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Nurs 726 Med Surg 2 > Test 2: Respiratory > Flashcards

Test 2: Respiratory Flashcards

1
Q

What is pneumonia?

A

An inflammatory process in the lungs caused by bacteria, viruses, toxins, or aspiration

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2
Q

Why is the color of sputum white in pneumonia?

A

Due to leukocytes

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3
Q

What is considered community-based pneumonia?

A

Pneumonia acquired in the community or diagnosed within 24 hours

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4
Q

What are the risk factors for pneumonia?

A

-Immobility (#1)
-Age
-Immunocompromise
-Co-morbidity/chronic conditions
-Respiratory Infections
-Conditions that increase the risk for aspiration/impaired ability to mobilize secretions
-Substance misuse
-Mechanical ventilation
-Damage to lungs

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5
Q

What are the SSAs for Pneumonia?

A

-Adventitious breath sounds: crackles, wheezes
-Decreased breath sounds/dull of percussion
-Productive cough
-Chills
-Flushed Face
-Tachypnea/SOB/difficulty breathing
-Pleuritic sharp chest pain
-Decreasing SpO2 (<92%)

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6
Q

What are the labs and diagnostics for pneumonia?

A

Increasing WBC (may be normal in elderly)
ABG: Decrease in PaO2<80mmHg
CXR: Consolidation (white areas are signs of consolidations
Check lactate and blood cultures (for signs of sepsis)

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7
Q

What are the first-do priorities assessments for pneumonia?

A

VS(increased RR, Temp and SpO2)
Lung Sounds
Periods of respiratory distress
Skin breakdown around nose & mouth from O2 delivery devices

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8
Q

What are the first do tasks for pneumonia?

A

Apply Supplemental O2
Position in high fowlers
Obtain sputum culture prior to abx
Encourage DB&C, IS
Ensure fluid intake is 2-3L
Administer IV antibiotics
Ensure adequate nutrition

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9
Q

Why is ensuring adequate nutrition important in patients with pneumonia?

A

Adequate nutrition is important to maintain the nitrogen balance because the auxiliary use of muscles for breathing increases metabolic demand

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10
Q

Why do patients with pneumonia need vitamin C?

A

Vitamin C helps the breakdown of catecholamines (norepinephrine and epinephrine)

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11
Q

What are the two Floroquinolones used to treat pneumonia?

A

Levofloxacin
Moxifoxacin

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12
Q

What are the nursing consideration for Floroquinolones?

A

-GI: N/V/D, abdominal pain
-Dizziness, insomnia, HA, CNS sx
-QT prolongation
-Black box warning: tendon rupture

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13
Q

What are the macrolides used to treat pneumonia?

A

Azithromycin
Clarthromycin

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14
Q

What are the nursing considerations for macrolides?

A

-GI: N/V/D, abdominal pain
-Take with food to decrease GI upset

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15
Q

What are the tetracyclines used to treat pneumonia?

A

Doxycycline
Minocycline

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16
Q

What are the nursing considerations for tetracyclines?

A

-GI: N/V/D, abdominal pain
-Avoid iron supplements, multivitamins, calcium or antiacids
-Photosensitivity
-Discoloration of teeth in fetuses and children

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17
Q

What are the nursing considerations for penicillin?

A

-GI: N/D, dyspepsia
-Verify all allergies & monitor for hypersensitivity
-Monitor for candidiasis infections

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18
Q

What are the immunizations for pneumonia?

A

PCV13
PPSV23
Influenza
COVID-19

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19
Q

Who is able to receive the immunizations for pneumonia?

A

Adults 65+ and those with chronic health problems

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20
Q

What are the expected outcomes for the treatment of pneumonia?
SpO2:
WBC:
Breathing:
Hormones:

A

SpO2: >94% on room air
WBC: 3.7-11K/uL
Breathing: No adventitious breath sounds without tachypnea or pleuritic chest pain
Circulation: No tachycardia
Hormones: No presence of lactate or procalcitionin

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21
Q

What are the possible complications of pneumonia?

