Term
| What is an air leak disorder? |
|
Definition
| It is a condition that results in extraalveolar air in the pleural space? |
|
|
Term
|
Definition
| An accumulation of air in the pleural space |
|
|
Term
| What are the causes of an air leak disorder? |
|
Definition
| Disruption of parietal or visceral pleura casued by blunt trauma and rupture of alveoli caused by pulmonary diseases. |
|
|
Term
| What causes a spontaneous pneumothorax? |
|
Definition
| Caused by rupture of subpleural blebs. It may be a cyst of the lungs, it can rupture at any time. |
|
|
Term
| What is the most common cause of barotrauma/volutrauma? |
|
Definition
|
|
Term
|
Definition
| Overdistension and rupture of alveoli due to increased pressure in alveoli |
|
|
Term
|
Definition
| Overdistention and rupture of alveoli due to increased volume in alveoli. |
|
|
Term
| How do you treat a sucking chest wound? |
|
Definition
| Cover wound with occlusive dressing, taping only 3 sides to allow air to escape. |
|
|
Term
| What causes a pneumothorax? |
|
Definition
| Air enters the pleura space, affected lung becomes compressed and collapses causing V/Q mismatching and intrapleural shunting. This results in hypoxemia and resp. failure. the increased pressure in the chest can lead to shifting of the mediastinum and decreased CO. |
|
|
Term
| What causes barotrauma/volutrauma? |
|
Definition
| Air enters the interstitial space and travels to the mediastinum, pleural space, subq tissues, pericardium, peritoneum. |
|
|
Term
| ___ can lead to cardiac tamponade. |
|
Definition
|
|
Term
| __ in the mediastinum can lead to decreased venous return and upper airway obstruction. |
|
Definition
|
|
Term
| A large pneumothorax leads to __ lung excursion on affected side, __ intercostal muscles, decreased or __ breath sounds over affected area. |
|
Definition
| Decreased, bulging, absent |
|
|
Term
| What does an ABG show on a patient with an pneumothorax? |
|
Definition
| Hypoxemia (Low O2) and Hypercapnia (High CO2) |
|
|
Term
| What does a chest x-ray show for pneumothorax? |
|
Definition
| increased translucency on affected side |
|
|
Term
| What can you assess to monitor for barotrauma/volutrauma? |
|
Definition
| Subq emphysema, evident by crepitus in the neck, upper chest and face. Substernal chest pain with position changes seen in pneumomediastinum. May hear friction rub over left side of chest with pneumopericardium. |
|
|
Term
| If pneuomthorax is greater than _% treatment to remove air from pleural space and reexpansion of the lung is required. |
|
Definition
|
|
Term
| There are 4 ways that air is removed in the case of a pneumothorax, what are they? |
|
Definition
| Aspiration with a needle, percutaneous catheter with Heimlich valves, insertion of a thoracic vent, or insertion of a chest tube with underwater-seal suction drainage. |
|
|
Term
| Chest tubes are inserted and connected to underwater chest drainage systed with _cm water suction. |
|
Definition
|
|
Term
| Reexpansion of lung is confirmed with a __? |
|
Definition
|
|
Term
| What are the emergencies for pneumothorax? |
|
Definition
| Tension pneumothorax and Tension pneumopericardium |
|
|
Term
| What does a tension pneumthorax cause? |
|
Definition
| It causes shifting of mediastinum to the unaffected side and decreased venous return (Decreased CO). |
|
|
Term
| What are the s/s of a tension pneumothorax? |
|
Definition
| Diminished breath sounds, tachycardia, hyperresonance to percussion, and hypotension |
|
|
Term
| How is tension pneumothorax treated? |
|
Definition
| Give O2, insert large bore needle in the 2nd intercostal space at the midclavicular line on the affected side. |
|
|
Term
| What does tension pneumopericardium cause? |
|
Definition
| Pressure inside the pericardium causes compression of the heart and development of cardiac tamponade. |
|
|
Term
| What is the treatment for tension pneumopericardium, and who performs it? |
|
Definition
| pericardiocentesis, performed by the doctor |
|
|
Term
| What does the nursing assessment include for pneumothorax? |
|
Definition
