Week 10: Sucking Chest Wound Flashcards
What are the S&S of a sucking chest wound (SCW)
Sucking sound on inhalation, cyanosis, diminished chest sounds, visible wound, paradoxical chest movement, tachypnea, dyspnea, tachycardia
There is increased difficulty to ventilate with a sucking chest wound
True of False
True.
With a SCW, there is an open pneumothorax affecting the expansion and contraction ability and gas exchange leaving only one lung left for ventilation, chest pain
What is a pneumothorax?
Air infiltration within the pleural space, applying pressure on the lung and leading to possible collapse
What form of pneumothorax occurs with a sucking chest injury?
Traumatic pneumothorax
Respiratory Alkalosis is seen with a pneumothorax.
True or False?
False.
Respiratory acidosis is seen
(unable to release CO2, increases acidity) low pH (<7.35), High PaCO2 (>40)
A patient is on positive pressure chest tube, what would the nurse expect to find in the water chamber?
The water in the chamber will decrease with inhalation and increase with exhalation
A patient has a chest tube inserted for a pneumothorax. What should the nurse expect when assessing the drainage system?
1. periodic bubbling in the water seal chamber immediately after insertion
2. no evidence of tidaling
3. vigorous bubbling in the suction control chamber
4. large amount of bloody drainage in the drainage collection chamber
A patient has a chest tube inserted for a pneumothorax. What should the nurse expect when assessing the drainage system?
1. periodic bubbling in the water seal chamber immediately after insertion
2. no evidence of tidaling
3. vigorous bubbling in the suction control chamber
4. large amount of bloody drainage in the drainage collection chamber
1.
Global Rationale: When a chest tube is inserted in the pleural space for a pneumothorax, the trapped air is allowed to escape and periodic bubbling is observed in the water seal as the lung reexpands. The water column in the water seal should rise with inspiration and fall with expiration (tidaling). There should be gentle bubbling in the suction control chamber to avoid rapid evaporation of the fluid in the chamber. Large amounts of bloody drainage would be anticipated after chest tube insertion for hemothorax.
The nurse is caring for a patient on mechanical ventilation with positive end expiratory pressure (PEEP). When assessing the patient, which finding would indicate the possibility of tension pneumothorax?
1. new onset of absent breath sounds over the right lung
2. blood pressure of 170/80
3. pulse oximetry readings ranging from 94% to 96%
4. crackles and wheezing heard in both lungs
The nurse is caring for a patient on mechanical ventilation with positive end expiratory pressure (PEEP). When assessing the patient, which finding would indicate the possibility of tension pneumothorax?
1. new onset of absent breath sounds over the right lung
2. blood pressure of 170/80
3. pulse oximetry readings ranging from 94% to 96%
4. crackles and wheezing heard in both lungs
1.
Global Rationale: In a tension pneumothorax, air enters the pleural space with each breath but does not exit. Progressive accumulation of air in the pleural space leads to collapse of the lung on the affected side and hypoxia. As a result, the patient would have absent breath sounds on the affected side rather than adventitious sounds (crackles and wheezes). As the pressure in the thorax increases, cardiac output declines and the patient becomes hypotensive. A pulse oximetry reading of 94% demonstrates adequate oxygenation.
The nurse is assessing a patient recovering from a motor vehicle crash. Which assessment finding indicates that the patient is experiencing a pneumothorax?
1. hyperresonance to percussion at the apex of the left lung
2. dullness to percussion at the base of the left lung
3. crackles throughout the left lung
4. shallow breathing
The nurse is assessing a patient recovering from a motor vehicle crash. Which assessment finding indicates that the patient is experiencing a pneumothorax?
1. hyperresonance to percussion at the apex of the left lung
2. dullness to percussion at the base of the left lung
3. crackles throughout the left lung
4. shallow breathing
- Global Rationale: In pneumothorax, the percussion tone is hyperresonant due to the trapped air in the pleural space. Dullness to percussion is suggestive of fluid accumulation, such as in hemothorax. Crackles in the left lung suggest fluid accumulation in the alveoli. Shallow breathing can occur but is not specific to pneumothorax. It would also be seen in rib fractures and flail chest.
A patient is diagnosed with a tension pneumothorax. What should the nurse expect to assess in this patient?
Standard Text: Select all that apply.
1. hypertension
2. distended neck veins
3. bradycardia
4. absent breath sounds on the affected side
5. tracheal deviation toward unaffected side
A patient is diagnosed with a tension pneumothorax. What should the nurse expect to assess in this patient?
Standard Text: Select all that apply.
1. hypertension
2. distended neck veins
3. bradycardia
4. absent breath sounds on the affected side
5. tracheal deviation toward unaffected side
2, 4, 5
Global Rationale: Manifestations of a tension pneumothorax include hypotension, shock, distended neck veins, severe dyspnea, tachypnea, tachycardia, decreased respiratory excursion, absent breath sounds on affected side, and tracheal deviation toward unaffected side.
What are the possible complications of chest tubes?
Chest tube malposition
Re-expansion pulmonary edema
Vasovagal response with symptomatic hypotension
Infection at site
Pneumonia
Frozen shoulder
The healthcare provider is providing teaching on pleural effusions. The healthcare provider understands that teaching has been effective when the patient states:
Choose 1 answer:
A
“A pleural effusion is accumulation of fluid in the airways of the lungs.”
(Choice B) “A pleural effusion is an accumulation of fluid in the alveoli.”
B
“A pleural effusion is an accumulation of fluid in the alveoli.”
C
“A pleural effusion is an accumulation of blood in the airspace.”
D
“A pleural effusion is an accumulation of fluid in the pleural cavity
D
The patient is undergoing a thoracentesis for a pleural effusion. After the procedure, the healthcare provider will monitor the patient for which of the following possible complications of the procedure?
a. coagulopathy
b. pulmonary fibrosis
c. pneumothorax
d. respiratory acidosis
c. pneumothorax
What is a pleural effusion?
What are the S&S?
Fluid leaking into the pleural space
S&S- progressive dyspnea, pleuritic pain, decreased chest movement on affected side, dullness and decreased breath sounds on affected side
Define pleurisy
Inflammation of the pleura