A

Sepsis
ARDS
Bilateral Edema
Need for ventilation
Hypercarbia

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22
Q

What are the techniques for mobilizing chest secretions?

A

Ambulation
Deep breathing & coughing
Incentive spirometry
Hydration (fluid thins mucous)

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23
Q

What is a pulmonary embolism?

A

Any substance (solid, liquid, air) that enters venous circulation and lodges in the pulmonary vessels

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24
Q

What is the most common type of pulmonary embolism?

A

A PE that originates as an embolus that breaks off from a DVT and travels as an embolus into pulmonary circulation

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25
Q

What 3 things can occur as a result of pulmonary vascular occlusion?

A

Impaired gas exchange
Pulmonary tissue ischemia and infarction
Increase in pulmonary vascular resistance -> acute right heart failure

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26
Q

What lab values will you see for a pulmonary embolism?

A

ABG: decreased PaO2
Increased D-dimer
Troponin, BNP

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27
Q

What is one of the biggest signs of a PE?

A

A feeling of impending doom

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28
Q

What are the important risk factors for a PE?

A

OCPs and Estrogen tx
Prolonged immobilization
Surgery
Pregnancy
Obesity
Tobacco Use
Coagulation disorders

Anything that participates in Virchow’s triad

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29
Q

What is Virchow’s Triad?

A

Venous Stasis
Endothelial injury
Hypercoagulability

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30
Q

How often should you be assessing respiratory and cardiac status for a patient suspected of a PE?

A

Q15-30 minutes

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31
Q

What priority actions should you take for a pt suspected of a PE?

A

Administer supplemental O2
Place pt in High-fowlers position
Administer medications per order

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32
Q

What are the categories of medication used to treat a PE?

A

Anticoagulants
Direct Factor Xa Inhibitors
Thrombolytics

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33
Q

Pulmonary Embolism Medications:
What are some examples of anticoagulants?

A

Warfain
Heparin

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34
Q

What labs should you be checking for Warfarin?

A

pT
INR

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35
Q

What labs should you be checking for heparin?

A

pTT
CBC (to monitor for internal bleeding and heparin-induced thrombocytopenia)

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36
Q

Pulmonary Embolism Medications:
What are examples of direct factor Xa inhibitors?

A

Rivaroxaban
Apixaban

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37
Q

Pulmonary Embolism Medications:
What is the thrombolytic given and when is it contraindicated?

A

Alteplace

Contraindicated in pregnancy, clotting disorders and recent surgeries

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38
Q

What patient education should you be giving for warfarin?

A

Make sure the patient knows to maintain a stable vitamin K intake and the need for frequent INR monitoring

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39
Q

What are the indications for intubation?

A

Respiratory failure or insufficiency
Protection of compromised airway
Prevention of aspiration
Need to provide FiO2 >60% for long periods of time

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40
Q

What are some examples of respiratory failure or insufficiency that would lead to intubation?

A

Hypoxemic Respiratory Failure (SpO2<60)
Hypercapnic Respiratory Failure (PaCO2 >50)

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41
Q

What are some examples of intubation to protect a compromised airway?

A

Trauma, swelling, obstruction, copious secretions or inhalation of toxic substances

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42
Q

Would a patient with heart failure require intubation?

A

No, these patients are on biPAPs and do not need to be intubated to prevent aspiration

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43
Q

What are the steps in Rapid Sequence Intubation?

A

Hyperoxygenate with BVM -> induction agent (sedative) ->paralytic agent -> ETT placed after 60 seconds of paralytic

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44
Q

What supplies are needed for rapid sequence intubation?

A

ETT with stylet
10cc syringe
Laryngoscope handle and blade
ETCO2 detector (or capnography setup)

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45
Q

What pressure should the ETT cuff be inflated to?

A

Pressure of 20 to 30cm H2O

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46
Q

What are the RN tasks before intubation?

A

Ensure suction is set up and working
BVM size appropriate
Glidescope if requested (video-assisted laryngoscope)
Patient prepped with IV access, continuous monitoring and pulse oximetry

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47
Q

What are the RN assessments before intubation?

