Quiz 2 - Modules 5 & 6 Flashcards
1
Q
How Breathing Occurs
A
- diaphragm contacts, moves down, makes thoracic cavity bigger
- increases volume and decreases pressure
- diaphram relaxes, moves up
- decreases volume and increases pressure
- If two areas of different pressure communicate, gas will move from area of higher pressure to area of lower pressure
2
Q
Chest Tube Thoracostomy
A
placing a hollow plastic tube between the ribs and into the chest to drain fluid or air from around the lungs in pleural space
* reestablish intrapleural pressure
* promote lung expansion and restore adequate oxygenation
* drains for hemo/pneumothorax, pleural effusion
* want to remove air/fluid promptly
* prevent air/fluid from returning
* restore negative pressure
3
Q
Pneumothorax
A
- Air between pleural space
- Occurs from central line placement, chest surgery, trauma to chest wall, traumatic intubation, mechanical ventilation
- Chest tube placement in upper thoracic cavity towards apex of the lungs
4
Q
Hemothorax
A
- Blood in pleural space
- Occurs from chest surgery, central line placement, chest trauma
- Chest tube placement towards lower aspect of thoracic cavity towards base of the lung
5
Q
Pleural Effusion
A
Transudate or exudate in pleural space
* Transudate: clear fluid from CHF, malnutrition, renal or liver failure
* Exudate: cloudy fluid with cells and proteins from TB and pneumonia
6
Q
Chest Tube Placement Check-Off
A
- consent
- correct placement - CXR
- sutured in place
- airtight dressing
- local anesthetic
- supplemental O2
- monitor for hypotention with loss of fluids
- need thoracotomy tray: larger tubes for liquid, smaller for air
- pleural vac for drainage
- positioning dependent on air/fluid
7
Q
Disposable 3 Chamber System
A
- Drainage collection
- Water seal
- Suction chamber: one for wet and one for dry
8
Q
Water Seal Chamber
A
- Tube from patient in 2 cm of water
- Prevents air and fluid from coming back into pleura
- Tidals with respirations: normal fluctuations that increase with inspiration and decrease with expiration (opposite on ventilator)
- No tidals: tube may be kinked or clamped
- Bubbling: air leak, can clamp in different places to find it
9
Q
Collection Chamber
A
- Keep upright below patient’s chest
- Assess color in drainage, report excessive
- Mark right on unit q1 hr every 24 hrs then q8 hrs - do not empty
- Encourage frequent position changes and coughing
10
Q
Wet Suction
A
- For harder secretions that need to be drained
- Fill suction control chamber with 20 cm of water
- Degree of suction is set by water level
- Gentle bubbles: normal
11
Q
Dry Suction
A
- No water column
- Suction monitor is below
- Dial control on side of unit
- Balances wall suction
12
Q
Care Considerations with Chest Tubes
A
- Assess for subq emphysema: collection of air in tissues under the skin, can threaten airway
- Assess for resp status, drainage, occlusive dressing, connections are taped, tubing is free of kinks, no infection at site
13
Q
Tension Pneumothorax
A
- S/S: trachial deviation towards pneumo, absent breath sounds on one side, JVD, resp distress, asym lung expansion, cyanosis, low BP/shock, organs get pushed
- Never clamp tube unless necessary: replacing unit or finding air leak
- Do not strip or milk tubing since it generated extreme negative pressure
14
Q
Emergency Equiptment for Chest Tube
A
- 2 Kelly clamps
- 1 vaseline gauze
- 4x4 gauze
- New drainage system
- Sterile water: 250mL container
15
Q
Dislodged Chest Tube
A
- Cover with sterile gauze and tape it on 3 sides to allow air to escape - can cause tension pneumo
16
Q
Chest Tube Removal
A
- Indications: Improved resp status, symmetrical rise and fall of chest, bilateral breath sounds, decreased chest tube drainage, absence of bubbling, improved CXR findings
- Assess breath sounds, RR, O2 levels, pain before and after
- Meds 30 mins prior
- Allow patient to bare down to prevent air from entering pleural space
- Site secured with occlusive dressing and heavy weight stretch tape