| Inspection and palpation of the trachea for deviation, chest excursion, and skin for crepitus. Percussion: hyperresonance over affected area. Ausculation: absent/diminished breath sounds on affected side, friction rubs may be hear. |
|
|
Term
| What are 2 main nursing diagnoses for pneumothorax? |
|
Definition
| Impaired gas exchange r/t V/Q mismatching or intrapulmonary shunting and Ineffective breathing pattern r/t decreased lung expansion |
|
|
Term
| What nursing interventions or implemented for patients with pneumothorax? |
|
Definition
| Optimize oxygenation and ventilation, maintain chest tube system, provide comfort and emotional support, and monitor for complications. |
|
|
Term
| You are administering PRBC in the ICU, 15 minutes after the infusion has began the patient c/o of SOB and pain. What do you do? |
|
Definition
| Stop the infusion and give O2. You would do the same thing when administering IV fluids. |
|
|
Term
| What is the purpose of a chest tube? |
|
Definition
| To remove air/fluid from the pleural space and reinstate the negative intrapleural pressure and reexpand a collapsed lung. |
|
|
Term
| How is a chest tube inserted? |
|
Definition
| It is inserted by a physician under sterile technique in the ER, OR, or at the bedside in the ICU. Chest tube is inserted into the 4th or 5th ICS, midaxillary line on affected side and connected to a water seal drainage system |
|
|
Term
| How many chambers does a water-seal drainage system have and what are they? |
|
Definition
| 3. Suction control Chamber, Water seal chamber, and the collection chamber. |
|
|
Term
| What does the suction control chamber do? |
|
Definition
| It is filled with sterile water to desired level and connected to suction. Steady, gentle bubbling occurs in this chamber. |
|
|
Term
| How much water do you add to the water seal chamber? |
|
Definition
| It is filled with 2cm of water, and acts as a one way valve |
|
|
Term
| What does the collection chamber do? |
|
Definition
| It collects fluid from the patient |
|
|
Term
| Which chamber is the only one that bubbles? |
|
Definition
| The suction control Chamber |
|
|
Term
| How does the water seal chamber work? |
|
Definition
| It fluctuates with respirations until the lung is fully reexpanded. |
|
|
Term
| What does bubbling in the water seal chamber indicate? |
|
Definition
| It indicates that there is an air leak in the system and needs to be located. All connections must be taped securely, an occlusive dressing is applied to the insertion site. |
|
|
Term
| Why is it important to always have sterile petroleum gauze, bottle of sterile water, and rubber-tipped clams at the beside. |
|
Definition
| If the tube becomes disconnected, the end of the tube needs to be placed in the sterile water. If tube comes out of patient the dressing must be applied to site. |
|
|
Term
| Where should the drainage system be kept at all times? |
|
Definition
| below the level of the patient's chest |
|
|
Term
| How often should you observe the dressing on a patient with a chest tube? |
|
Definition
|
|
Term
| How often should you encourage deep breathing for a patient with a chest tube? |
|
Definition
| every 2 hours, can use incentive spirometry |
|
|
Term
| What are some important nursing responsibilites for the patient with a chest tube? |
|
Definition
| Keep all tubing straight, no kinks; ensrue all connections are tight/taped, milk tubing as needed, adminster pain meds for discomfort, assess VS, O2 sat, resp and CV status, ausculate breath sounds q2h, monitor for crepitus, and monitor patency and integrity of drainage system |
|
|
Term
| What is done when transporting a patient with a chest tube? |
|
Definition
| Disconnect suction, keep system below chest level and upright. Keep rubber-tipped clamps with patient. If pt becomse dyspneic may have to clamp tubing. |
|
|
Term
| What is doen before and after removal of a chest tube? |
|
Definition
| Premedicate patient before procedure, explain procedure to client, doctor removes chest tube and occlusive dressing is applied to site. Monitor respiratory status. |
|
|