A

Allergies to anesthesia (or previous adverse rxns)
VS, Cardiac Rhythm
Lung sounds to establish baseline `

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48
Q

Patients cannot be weaned from a ventilator if:

A

They cannot establish a proper LOC
HR increases by 20bpm
RR increases by 10bpm
Systolic BP decreases 20mmHg
Pt becomes diaphoretic (indicating work of breathing is too hard)

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49
Q

What are the 3 methods for weaning patients off a ventilator?

A

T-Piece
Synchronized intermittent mandatory ventilation
Pressure support trials

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50
Q

On an end-tidal CO2 detector, what occurs when the purple turns to yellow?

A

When the purple turns to yellow, CO2 is present

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51
Q

What is the normal pressure of CO2 for a mechanically ventilated patient?

A

35-45 mmHg

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52
Q

What is tidal volume?

A

Volume of air delivered to the patient with each machine breath

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53
Q

What is the volume of normal tidal volume?

A

6-10mL/kg

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54
Q

The rate of the ventilator is…?

A

The number of breaths per minute delivered by the ventilator

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55
Q

What is the normal rate of a ventilator?

A

10-14 bpm

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56
Q

What is FiO2?

A

The amount of oxygen delivered to the patient

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57
Q

What is PEEP?

A

Positive end pressure
The positive pressure applied at the end of expiration

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58
Q

What can PEEP be used for?

A

PEEP can be used to increase functional residual capacity and improve overall oxygenation

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59
Q

What is ventilator sensitivity?

A

Sensitivity determines the amount of effort the patient must generate to trigger a breath from the ventilator

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60
Q

What is the I:E ratio for a ventilator?

A

The I:E ratio is the ratio that determines the length (or duration) of inspiration to the length of expiration

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61
Q

What is the flow rate of a ventilator?

A

How fast each breath is delivered by the ventilator

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62
Q

What assessments should you complete for a mechanically ventilated patient?

A

Ability to speak (if they can, the cuff is not properly inflated)
Placement of ET markings (cm)
Mucous membranes for color and dryness
ABGS
Capnography readings
Respiratory Status

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63
Q

What tasks should you be completing for a mechanically ventilated patient?

A

Oral care q2 hr/PRN
Suction Q2-4 and PRN
Verify alarm settings correct and on at all times
Soft wrist restraints or sitter
Reposition Q2 hours for lung expansion and drainage
Verify emergency equipment at bedside
Verify and document vent settings hourly

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64
Q

What should the RN be concerned about regarding nutrition for the mechanically ventilated patient?

A

Nitrogen balance->notify provider without nutrition for 48 hours (going to consume stores)
Raise HOB 30 degrees to prevent aspiration
Verify residuals Q4hrs
Hold tube feeding when moving

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65
Q

What conditions are medications going to be given prophylactically in the mechanically ventilated patient?

A

DVT
Peptic ulcer disease (Esp when giving anticoagulants)

66
Q

What do high pressure alarms indicate?

A

Secretions
Bronchospasm
Pneumothorax
Displaced Tube
Blocked with water
Kinked tubing
Pt ‘fighting’ vent (normally biting)

67
Q

What do low pressure alarms indicate?

A

Disconnection
Pt stops spontaneously breathing
Cuff leak

68
Q

What does DOPE stand for>

A

Dislodged or displaced tube
Obstructed tube (secretions, mucous plug, kink)
Pneumothorax
Equipment failure

69
Q

What is a VAP bundle?

A

Ventilator-Associated Pneumonia Bundle

70
Q

What is included in a VAP bundle?

A

Elevate HOB 30-45 Degrees
Daily “sedation vacations”
Assessment of readiness to wean/extubate
Venous thromboembolism prophylaxis
Sterile Suctioning technique
Mouth Care q2/PRN (with chlorhexidine)
Meticulous hand hygiene

71
Q

What assessments should you perform for ventilator safety?

A

Skin Breakdown/Irritation around ETT holder/tape
Depth of tube using markings at teeth or lips
Stability of tube with tube holder or tape
Cuff at the right pressure
Avoiding excess pressure while suctioning
Ensuring ventilator tubing is supported

72
Q

What are some of the complications of a ventilator?

