T3: Chest Trauma Flashcards
blunt trauma
*occurs when the chest strikes or is struck by an object
Penetrating trauma
is an injury in which a foreign object impales or passes through the body tissues, creating an open wound
treatment options for chest trauma
depends on severity; may resolve spontaneously
*Thoracentesis
*Chest tubes
*Pleurodesis
thoracentesis
surgical puncture to remove fluid from the pleural space
Pleurodesis
creation of adhesions between the parietal and visceral pleura to treat recurrent pneumothorax
most common rib fracture
5-9
clinical manifestations of rib fractures
*Pain
*Splinting
*Shallow respirations
What can rib fractures lead to?
atelectasis and pneumonia
treatment for rib fracture
*NO strapping or binding chest
*NSAIDs, opioids, nerve blocks
patient teaching for rib fracture
*Deep breathing and coughing
*Incentive spirometry
*Appropriate use of anaglesics
flail chest
fracture of two or more adjacent ribs in two or more places that allows for free movement of the fractured segment
clinica manifestations of flail chest
-movement of thorax is asymetric and uncoordinated (moves air poorly)
-rapid shallow breaths
-tachycardia
-chest splinting
diagnosis of flail chest
-Observation of abnormal thoracic cavity movements
-palpitation for crepitus near the rib fractures
-chest x-ray
management of flail chest
*Adequate airway and ventilation
*Oxygen therapy
*Analgesia
*Surgical fixation
signs of respiratory distress
*Dyspnea
*Cough with or without hemoptysis
*Cyanosis
*Tracheal deviation
*Decreased breath sounds
*Decreased O2 saturation
*Frothy secretions
signs of cardiovascular compromise
*Rapid, thready pulse
*Decreased BP with narrowed pulse pressure and/or asymmetric readings
*Distended neck veins
*Muffled heart sounds
*Chest pain
*Dysrhythmias
Initial interventions for any patient with chest trauma include
*Circulation, airway, breathing
*Administer O2
*Establish IV access with 2 large-bore catheters and begin fluid resuscitation as appropriate
*Remove clothing to assess injury
*Cover sucking chest wound with nonporous dressing taped on 3 sides
*Stabilize impaled objects
*Place patient in a semi-Fowler’s position or on injured side
*After ruling out cervical spine injury
*Administer analgesia
*Prepare for emergency needle decompression
sucking chest wound care
(an open chest wound)
*Cover with nonporous dressing taped on 3 sides
when there is a chest wound with an impaled object
*Stabilize impaled objects with bulky dressings. Do not remove object.
Chest Tubes and Pleural Drainage
-To remove air or fluid from pleural and/or mediastinal space
-Reestablishes negative pressure
-Lung reexpands
Flutter (Heimlich) Valve
-One-way valve that is used to evacuate air from the pleural space, attached to a drainage bag that has a vent opening
Bubbling in water-seal chamber indicates
air leak
Tidaling in water chamber of chest tube reflects
*changes in pressure, this will disappear as lung reexpands
treatments for lung cancer
chemo, radiation, or surgery
SE of chemo
-NV; anorexia
-mucosal irritation
-alopecia
-mood changes/depression
nadir
WBC count LOW after chemo and makes the patient at increased risk for oppportunistic infection (usually 10-14 days after chemo)
Chemo precautions
isolation for patient, no fresh flower, fruit or veggies
clinical manifestations of lung cancer
*Anorexia, fatigue, weight loss
*Nausea/vomiting
*Hoarseness
*Unilateral paralysis of diaphragm
*Dysphagia
*Palpable lymph nodes
PET scan
scans for metastasis by giving glucose, tumors love glucose so they will soak it up and the scan will light up where there is a tumor
thoracotomy
incision of the chest
lobectomy
removal of a lobe
Pneumonectomy
removal of a lung
post op concerns of thoracotomy
*Pain
*Chest tubes
*Respiratory distress and effort
*Daily CXRs for lung re-xpansion
*Pneumonectomies—area fills with fluid
if a lung transplant is done, what does the patient need to do
-take antirejection medications (on the minute and hour, lifelong)
-vaccinations (not live ones)
3 meds specific to suppress immune system:
-Mycophenolate Cellcept
-Tacrolimus
-Prednisone
Rejection signs and symptoms:
Fever, chills, fatigue, dyspnea, cough, low O2 sats