- CHR placed to ensure lung is fully inflated
17
Q
Respiratory Artificial Airways
A
- For patients with decreased level of consciousness and airway is at risk for obstruction or become obstructed
- Maintains airway patency
- Aids in removal of secretions
- Risk for infection and airway injury
- Clean technique for oral airway, sterile for endotrach and trach
- Need to stay in correct position
18
Q
Oropharyngeal Airway
A
- Used to keep upper airway patent when at risk of being obstructed by tongue or secretions
- Extends from teeth to oropharynx - maintains tongue in normal position
- Measuring: corner of patient’s mouth to angle or jaw below the ear
- If too small: tongue will not stay positioned in anterior part of mouth
- Too large: push tongue towards epiglottis and obstruct airway
- Triggers gag reflex
- To insert: curved part goes upwards until reaches back of the mouth, then is rotated 180 degrees
19
Q
Nasopharyngeal Airway
A
- Keeps upper airway patent
- Inserted through nares and extend to pharynx
- Measured from nose to angle of jaw
- No gag reflex, for patients that are alert
20
Q
Endotrachial Tube
A
- Used to administer mechanical ventilation, relieve upper airway obstruction, protect against aspiration, or clear copious amounts of secretions
- Short term, not more than 14 days, put risk of infection and airway injury
- Placed either through nose or mouth past epiglottis and vocal cords into the trachea and down when it bifurcates into bronchi
- Use Laryngoscope to visualize patient anatomy, has light in it
- Size determined by age and size of patient
- Adults will have cuff that is inflated with air after insertion to prevent air from leaking around the tube and prevent oral and gastric secretions from being aspirated
21
Q
Laryngeal Mask Airway
A
- Used for paramedics or other less experienced providers, fast and accurate placement regardless of circumstances
- Less gastric distention, not induce aspiration
- Good for when patient does not need to be intubated for long time or placement of ET tube not feasible
22
Q
Tracheostomy Tube
A
- Used to establish a surgical airway via tracheotomy
- Placed below level of larynx – unable to speak
- May be permanent or temporary
- indications: replace ET tube, mechanical vent, acute or chronic airway obstruction, copious secretions
23
Q
Nurse’s Role in Intubation
A
- Check and assemble equipment
- Hand equiptment to provider
- Check pulse ox
- Secure tape or ET holder to prevent deviation
- CXR and ABG
- Confirm tube position via auscultation, bilateral chest rise, tube locator at teeth (20-25cm), CO2 detector - pH sensitive and will turn purple to yellow
- False positives whenwhen gastric contents, mucus, epi come in contact – will permanently change to yellow and not fluctuate
24
Q
Stabilizing ETT
A
- Use tape or prepackaged ET tube holder with Velcro
- Assess resp status every 2 hrs
- Assess nasal and oral mucosa for redness or irritation
- Place patient in semi fowlers or side lying - reposition every 2 hours
- Monitor cuff pressure: 20-25mm to minimalize risk of necrosis
- Oral care every 4 hours using antibacterial solution and use bite block to avoid biting down on tube
- Communicate frequently with patient and give them means to communicate with like a white board
25
Q
Metal Trach Tube
A
Temp sensitive, must be protected from heat and cold to prevent tissue injury
26
Q
Double Cannula
A
- Contains outer and inner cannula
- Permanent inner cannula: take out, clean, put back in
- Disposable inner cannula: can dispose and get new one
27
Q
Parts of Trach Tube
A
- Outer cannula: outer tube that holds trach open
- Obturator: inserted into the main body of the tracheostomy tube and acts as a guide to help place the trach tube into the airway
- Inner cannula: held in place by twist lock or pressure clip at base of flange
- Flange: Have holes to hold trach in place with tape or Velcro
- Cuff: Balloon around distal end of cannula, forms seal