A

Barotrauma
Fluid retention
Oxygen Toxicity
Hemodynamic Compromise
Aspiration
VAP

73
Q

What is a tracheotomy?

A

Surgical incision into trachea to create an airway to maintain gas exchange

74
Q

What is a tracheostomy?

A

Opening/Stoma

75
Q

What types of air can a tracheotomy be used with?

A

Room Air
Mechanical Ventilation
Trach collar with humidified oxygen

76
Q

What does COAST stand for?

A

C: Another Cannula
O: Obtorator
A: Airway maintenance (bag valve mask)
S: Suction
T: Trach tube placement

77
Q

What is conscious sedation?

A

Administration of sedatives to obtain a level of relaxation in a client so that minor procedures can be performed without discomfort but airway is maintained by patient

78
Q

What type of sedation does a patient experience a decrease in LOC but can respond, is arousable, and retains their gag reflex?

A

Conscious sedation

79
Q

What equipment should be at the bedside when a patient is under conscious sedation?

A

Crash cart
RSI box
Ambu bag
Suction
O2

80
Q

What is the RN monitoring during conscious sedation?

A

Telemetry
Pulse Oximetry
Capnography

81
Q

What are the common meds used for conscious sedation?

A

Benzodiazepines: Midazolam, lorazepam, diasepam
Opioids: Fentanyl, morphine, hydropmorphone
Anesthetics: Propofol, Ketamine

82
Q

What are some of the indications for conscious sedation?

A

Endoscopy, lumbar puncture, cardioversion
Painful dressing changes, incision & drainage of abscesses
Burn debridement
Reduction/immobilization of fractures or dislocations
Minor surgical procedures
Removal of implanted devices and tubes
Bone marrow aspiration

83
Q

What should the RN assess for prior to conscious sedation?

A

Allergies/prior experience with conscious sedation/anesthesia
Full baseline assessment of VS, cardiac rhythm, heart and lung sounds, LOC

84
Q

How long should a patient generally be NPO before conscious sedation>

A

normally NPO for around 4 hours

85
Q

What are the RN assessments post-procedure?

A

Q5 minutes during
Q15 post procedure until Aldrete Score
LOC
VS
SpO2
ETO2
Cardiac Rhythm
Lips and mucous membrane color
Ensure on supplemental O2
Ensure deep breathing and coughing

86
Q

What are complications of conscious sedation?

A

Respiratory Depression
Cardiac Dysrhythmias
Hypotension
Aspiration
Airway Obstruction
Progression to deep sedation that requires intubation

87
Q

What are the two types of respiratory failure?

A

Hypoxemic Normocapnia
Hypoxemic Hypercapnia

88
Q

What type of failure is Hypoxemic Normocapnia?

A

Oxygenation failure
Normally fluid filling or collapse of alveoli

89
Q

What are the ABG signs of Hypoxemic Normocapnia respiratory failure?

A

Decreased PaO2 and normal PaCO2

90
Q

What type of failure is Hypoxemic Hypercapnia?

A

Ventilatory Failure caused by insufficient carbon dioxide removal that may be corrected by O2 administration

91
Q

What type of CNS abnormalities can cause Hypoxemic Hypercapnia respiratory failure?

A

Overdose of respiratory depressant drug
High level spinal cord injuries
Traumatic brain injuries
Limited nerve supply to the respiratory muscles

92
Q

What type of Chest wall abnormalities can cause Hypoxemic Hypercapnia respiratory failure?

A

Flail Chest
Kyphoscolosis
Severe obesity

93
Q

What type of neuromuscular disorders can cause Hypoxemic Hypercapnia respiratory failure?

A

Guillian-Barre
Muscular dystrophy
Myasthenia Gravis
Multiple Sclerosis

94
Q

What are the 4 main pathological mechanisms in respiratory failure?

A

V/Q mismatch
Alveolar Hypoventilation
Diffusion Limitation
Shunting/Intrapulmonary Shin

95
Q

What are the SSAs of Respiratory failure indicating cerebral hypoxemia?

