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MedSurg 2 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is a pneumothorax?

A

Accumulation of air in the pleural space causing partial or all of lung to collapse.

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2
Q

What are the different types of pneumothorax?

A
  1. spontaneous
  2. Iatrogenic
  3. Traumatic: penetrating or blunt
  4. Hemothorax
  5. Hemopneumothroax
  6. Chylothorax
  7. Tension pneumothorax
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3
Q

What population is a chylothoarx typically seen in?

A

seen in kiddos

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4
Q

Why is a tension pneumothorax the most dangerous?

A

due to the lung collapsing

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5
Q

What is a tension pneumothorax?

A

penetrating injury where you can breathe in but air can no longer expel out.

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6
Q

With a tension pneumothorax, what will happen to the organs?

A

organs will shift aka mediastinal shift which is SPECIFIC to a tension pneumothorax

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7
Q

Besides a mediastinal shift caused by a tension pneumothorax, what other issue may occur?

A

hemodynamic instability.

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8
Q

what are some clinical manifestations of a pneumothorax?

A
  1. anxiety
  2. pleuritic pain
  3. asymmetrical chest wall movement
  4. mild dyspnea and tachycardia to respiratory distress
  5. diminished or absent breath sounds on affected side
  6. **HYPERRESONANCE or dullness on percussion.
  7. subcutaneous emphysema
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9
Q

what is pleuritic pain?

A

surrounding rib cage pain

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10
Q

Why may tachycardia happen with a pneumothorax?

A

BP drops so the HR will compensate by speeding up.

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11
Q

Can a pneumothorax lead to shock? How?

A

yes, perfusion issues arise due to left side of heart not being able to pump blood out to the rest of the body.

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12
Q

What TWO clinical manifestations are specific to a tension pneumothorax?

A
  1. tracheal deviation to unaffected side
  2. JVD on affected side
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13
Q

What is subcutaneous emphysema?

A

AKA crepitus

trapped pockets of air under the skin (look under clavicle sounds like rice crispies)

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14
Q

What are some diagnostic studies for a pneumothorax?

A
  1. ABG
  2. CXR
  3. Thoracentesis
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15
Q

What will happen to the ABGs for a pneumothorax?

A
  1. PaO2 will decrease
  2. PaCo2 will increase
  3. PH will be acidic (below 7.35)

Respiratory acidosis

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16
Q

For post-procedure care, what will you ensure to monitor for on your patient?

A

RR
O2 Sat
Cyanosis: concentrated around the mouth

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17
Q

What are the treatment options for a pneumothorax?

A
  1. Spontaneous resolution
  2. Urgent needle decompression for tension pneumothorax
  3. Thoracentesis
  4. Chest tube
  5. Pleurodesis
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18
Q

What is a pleusodesis?

A

chemically sealing an area between the lung ad the space (usually injecting a tetracyclic)

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19
Q

What is the drug therapy for a pneumothorax?

A

Benzodiazepine
Opioid: usually Norco

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20
Q

why would you give Norco instead of another opioid like morphine to someone with a pneumothorax?

A

you don’t want to cause heavy respiratory depression. Norco is half acetaminophen and half oxycodone

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21
Q

What benzodiazapine would be given to someone with a pneumothorax?

A

Lorazepam aka Ativan

22
Q

What are some nursing interventions for someone with a pneumothorax?

A
  1. O2 therapy and positioning for max ventilation
  2. VS and lung sound monitoring
  3. IV therapy for circulatory support
  4. Chest tube drainage care
  5. Respiratory and pulmonary consult
  6. emotional support
23
Q

For IV therapy and circulatory support for a patient with a pneumothorax, what is usually given and why?

A

Isotonic solutions like normal saline or LR to keep them from going into shock

24
Q

What is the purpose of a chest tube/pleural drainage?

A
  1. Remove air or fluid from pleural and/or mediastinal space
  2. reestablish negative pressure
  3. re-expand lung
25
Q

What are the three parts of a pleural drainage system?

