Respiratory Flashcards
pre-procedure for thoracentesis you need ___ and baseline ____
CXR
VS
position for thoracentesis
sitting up leaning over bedside table
if they can’t sit up what position for thoracentesis
lie on unaffected side with HOB at 45 degrees
since you are removing fluid with a thoracentesis you may put the client into a fluid volume ____
deficit
post procedure for thoracentesis
another CXR
if a chest tube is placed in the upper anterior chest it is for the removal of ____
air
if the chest tube is placed laterally in the lower chest then it is for the removal of _____
fluids
3 chambers of the chest tube drainage system
drainage collection chamber
water seal chamber
suction control chamber
you will see ____ in the water seal chamber
tidaling
you want to see what in the suction control chamber
slow gentle continuous bubbling
record drainage from a chest tube every hour for ___ hrs and then every ____ hrs
24 hrs
8hrs
notify dr when there is ____ ml of drainage from chest tube in one hour
100
who can transfer a client with a chest tube?
RN
LPN
tidaling (fluctuations) will stop when what has occurred?
lung re-expansion
what do you do if the tubing becomes disconnected?
another sterile connector at bedside
reconnect dirty one as fast as you can
the water seal chamber has ___ml of water in it
2
what if the chest tube is accidentally pulled out
occlusive dressing on 3 sides
when is bubbling a problem?
if there is continuous bubbling in the water seal chamber
how do you remove a chest tube?
have client take a deep breath and hold and place an occlusive dressing over the site
sx of hemo/pneumothorax
SOB increased HR diminished breath sounds less movement on affected side chest pain cough
treatment for hemo/pneumothorax
thoracentesis
chest tubes
daily CXR
if a pneumothorax is present and the client has a chest tube, what type of bubbling would be expected in the water seal chamber?
intermittent bubbling
causes of tension pneumothorax
trauma
PEEP
clamping a chest tube
taping all 4 sides
pressure has built up in the chest/pneural space and has collapsed the lung
pressure pushes everything to the opposite side
tension pneumothorax
sx of tension pneumothorax
subQ emphysema
absence of breath on one side
asymmetry of thorax
resp. distress
treatment of tension pneumothorax
large bore needle is place into 2nd intercostal space
opening through the chest allows air into the pleural space
open pneumothorax
tx of open pneumothorax
valsava
3 sided petroleum gauze
sit client up
most common injuries from chest trauma
rib and sternum fracture
sx of rib and sternum fractures
pain and tenderness
crepitus
shallow respirations
respiratory acidosis
treatment of rib and sternum fractures
non-narcotic analgesics
nerve block
support injured area with hands
no chest binders
flail chest occurs with multiple ___ fractures
rib
sx of flail chest
pain
paradoxical chest wall movement
dyspnea
increased pulse
treatment of flail chest
stabilize area
intubate
ventilate
(PEEP, CPAP, and BiPAP)
with PEEP, the client is on the ____
vent
on end expiration, the vent exerts pressure down into the lungs to keep the ____ open
alveoli
the classic reason to use PEEP is for?
ARDS
causes of pulmonary embolism
dehydration venous stasis BC pills clotting disorders A. fib
sx of pulmonary embolism
hypoxemia SOB increased D-dimer positive VQ scan a positive CT
treatment for pulmonary embolism
prevent
oxygen
ABGs
decrease pain
what are the common anticoagulant drugs?
heparin
warfarin
enoxaparin
normal aPTT
30-40 seconds
normal PT
11-12.5 seconds
therapeutic INR
2-3