A

Restlessness
Confusion
Combative Behavior

96
Q

What are the SSAs of Respiratory failure indicating hypercapnia?

A

Morning Headache
Slower respiratory rate
Decreased LOC

97
Q

What are the SSAs of Respiratory failure indicating acidosis?

A

Chest pain
Cardiac Dysrhythmias
If prolonged, kidney and cerebral damage

98
Q

What are the SSAs of Respiratory failure indicating Respiratory Distress?

A

Tachypnea (rapid breathing)
Retraction
Use of accessory muscles
Paradoxical breathing
Change from tachypnea to bradypnea

99
Q

What is the pathway of ARDS?

A

Massive system inflammatory response-> Injury and increased permeability of the alveolar-capillary membrane->fluid movement into interstitial and alveolar spaces -> hyaline membrane formation -> decreased surfactant -> decrease pulmonary compliance->Impaired gas exchange->Acute respiratory failure t

100
Q

What is a ‘stand out’ SSA for ARDS?

A

Refractory hypoxemia-dropping SpO2 in the presence of FiO2 100%``

101
Q

ARDS:
What are the ABG findings?
PaO2
PaCO2
pH

A

PaO2: <60mmHg
PaCO2: >45mmHg
pHL <7.35 with SpO2 <90

102
Q

What are the early manifestations of ARDS?

A

Dyspnea with use of accessory muscles
Tachypnea
Restlessness
Normal Breath Sounds-Fine scattered crackles
Respiratory Alkalosis
CXR normal or minimal scattered infiltrates

103
Q

What are the Progressive manifestations of ARDS?

A

Increased WOB
Intercoastal Retractions
Tachypnea
Diaphoresis
Cyanosis/Pallor
Change in mental status
Diffuse crackles and Ronchi
CXR-extensive and dense bilateral infiltrates
Reduced lung compliance
Profound Dyspnea and refractory hypoxia

104
Q

What is the treatment for refractory hypoxia?

A

Mechanical Ventilation

105
Q

What are the first do priorities for ARDS for oxygenation?

A

Titrate supplemental O2 to maintain PaO2>60mmHg
Monitor H&H, promote nutrition (to maintain H&H)
Give fluids to enhance preload
Keep BP stable to maintain afterload
Monitor for tissue hypoxia

106
Q

What are the first do priorities for ARDS for Alveolar ventilation improvement?

A

Chest percussion/positioning/suctioning/proning to mobilize secretions
Give bronchodilators to relieve bronchospasms
Conservation of fluids and administration of diuretics to improve pulmonary edema
Increase positive and expiratory pressure (PEEP) on mechanical ventilation

107
Q

What is the drug therapy for ARDS?

A

Bronchiodilators
Mucolytics
Exogenous Surfactants
Corticosteroids, ketoconazole
Sedation then neuromuscular blockage

108
Q

What are the signs of oxygen toxicity?

A

Stuffy nose
N/V
HA

109
Q

What are the expected ABG findings for successful treatment of ARDS?

A

PaO2>80mmHg on RA
PaCo2>35-45mmHg
pH 7.35-7.45
SpO2 >94%

110
Q

What are the respiratory complications of ARDS?

A

Oxygen Toxicity
Barotrauma from positive pressure ventilation
Tension Pneumothorax from high PEEP settings
Tracheomalacia

111
Q

What are the cardiovascular complications of ARDS?

A

Dysrhythmias
Decreased CO from high intrathoracic pressure (fluid retention and poor renal perfusion)

112
Q

What are the GI complications from ARDS?

A

Paralytic Ileus
Peptic Ulcer Formation

113
Q

What are the renal complications from ARDS?

A

AKI

114
Q

What are the hematological and immunologic complications from ARDS?

A

DIC
Anemia
VTE
Infections like VAP, CLABSI, CAUTI, sepsis

115
Q

What are the systemic complications of ARDS?

A

Delirum
Deconditioning from immobilization
MODS and death

116
Q

A hemothorax is?

