Respiratory Flashcards
What do you need prior to a thoracentesis
Chest xray
Vitals
How do you position the client during a thoracentesis
Sitting up leaning over side table.
Sit in a chair backwards propped up over the chair.
Lie on unaffected side with HOB at 45degrees
What occurs in a thoracentesis
Fluid/blood/exudate is being removed from pleural space
What do you expect to occur as a result of a thoracentesis
The lungs to expand
What do you want to monitor as a result of thoracentesis
Vital signs
After a thoracentesis what should you do
get an cxr
Why would a client need a chest tube?
The lung have collapsed
If a chest tube is placed in the 2nd intercostal space what do you expect to be removed
air
If a chest tube is placed in the 8th or 9th intercostal space what do you expect to be removed
drainage
What is the purpose of a cdu
to restore normal vacuum pressure in the pleural space.
What do you do if the drainage chamber fills up
change it
What is the purpose of the water seal chamber
to promote one way flow and prevent air from going into patient
What do you do if you see bubbling/tidalling in the water seal chamber
It is normal when the client is breathing, coughing, sneezes or exhales.
It should be intermittent
What happens if a patient was on dry suction system, do you expect bubbling
No because there is no water to regulate the pressure. Instead a dial is used to give negative pressure.
As a nurse what are some things you need to assess for in a patient with a CDU
- Assess Dressing must be tight and intact
- Auscultate Lung sounds bilaterally
- Vitals-monitor o2 sats report anything 100 in the first hour and if there is a change in color to bright red
Record drainage for first 24 hours and then every 8 hours. Notify physciain if drainage is greater than 100 in the first hour and if there is a change in color to bright red - Encourage deep breath, cough, insentive spirometer
- Lab- watch for increased wbc, fever, and daily cxr
Where should the CDU be kept
below the level of the chest, if too high drainage will go back into patient
What do you monitor with the CDU system
Make sure there are no kinks, and it is a closed system. monitor water levers and tidaling.
What happens when tidalling stops?
Check the tubing, or is there a dependent loop present in the system then…
Check to see if the lung has re-expanded
What do you do if the tubing gets disconnected
Use sterile water that would be at the bedside, and reconnect as fast as you can
What happens if the water seal chamber falls over
Re-establish a water seal, set cdu upright and fill chamber to 2cm water.
Have client deep breath and cough in case any air went into pleural space
What if the chest tube was accidently pulled out
Maintain a 3 way valve opening with gauze
Is bubbling normal when chest tube is connected to suction and you see continous bubbling in the suction chamber
yes
Is bubbling normal when your client coughs and you see intermittent bubbling in the water seal chamber
yes
Is bubbling normal when you have continous bubbling in the water seal chamber
NO
What do you need in order to clamp a chest tube and why
An order, because it could cause a tension pneumothorax
When removing a chest tube, what do you ask the client to do
Deep breath, valsalva, and then place an occlusive dressing over site
What has happend to the lung that you need a pneumothorax/hemothorax and how?
Collapsed lung, due to accumulated blood or air in the pleural space
What s/s do you see in a hemo/pneumothorax
SOB Increase HR Decreased breath sounds to affected side less movement on affected side Chest pain Cough Subcutaneous emphysema
What would you see on the CXR of someone with a pneumo or hemothorax
air or fluid
What treatment options available for a person with a pneumothorax or hemothorax
Thoracentesis
Chest tubes
Daily cxr
Do you see intermittent bubbling in the water seal chamber of someone with a pneumothorax
yes
What occurs in a Tension Pneumothorax
Pressure build up in the plueral space and collapsed the lung, pressure pushes everything to opposite side, mediastinal shift
What can cause a tension pneumothorax
Trauma
PEEP
Clamping a chest tube
taping an open pneumothorax on all 4 sides
What are the S/S of a Tension pneumothorax
Subcutaneous emphysema Absent breath sounds Asymetry of thorax respiratory distress Eventually can lead to decreased cardiac output
What is the treatment plan for a tension pneumo
Large bore needle in the 2nd intercostal space to allow air to escape,
Then find the cause
Chest tubes will be inserted
What occurs in an open pneumothorax
The opening in the chest allow
What are treatment options for someone with an open pneumothorax
- Have client inhale and hold it
- Then place a gauze and tape on 3 sides
- Have the client sit up if possible to expand lungs, unless trauma patient
What is the most common injury from a chest trauma
Fractured ribs and sternum
When someone has: Pain and tenderness Crepitus Shallow resps and resp acidosis what could these be a sign of
Fractured rib and sternum
What treatment options are there for a fractured rib and sternum
Non-narcotic analgesic
nerve block to assist with productive cough
support injured area
Do not immobilize chest it could lead to shallow breathing, atelectasis and pneumonia
What complications could occur with a fractured rib and sternum
Pneumo/hemothorax
Flail chest
What is a flail chest
Multiple rib fractures
When a person has: pain paradoxical chest wall movement chest sucks inward on inspiration and puffs on expiration Dyspnea, cyanosis increased pulse What are these s/s related to
Flail chest
What are some treatment options for someone with a flail chest
- stabilize area, intubate, ventilate
2. Positive pressure ventilation stabilizes area
What are some types of positive pressure ventilation
- PEEP (positive end expiratory pressure)
- BiPap(Bi-level positive airway pressure)
- CPAP (continuous positive airway pressure)
Out of PEEP, BiPap, and CPAP which system would you use for someone on a ventilator
PEEP
Out of PEEP, BiPap, and CPAP which system would you use for someone with Sleep Apnea
CPAP or BiPap
Out of PEEP, BiPap, and CPAP which system would you use for someone with ARDS
PEEP
Out of PEEP, BiPap, and CPAP which system would you use for someone with COPD, heart failure
BiPap
Out of PEEP, BiPap, and CPAP which system would you use for someone with pulmonary edema or severe hypoxia
PEEP
If a person becomes dehydrated, has had a surgery and is immobile or is taking birth control pills, what are they at risk for
pulmonary embolism
What are some common s/s related to PE
- Hypoxemia
- Low PO2
- SOB, Cough and increased RR and Pulse and BP
- Increased D-Dimer
- Positive VQ Scan (dye is used)
- Positive spiral CT or CT angiograpy
- Hemoptysis
- Chest Pain
- CXR shows atelactasis
What do you do to prevent a PE
Early ambulation and hydration
Isometric exercises
What are some treatment options for PE
oxygen decrease pain anticoagulant - bleeding precautions surgery bed rest elevate extremities TED hose/SCD's Warm moist head decreases inflammation