A
  1. collection chamber
  2. Water seal chamber
  3. Suction contro, chamber
26
Q

What should NOT be seen in the water seal chamber?

A

bubbles should NOT be seen in the seal chamber

27
Q

What two different types of suction control chambers are there?

A

water and dry

28
Q

When is bubbling only expected?

A

Bubbling is only expected when its a wet chamber OR continuous in a suction control chamber in a wet setup.

29
Q

What are some nursing interventions for set-up and insertion?

A
  1. verify informed consent
  2. Position client client
  3. Gather and setup equipment
30
Q

What are some nursing interventions for a client clinical status?

A
  1. Monitor VS, lung, and pain level
    Monitor for complications such as
    -Re-accumulation of air and fluid in the lung
    -bleeding
    -infection
    -subcutaneous emphysema
31
Q

What should you always have at the beside as a nurse who has a patient with a chest tube?

A
  1. 4x4 dressings
  2. xerform
  3. sterile water
  4. clamps
32
Q

Why is sterile water so important at the bedside for someone with a chest tube?

A

if the chest tube becomes dislodged the sterile water can serve as a water seal when placing the chest tube into the water

33
Q

Usually crepitus (subcutaneous emphysema) will rise to the clavicular area. Will it rise for a complication of the chest tube?

A

No. if there is subcutaneous emphysema around the Chets tube insertion site, it will stay locally

THIS IS IMPORTANT FOR A CHEST TUBE ASSESSMENT

34
Q

What are some nursing interventions for the drainage system of a chest tube?

A
  1. DO NOT elevate the tubing and unit above the chest
  2. Maintain latency of tubing
  3. Secure all connections
  4. MONITOR TIDALING!!!
  5. Monitor fluid level in the collection chamber
  6. Have client exhale and cough if the unit is overturned
35
Q

What does it mean if there is no longer any tidaling?

A

the lung has likely re-expanded and there is no longer a need for a chest tube

36
Q

What are nursing interventions for a dressing change of the chest tube?

A
  1. observe sterile technique
  2. Use sterile occlusive dressing
37
Q

What is important to note about doing a dressing change on a. chest tube?

A

ONLY tape 3 sides because if you tape 4 sides they’re at risk for a tension pneumothorax because it turns into a one way valve

38
Q

What would you teach your client about their chest tube?

A

use of incentive spirometer, and ROM on affected side

39
Q

What are your nursing interventions for removing a chest tube?

A
  1. premeditate client
  2. Ask client to bear down
  3. Apply occlusive dressing
  4. Monitor for respiratory distress
  5. Obtain CXR
40
Q

What is a pleural effusion?

A

Collection of fluid in the pleural space

41
Q

What are the different types of pleural effusions?

A
  1. Transudative
  2. Exudative
  3. Empyema
42
Q

What is a transudative pleural effusion?

A

fluid that comes from the movement of blood

43
Q

what is an exudative pleural effusion?

A

can come from infection

MOST COMMON

44
Q

what is an example of a empyema pleural effusion?

A

puss

45
Q

what is an example of empyema pleural effusion?

A

TB

46
Q

Where can exudative pleural effusion come from?

A

infections

47
Q

**When you auscultate and percuss a lung with pleural effusion, what may you hear? **

A

fine crackles and dullness on percussion

for all three different types of pleural effusion

48
Q

For pneumothorax what do you get on percussion and auscultation?

A

diminished lung sounds on auscultation and hyper-resonance on percussion.

49
Q

what are the collaborative options for pleural effusion?

A
  1. thoracentesis
  2. chemical pleurodesis
  3. chest tube
  4. antibiotic therapy
  5. Decortication
50
Q

What is the specific collaborative care for an empyema for a pleural effusion?

A
  1. Chest tube
  2. Antibiotic therapy
  3. Decorticiation

MedSurg 2 (5 decks)

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