A

Blood in the plural space between the parietal pleura and visceral pleura

117
Q

What are the steps of a pnemothorax?

A

Air becomes collected between the visceral and parietal pleura->loss of negative pressure->collapsed lung

118
Q

What are the steps of a tension penumothorax?

A

Air in pleural space that cannot escape->increase in pleural space->increased pressure in thoracic cavity-> life-threatening mediastinal shift->respiratory and cardiac compromise

119
Q

A mediastinal shift of the trachea to the unaffected side indicates a?

A

Tension pneumothorax

120
Q

What is a spontaneous pneumothorax?

A

a PTX with no precipitating factor, but commonly is the rupture of a small subpleural emphysematous vesicle

121
Q

When does a spontaneous pneumothorax normally occur?

A

Many times it occurs in the middle of the night or during exercise

122
Q

What is a pleural effusion?

A

Accumulation of exudate in the pleural space

123
Q

What are the two common causes of pleural effusion?

A

Lupus
Cancer if it comes out of nowwhere

124
Q

What is Empyema?

A

Purulent drainage in the pleural space from pulmonary infection, lung abscess or infected pleural effusion

125
Q

What are the SSAs for percussion for a pneumothorax?

A

Hyperresonance (hollow sounds like a drum) on percussion of the affected side due to air in the pleural space

126
Q

What are the SSAs for percussion for a hemothorax or pleural effusion?

A

dullness or flatness on percussion of affected side

127
Q

What are te SSAs for HTX/PTX?

A

Tachypnea
Tachycardia
Dyspnea
Sudden, sharp pleuritic pain on the affected side
Coughing
Diminished/Absent breath sounds on affected side
Restlessness
Anxiety
Subcutaneous emphysema (rice crispy popping)
PaO2<80mmHg
White density where lung has shrunken on CXR

128
Q

What are first do priority assessments for HTX/PTX?

A

Heart/Lung sounds
VS
SpO2
Pain levels/meds for pulmonary hygiene
Assessments for Chest tube

129
Q

What amount of continuous chest tube drainage is alarming and should warrant an immediate call to a provider?

A

> 70mL output from chest tube

130
Q

What are the first do priority tasks for HTX/PTX?

A

Titrate O2 to maintain SpO2>94%
Daily CXR
DB&C
Incentive Spirometry
Turning/Ambulation
Encourage fluids

131
Q

What are the positional differences for HTX and PTX?

A

HTX: High-fowlers
PTX: Semi-fowlers

132
Q

What’s the difference in chest tube placement between a HTX and PTX

A

For a PTX, the chest tube will be inserted higher

133
Q

What is the first area of a chest tube drainage system for?

A

For the drainage from the patient and should be under <70mL

134
Q

What is the second area of a chest tube drainage system for?

A

The waterseal chamber that is REQUIRED to have at least 2cm of water

135
Q

What is the third area of a chest tube drainage system for

A

traditionally used for water suction (prescribed amount of water) and suction pressure is 20mmHg or 20cm suction

136
Q

What is the amount of pressure the wall suction should be set to for a chest tube?

A

80mmHg

137
Q

What is the amount of suction the chest tube drainage system should be set on?

A

20cm suction

138
Q

Continuous bubbling in the water seal chamber is indicative of?

A

An air leak

139
Q

How do you figure out where an air leak is in a chest tube drainage system?

A

Clamp chest tube at insertion site (if stops you know that the leak is in the insertion site or lung)
Continue clamping down to figure out where the airleak is
Never clamp down for more than a few seconds or you can cause a PTX

140
Q

If an air leak has occurs, what normal function will you typically not see?

A

titaling

141
Q

What are the indications for a chest tube?

A

Need for drainage of fluid, blood, or air from pleural space
Helps re-establish negative pressure in pleural space for lung (fx) and expansion
Uses a one way valve to keep air from entering pleural cavity

142
Q

What are the nursing assessments for a chest tube?

