Week 2 -- Ears & Lower Respiratory Disorders

Question 1

Pneumothorax

Answer 1

air in the lungs

Question 2

Spontaneous Pneumothorax

Answer 2

without trauma
could be caused by illness

Question 3

s/s of Pneumothorax

Answer 3

*HYPER-RESONANCE
*TRACHEA DEVIATION
hypotension
JVD
tachypnea
diminished breath sounds

Question 4

priority action for spontaneous pneumothorax

Answer 4

large bore IV needle for decompression

Question 5

Hemothorax & what it sounds like

Answer 5

Blood collected in the lungs

*DULL percussion

Question 6

Flail chest

Answer 6

when neighboring ribs sustain fractures causing an unstable chest wall

Question 7

4 s/s of flail chest

Answer 7

hypotension
paradoxical chest movement
dyspnea
cyanosis

Question 8

meds for pneumo/hemo- thorax

Answer 8

Benzo’s for anxiety – lorazepam

Opiods for pain

Question 9

Iatrogenic pneumothorax

Answer 9

caused by medical intervention

Question 10

chylothorax

Answer 10

buildup of lymphatic fluid **pediatrics

Question 11

subcutaneous emphysema

Answer 11

air trapped under the skin
upper chest & shoulders*

*crepitus = sounds like rice krispies

Question 12

chest x ray for pnuemothorax will show as

Answer 12

hollow & opac

Question 13

pleurodesis

Answer 13

chemical destruction (doxycycline & aspirin) of pleura that keeps rupturing

Question 14

nursing intervention for open pneumothorax w/ chest tube

Answer 14

apply occlusive petroleum gauze

tape on THREE sides

Question 15

pneumothorax commonly occurs in

Answer 15

tall/slender white males

Question 16

necessary supplies that must be in a room with a chest tube

Answer 16

• 4x4’s
• vaseline gauze (occlusive petroleum dressing)
• sterile water / normal saline
• tape
• kelley clamps/ forceps

Question 17

heimlich valve

Answer 17

specific to chest tubes
*fluid out but no air

Question 18

3 never’s w chest tubes

Answer 18

1. never milk / strip the tube
2. never clamp
3. never allow continuous bubbling

Question 19

emergency finding for chest tube

Answer 19

BRIGHT RED blood > 100ml/hr

Question 20

normal finding for a chest tube

Answer 20

dark red blood collected

Question 21

3 parts of a chest tube system

Answer 21

1. suction control chamber
2. water-seal chamber
3. collection chamber

Question 22

continuous bubbling is allowed in which chamber of a chest tube

Answer 22

*GENTLE & STEADY continuous bubbling is allowed in collection chamber

Question 23

tidaling in the water seal chamber indicates

Answer 23

aka “fluctuations”

a normal finding = shows lungs have not re-expanded

Question 24

no tidaling in the water seal chamber indicates

Answer 24

lung re-expanded
OR
blood clot / kink occlusion

Question 25

3 things to remember with the water-seal chamber

Answer 25

1. NO CONTINUOUS BUBBLING –intermittent is okay
2. tidaling is normal
3. air leak monito

Question 26

chest tubes & subcutaneous emphysema

Answer 26

subcutaneous emphysema is normal but should not spread

spreading = dislodgment & crepitus (rice krispies)

Question 27

priority action for chest tube damage

Answer 27

distal end in 250 ml of sterile saline / normal saline

Question 28

patient teaching for priority action if chest tube dislodges

Answer 28

COUGH & EXHALE immediately

Question 29

patient teaching for chest tube removal

Answer 29

deep breath and hold it down

*valsalva manuever

Question 30

pleural effusion

Answer 30

fluid in the pleural space

Question 31

3 types of fluids in pleural effusion

Answer 31

1. Transudative; serous fluid
2. Exudative = purulent w WBC
3. Empyema = pus in a hollow cavity

Question 32

2 normal causes of pleural effusion

Answer 32

pneumonia
heart failure

*FLUID BUILDUP

Question 33

s/s of pleural effusion

Answer 33

DULL reasonance
chest pain on INHALATION
dyspnea
diminished breath sounds

Question 34

nursing interventions for a thoracentesis

Answer 34

1. STOP all blood thinners
2. Chest x-ray BEFORE & AFTER
3. deep breaths AFTER the procedure
4. lie on UNAFFECTED side