam)
opioid (norco - hydrocodone/acetaminophen)
used for treatments that can cause anxiety/pain
caution: can cause resp. depression
What are the nursing interventions for pneumothorax?
O2 therapy
semi-fowler’s
VS and lung sound monitor Q4
IV therapy for circulatory support
chest tube drainage care
respiratory/pulmonary consult
What is the order of supplemental oxygen devices?
Nasal cannula 2-6 L
Simple mask 6-10 L
Nonrebreather 10-15L
What is a chest tube?
catheter attached to drainage system
What does a chest tube do?
remove air or fluid from pleural and/or mediastinal space
re establish negative pressure
re-expand lung (primary goal)
What is a pigtail tube and heimlich valve?
one way system that allows air to exit pleural space
What are the components of a pleural drainage system?
collection chamber
water seal chamber
suction control chamber (wet or dry)
In the water seal chamber, what is tidaling? What does it indicate? What does it mean when there is no tidaling?
movement of fluid level with respirations (expected finding)
indicates proper function/patency
no tidaling = lung has re expanded
In the water seal chamber, how will one know if there in an air leak?
continuous bubbling = large leak
intermittent bubbling = air leak b/w pt and drainage system
In the suction control chamber for a wet suction system, what does the water do? How is it regulated?
uses water to control the amount of suction from the wall regulator
regulated by adding water to the suction control chamber
What does it mean when it is a dry system in suction control chamber? How is it regulated?
no water
self-regulated with an internal barometer
When is continuous bubbling acceptable in the suction control chamber?
when wall suction is turned on for a wet system in the suction control chamber only
Where should the drainage device be placed in the room? Why?
below the patient due to risk of air coming back
avoid kicking
What items must be present in a patient’s room when a chest tube is placed?
4x4s
vaseline gauze
kelly clamps/forceps
paper or medipore tape
sterile water or normal saline
What are the nursing interventions for a patient’s clinical status who just had a chest tube placed?
monitor VS, lung sounds, and pain
monitor for complications:
- re-accumulation of air/fluid in lung
- bleeding
- infection
- subcutaneous emphysema
What are the nursing interventions for set up and insertion for a chest tube?
verify informed consent
position patient
gather and set up equipment
What are the nursing interventions for a chest tube drainage system?
do not elevate above pt
maintain patency
secure all connections
monitor tidaling
monitor fluid level in collection chamber
reestablish water-seal if disconnects
have client cough and deep breath
What are the nursing interventions for a dressing change for a patient with a chest tube?
observe sterile technique
use sterile occlusive dressing
What will a nurse teach a client who just had a chest tube placed?
encourage:
CDB
incentive spirometer
ROM on affected side
What are the nursing interventions for the removal of a chest tube?
premedicate client
ask client to bear down
apply occlusive dressing
monitor respiratory distress
obtain CXR
What is pleural effusion? What is heard through auscultation and percussion?
collection of fluid in the pleural space
ausc: crackles
percus: dullness
What are the types of pleural effusion?
transudative
- rare
- clear pale yellow
- fluid that comes from movement of blood, noninflammatory
exudative
- most common
- from infection
- inflammatory reaction
empyema
- pus
- caused by pneumonia, TB
What are the clinical manifestations of pleural effusion?
dyspnea
cough
non-radiating chest pain (worse on inhalation)
diminished breath sounds
decreased chest movement
dullness on percussion
empyema
What are the clinical manifestations of empyema?
same as pleural effusion
Also includes:
fever
night sweats
weight loss
What is the treatment for pleural effusion?
thoracentesis
chemical pleurodesis
empyema
- chest tube
- antibiotic
- decortication
What is decortication?
the removal of fibrous tissue from the surface of the lungs
What might indicate the chest tube is dislodged?
crepitus around the chest tube insertion site
