Respiratory

Question 1

If a chest tube is placed in the upper anterior chest (2nd intercostal space) then it is for removal of ______.

Answer 1

Air

Question 2

If a chest tube is placed laterally in the lower chest (8th or 9th intercostal space) then it is for removal of _______.

Answer 2

Fluid/exudate

Question 3

Can you see bubbles in the water seal chamber of a chest tube drainage system?

Answer 3

Yes - when patient coughs, sneezes, exhales

Question 4

What is it called when you see s light rise and fall of water in the water seal tube as the patient breathes?

Answer 4

Tidaling - this is normal

Question 5

When should you notify the physician of a patient’s chest tube drainage?

Answer 5

> Change in color to bright red

Question 6

What should you do if the chest tube is accidentally pulled out?

Answer 6

Tape sterile vaseline gauze down on 3 sides

Question 7

What should you do if the chest drainage unit falls over and the water leaks out?

Answer 7

Set it upright and add more water

Have patient cough in case any air went into the pleural space

Question 8

Blood or air has accumulated in the pleural space and the lung has collapsed. Symptoms include SOB, increase HR, diminished breath sounds and movement on the affected side, chest pain, and cough.

Answer 8

Hemothorax/pneumothorax

Question 9

Pressure has built up in the chest/pleural space and has collapsed the lung. The pressure pushes everything to the opposite side. Symptoms include subcutaneous emphysema, absence of breath sounds on one side, asymmetry of thorax, and respiratory distress.

Answer 9

Tension Pneumothorax

Question 10

How do you treat a tension pneumothorax?

Answer 10

Large bore needle into 2nd intercostal space to allow excess air to escape
Find cause
Chest tubes

Question 11

Opening through chest that allows air into the pleural space.

Answer 11

Open pneumothorax (sucking wound)

Question 12

How do you treat an open pneumothorax?

Answer 12

Have client inhale and hold
Tape piece of petroleum gauze down on 3 sides
Have client sit up if possible to expand lungs

Question 13

What are 4 symptoms of flail chest (multiple rib fractures that have separated from the sternum or the sternum has cracked)?

Answer 13

1. Pain
2. Paradoxical chest wall movement
3. Dyspnea/cyanosis
4. Increased pulse

Question 14

What are 3 ways flail chest is treated?

Answer 14

1. Stabilize the area - 1st priority
2. Intubate
3. Ventilate

Question 15

How does Positive End Expiratory Pressure help treat flail chest?

Answer 15

Expands and realigns the ribs so they can start growing back together

Question 16

What are 7 symptoms of a pulmonary embolism?

Answer 16

1. Hypoxemia - low O2 sat
2. SOB
3. Tachycardia
4. Tachypnea
5. Pulmonary HTN
6. Hemoptysis
7. Chest pain

Question 17

What position should you put a patient in for a thoracentesis if they are unable to sit up?

Answer 17

Lie on unaffected side with HOB at 45 degrees

Question 18

What is a complication of a thoracentesis?

Answer 18

Fluid volume deficit