Term
| A collection of air in the pleural space. |
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Definition
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Term
| This is an accumulation of blood or fluid in the pleural cavity. |
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Definition
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Term
| What is the difference between a pneumothorax and a hemothorax? |
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Definition
| Shock is present w/hemothorax d/t blood loss. |
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Term
| What are the symptoms of a pneumothorax/hemothorax? |
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Definition
- Decreased breath sounds in apex of affected side.
- Shortness of Breath
- Chest pain or pressure
- Hypoxia
- Decreased excursion on affected side (one side not expanding as much during breathing).
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Term
| What is a tension pneumothorax? |
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Definition
| Air comes in but can't get out. It exerts pressure on lung causing collapse. As pressure continues to increase, it causes tracheal shift to opposite side compressing heart and great vessels. |
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Term
| Why is tension pneumothorax considered to be an emergency? |
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Definition
| B/C of no or low blood flow from the heart. |
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Term
| What is water sealed suction? |
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Definition
| A prescribed amount of sterile fluid (eg. 20cm of H2O) is poured into the suction control chamber, which is then attached to a suction source by tubing. The amount of sterile H2O added depends on the manufacturer's recommendations. The chamber is filled to the set volume for the prescribed amount of suction. Sterile water may need to be added several times a day because of evaporation. As the fluid level decreases, the amount of suction also declines. |
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Term
| Why is it important to use water sealed suction with chest tubes? |
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Definition
| Air has bo be pulled out while maintaining negative pressure in the chest, so the water seal allows this to happen. |
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Term
| What is a Heimlick valve? |
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Definition
| A one-way valve attached to the chest tube. Allows air out, but not in. Used for chronic air leaks to allow Pt to go home. |
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Term
| How does the nurse assess a client with chest tubes? |
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Definition
- Stable vital signs
- Respiratory distress
- Chest px (presence is not standard if chest tube is working properly)
- Decreased breath sounds
- Asymmetrical chest movements
- Subcutaneous emphysema (air bubbles trapped under the skin. Typically not threatening, just chart)
- Hypotension
- Tachycardia
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Term
| What is the difference between fluctuation and bubbling in the water sealed chamber of a chest suction apparatus? |
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Definition
Fluctuation: Present when the patient has respiratory activity. Water level may go up and down slightly (tidal activity). Bubbling: On insertion (expected); Intermittent (air from pleural space being removed); Continuous (indicates air leak. Notify the doctor) |
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Term
| What should the nurse document on the client with chest tubes? |
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Definition
Patient: Dressing, assessment of site with each dressing change, and presence of subQ emphysema. System: Amount/type of drainage (mark on system, then transfer to I/O report; Presence or absence of air leak; tidaling. |
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Term
| What should the nurse do if a client with chest tubes needs to be taken to radiology or some other place off of the nursing unit? |
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Definition
| Attach apparatus to the bed and use a portable air canister to maintain suction. |
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Term
| What should the nurse do if a client's chest tube becomes disloged? |
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Definition
| Tension pneumothorax is possible. Place 4X4 with tape on three sides for immediate action. Place on when Pt. coughs (expiration). Notify Dr. immediately. |
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Term
| What should the nurse do if there is continuous bubbling in the water sealed chamber? |
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Definition
| This indicates an air leak. Chart and notify doctor. |
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Term
| In a pneumothorax, why has the trachea shifted to the unaffected side? |
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Definition
| The build up of air in the pleural space compresses the structures in the right chest and creates a mediastinal shift to the unaffected side. |
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Term
| What is the appropriate position of the client for chest tube insertion? |
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Definition
Pneumothorax: Lateral side-lying with affected side up; arm above head or semi-Fowler's with arm above head. Hemothorax: Dangle at bedside leaning forward on bedside table. |
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Term
Where will the tube be inserted for pnuemothorax? for hemothorax? |
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Definition
2-3rd intercostal, midclavicular. For hemothorax, it will be between 8-9th intercostal, mid axillary line |
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Term
| Why do we use "negative" suction pressure in chest drainage systems? |
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Definition
| Under normal conditions, there is always negative pressure in the pleural cavity. This vacuum effect is necessary for the lungs to stay fully expanded up against the inside of the chest wall. Applying suction pressure will facilitate removal of air and fluid from the pleural space and reestablish normal negativity. |
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Term
| What is the most important connection to keep sterile during set-up of the system? |
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Definition
| Patient drainage tube connection that attaches to the chest tube. |
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Term
| What is the advantage of a dry system? |
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Definition
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Term
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Definition
| Localized accumulation of air in the subQ tissues that is palpated as crackles under the skin. Usually resolves on its own but may cause problems if it increases and moves toward trachea. Nursing responsibility is to assess regularly and note any increase. |
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Term
| Are fluctuations in the water-seal tubing normal? |
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Definition
| yes, when pneumothorax is present, the fluid level rises with inspiration and falls with expiration. Absence of fluctuations indicates possible obstruction in system or resolution of the pneumothorax. |
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Term
Assessment of the water-seal meter: Intermittent bubbling |
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Definition
| This is normal with expiration or coughing when a client has a pneumothorax. It means there is still air in the pleural space. No action required, document in nurse's progress notes. |
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Term
Assessment of the water-seal meter: Absence of bubbling |
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Definition
| means there is an obstruction in the system - kinked tubing or blood clot; or may indicate that the pneumothroax is resolved. Assess for obstruction, gently milk chest tube to dislodge a clot. |
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Term
Assessment of the water-seal meter: Continuous bubbling |
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Definition
| Means there is a leak in the system - somewhere from collection unit to client. Assess all connections and tubing for a leak. |
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Term
| Why is it contraindicated to "strip" a chest tube? |
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Definition
| Stripping a chest tube creates too much negativity in the pleural space and can cause tissue damage. |
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Term
| What is the risk of keeping the Vaseline gauze dressing on the insertion site for any length of time? |
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Definition
| A tension pneumothorax might develop if the client still has an air leak. |
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Term
| What are the signs of a tension pneumothorax? |
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Definition
| Dyspnea, tachypnea, tachycardia, hypotension, restless, diminished breath sounds on the affected side, mediastinal shift on the unaffected side. |
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Term
| What should you do if you suspect a tension pneumothorax is developing? |
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Definition
| Intermittently lift the Vaseline gauze dressing to allow air to escape until the physician can re-insert the tube. |
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Term
| Why is it important to not clamp the drainage tubing during transport? |
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Definition
| If the client still has an air leak, a tension pneumothorax might develop. |
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Term
| What are the only times it is alright to clamp the drainage tube? |
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Definition
| To locate possible leaks in the system or briefly when changing the collection unit. |
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Term
| Why is it preferable to obtain a specimen for culture and sensitivity from a dependent loop vs. from the collection chamber? |
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Definition
| It would be a "fresh" specimen and be more appropriate for culture. |
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