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Critical Care > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the worst kind of pneumothorax?

A

Tension pneumothorax

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2
Q

What is an open pneumothorax (sucking chest wound)?

A

Opening in the chest wall that allows air into the pleural space.

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3
Q

What is the treatment for an open pneumothorax?

A
  • inhale and hold valsalva or hum
  • place petroleum gauze over area and tape down on 3 sides (4th side acts like an air vent/flutter valve)
  • have client sit up (exception would be trauma patients who lie flat until evaluated)
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4
Q

Where is a chest tube placed for removal of air?

A

Upper anterior chest (2nd intercostal space)

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5
Q

Where is a chest tube placed for removal or drainage?

A

Lateral lower chest (8th or 9th intercostal space)

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6
Q

What should you do if a CDU (chest drainage unit) fills up?

A

Get a new unit.

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7
Q

What is the first chamber of a CDU? (closest to patient)

A

The drainage chamber.

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8
Q

What is the second chamber?

A

Water seal chamber.

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9
Q

What is the third chamber?

A

Suction control chamber.

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10
Q

What do fluctuations in the water seal chamber help identify?

A

Patency. The level will rise and fall as the patient breathes (tidaling) and is normal.

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11
Q

What does continuous bubbling in the water seal chamber indicate?

A

An air leak. Notify HCP.

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12
Q

Slow, gentle and continuous bubbling is normal in which chamber?

A

Suction control chamber.

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13
Q

What might cause tidaling in the water seal chamber to stop?

A

Re-expansion of the lung OR a kink in tubing OR dependent loop.

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14
Q

How must the dressing of a CDU be kept?

A

Tight and intact. Nurses may be required to reinforce the dressing.

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15
Q

What to do if CDU drainage is more than 200 mL in one hour or greater than 100 mL any hour after the first hour.

A

Notify HCP.

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16
Q

Where is chest drainage specimen obtained?

A

From the chest tube itself, with a 20 g needle.

17
Q

Transport of chest tube clients may only be delegated to who?

A

RNs/LPNs

18
Q

CDUs must be kept in what position?

A

Below the level of the chest.

19
Q

When is bubbling a problem with a CDU?

A

Continuous bubbling in the water seal chamber means air leak.

20
Q

What should you never do to a CDU without a prescription?

A

Clamp the chest tube…could lead to tension pneumothorax.

21
Q

What to do if CDU disconnects?

A

Reattach with another sterile connector at bedside. OR hold pressure and call for help.

22
Q

What if CDU falls over?

A

Reestablish water seal ASAP. Put end of tube in sterile water if necessary.

23
Q

How to remove chest tube?

A

Client takes deep breath and valsalva, place occlusive dressing over the site.

24
Q

Treatment for broken ribs?

A
  • non-narcotic analgesic
  • nerve block to assist with productive cough
  • incentive spirometry
  • nurse/patient may support injured area with hands
  • do NOT immobilize chest with binders and straps as it can lead to shallow breathing, atelectasis and pneumonia
25
Q

What is the classic reason to use PEEP?

A

ARDS

26
Q

What can PEEP do to help clients with flail chest?

A
  • improve gas exchange

- expands and realigns ribs so they can grow back together

27
Q

What is the priority assessment for any patient with PEEP, CPAP or Bi-PAP?

A

Lung sounds!

28
Q

What common S/S of pulmonary embolism can lead to right-sided heart failure?

A

Pulmonary hypertension.

29
Q

What is the lab test used to diagnose PE?

A

Increased D-dimer. Identifies presence of clots anywhere in the body.

30
Q

Are pneumatic compression devices used when DVT is suspected?

A

No, it could dislodge and become PE.

31
Q

What is the most frequently used test to diagnose PE?

A

CTA (Computerized Tomography Angiogram)

32
Q

How to prevent PE?

A
  • early mobilization
  • change position every 2 hours
  • prevent stasis
  • walk 4-6 times a day
  • TED hose
  • hydrate
33
Q

Treatment for PE?

A
  • bed rest, elevate affected extremity above heart
  • oxygen
  • pain management
  • anticoagulants
  • bleeding precautions
  • fibrinolytic agents like tPA
  • pulmonary embolectomy
34
Q

For what should you assess with a patient on PEEP with settings greater than 5mmH20?

A
  • pneumothorax

- decreased cardiac output

Critical Care (10 decks)

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