Respiratory

Question 1

List interventions to prevent the development of a DVT (4).

Answer 1

1. SCDs
2. Anticoagulants
3. Early ambulation
4. Exercises to avoid venous stasis

Question 2

Heparin therapy: Lab value to monitor? Antagonist?

Answer 2

Lab: PTT (30-40) or aPTT, anti-Xa
Antagonist: Protamine sulfate

Faster onset than warfarin

Question 3

Warfarin therapy: Lab value to monitor? Antagonist?

Answer 3

Lab: PT (10-13) & INR (2.0-3.0 on warfarin, <1.0 normal)
Antagonist: Vitamin K

Question 4

List medications that can be given if a patient has heparin-induced thrombocytopenia (HIT).

Answer 4

Thrombin inhibitors: (-ban, -rudin)
- Argatroban
- Rivaroxaban
- Dabigatran
- Bivalirudin
- Desirudin
- Lepirudin

Warfarin contraindicated, can lead to tissue necrosis. HIT more prone to bleeding, less platelets.

Question 5

Discuss conditions that would result in a chest tube being inserted in a patient.

Answer 5

• Pneumothorax, hemothorax
• Blunt or penetrating trauma
• Pleural effusion
• Flail chest

From pulmonary or heart contusion, sternal or rib fractures

Question 6

What is the purpose of chest tubes? (4)

Answer 6

• Treat pneumothorax/hemothorax
• Establish negative pressure
• Drain fluid/air
• Facilitate lung expansion

Question 7

Nursing management of chest tubes

Answer 7

• Tidaling is normal
• Maintain occlusive dressing
• Secured with tape at connection
• Keep below level of chest
• Never clamp without an order
• Monitor drainage chamber, water seal chamber & suction chamber (wet or dry)
• Monitor output (measure & color)
• Monitor respiratory status
• Keep hemostats, sterile water & dressing supplies nearby
• Watch out for complications (leaks, removal)

Question 8

Purpose of suction control (dry or wet).

Answer 8

Reestablish negative intrathoracic pressure

Question 9

Purpose of water seal chamber on a pleura vac.

Answer 9

• Air exits & prevents air from flowing back to chest
• Filled to 2 cm mark to maintain underwater seal
• Fluctuates as client breathes
• Intermittent (not continuous) bubbling is normal

Question 10

List signs and symptoms of a pneumothorax/hemothorax.

Answer 10

• Dyspnea
• Tracheal deviation towards unaffected side
• On affected side:
  Diminished breath sounds
  Percussion dullness
  Unequal chest expansion
• Crepitus over the chest
• Other: Tachypnea, hypotension, cyanosis, diaphoresis, air hunger, agitation