Respiratory Flashcards
What is the worst kind of pneumothorax?
Tension pneumothorax
What is an open pneumothorax (sucking chest wound)?
Opening in the chest wall that allows air into the pleural space.
What is the treatment for an open pneumothorax?
- 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)
Where is a chest tube placed for removal of air?
Upper anterior chest (2nd intercostal space)
Where is a chest tube placed for removal or drainage?
Lateral lower chest (8th or 9th intercostal space)
What should you do if a CDU (chest drainage unit) fills up?
Get a new unit.
What is the first chamber of a CDU? (closest to patient)
The drainage chamber.
What is the second chamber?
Water seal chamber.
What is the third chamber?
Suction control chamber.
What do fluctuations in the water seal chamber help identify?
Patency. The level will rise and fall as the patient breathes (tidaling) and is normal.
What does continuous bubbling in the water seal chamber indicate?
An air leak. Notify HCP.
Slow, gentle and continuous bubbling is normal in which chamber?
Suction control chamber.
What might cause tidaling in the water seal chamber to stop?
Re-expansion of the lung OR a kink in tubing OR dependent loop.
How must the dressing of a CDU be kept?
Tight and intact. Nurses may be required to reinforce the dressing.
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.
Notify HCP.
Where is chest drainage specimen obtained?
From the chest tube itself, with a 20 g needle.
Transport of chest tube clients may only be delegated to who?
RNs/LPNs
CDUs must be kept in what position?
Below the level of the chest.
When is bubbling a problem with a CDU?
Continuous bubbling in the water seal chamber means air leak.
What should you never do to a CDU without a prescription?
Clamp the chest tube…could lead to tension pneumothorax.
What to do if CDU disconnects?
Reattach with another sterile connector at bedside. OR hold pressure and call for help.
What if CDU falls over?
Reestablish water seal ASAP. Put end of tube in sterile water if necessary.
How to remove chest tube?
Client takes deep breath and valsalva, place occlusive dressing over the site.
Treatment for broken ribs?
- 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
What is the classic reason to use PEEP?
ARDS
What can PEEP do to help clients with flail chest?
- improve gas exchange
- expands and realigns ribs so they can grow back together
What is the priority assessment for any patient with PEEP, CPAP or Bi-PAP?
Lung sounds!
What common S/S of pulmonary embolism can lead to right-sided heart failure?
Pulmonary hypertension.
What is the lab test used to diagnose PE?
Increased D-dimer. Identifies presence of clots anywhere in the body.
Are pneumatic compression devices used when DVT is suspected?
No, it could dislodge and become PE.
What is the most frequently used test to diagnose PE?
CTA (Computerized Tomography Angiogram)
How to prevent PE?
- early mobilization
- change position every 2 hours
- prevent stasis
- walk 4-6 times a day
- TED hose
- hydrate
Treatment for PE?
- bed rest, elevate affected extremity above heart
- oxygen
- pain management
- anticoagulants
- bleeding precautions
- fibrinolytic agents like tPA
- pulmonary embolectomy
For what should you assess with a patient on PEEP with settings greater than 5mmH20?
- pneumothorax
- decreased cardiac output