A

Keep drainage system below the level of chest without any kinks in the tubing or dependent loops
Keep two pairs of hemostats at bedside
Assess insertion site for s/s of infection
Assess surrounding tissue for subq emphysema
Maintain occlusive dressing
Assess lung sounds for pleural friction rub and VS
Monitor for air leak
Note presence of normal titaling in the water seal chamber
Promote pulmonary hygiene

143
Q

What is normal tidaling if the patient is NOT on a ventilator?

A

With inspiration, tidaling will go up and with expiration tidaling will go down

144
Q

What is normal tidaling if the patient is on a ventilator?

A

Tidaling will go down when a breath is given by ventilator and up when the breath goes out

145
Q

What should the RN be documenting in concerns to a chest tube?

A

Dressing appearance
Absence of sub-Q air
Negative for air leak (to suction or H2O seal)
Drainage color and amount
Client tolerance to pain

146
Q

What are the supplies needed for a chest tube dressing change?

A

Sterile Gloves
Chlorhexidine sponge
Petroleum gauze
Sterile drain sponge
Sterile 4x4
Adhesive tape
Tape only 3 sides (do not remove if provider tapes 4)

147
Q

What are two important things NOT to do concerning chest tubes?

A

Do not strip/milk tubes (this increases pressure and can cause significant damage)
Do not clamp chest tubes unless given specific orders to do so and under what condiitons

148
Q

What are the expected outcomes after treatment with a chest tube?

A

Lung is re-expanded and negative pressure is reestablished
Resolution of drainage from pleural space
Clear breath sounds over all lung fields
SpO2>94% on RA with no accessory muscle use, tachypnea or increased work of breathing

149
Q

What are the complications associated with a chest tube?

A

Respiratory Distress->Respiratory Failure
Infection at the insertion site
Crepitus (popping/crackling->subq emphysema)
Tension PTX
Air leak (continuous bubbling in water chamber)
Tube disconnection from chamber (place in sterile water)
Tube dislodgement from pt (place occlusive dressing w/only 3 sides taped)

150
Q

What are the s/s of a tension pneumothorax in concerns to complications from a chest tube?

A

S/S of cardiac tamponade
S/S of decreased cardiac output
Tracheal deviation (late)
Cardiogenic shock
Respiratory and cardiovascular collapse
Recurrent PTX after chest tube removal

151
Q

What are the s/s of cardiac tamponade?

A

muffled heart sounds
Pulsus paradoxus
Increased CVP with JVD
Absence of lung sounds on affected side

152
Q

What are s/s of decreased cardiac output in regards to chest tube complications?

A

Weak pulse
Change of LOC
Pallor
SOB
Cap refill >2 sec
Tachycardia

153
Q

What should the RN do to manage risks for a patient with a chest tube?

A

Emergency equipment at the bedside (padded hemotstats, gauze, bottle of sterile water, dressing)
Oxygen and suction set up and working
Ensure no kinks or obstruction with tubing
Monitor for change in output or excessive output
Monitor for decrease in breath sounds, SpO2
Monitor for increased RR, HR
Monitor for change in work of breathing
Do not delegate to UAP

154
Q

What is a fail chest?

A

3 or more neighboring ribs on the same side of the chest sustain multiple fractures resulting in free-floating rib segments

155
Q

Because there are free-floating rib segments in flail chest, what is occuring?

A

The ribs are not attached and are flopping around due to changes in pressure of the thorax

156
Q

How does flail chest normally occur?

A

Normally a result of a huge impact (such as falling off a building or getting hit by a car)
Blunt chest trauma

157
Q

What are you going to observe in the breathing pattern of a patient with flail chest?

A

Lungs below flail segments cave in on inhalation and ballon out on exhalation=Paradoxical chest movements
unequal chest expansion
tachycardia
Dyspnea
Chest pain
hypotension

158
Q

How is a patient with flail chest and paradoxical chest movements normally stabilized?

A

Typically stabilized by positive pressure ventilation so the RN should prepare for the high possibility of intubation and mechanical ventilation

159
Q

Patients with flail chest are at a high risk of developing what other respiratory condition?

A

ARDS

160
Q
A

Nurs 726 Med Surg 2 (6 decks)

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