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Med Surg 2 > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What is pneumothorax?

A

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

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2
Q

What is spontaneous pneumothorax? What are the two types?

A

air in the intrapleural space

no preceding trauma or underlying disease

primary: tall white slender males age 10-30 at higher risk

secondary: anyone can get it, patients with long term emphysema at risk

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3
Q

What is iatrogenic pneuomothorax?

A

caused by medical procedures

air in the pleural space

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4
Q

What is traumatic pneumothorax?

A

air in pleural cavity, can enter and leave
can lead to hemothorax and hemopneumothorax

penetrating
- can lead to tension pneumothorax
- due to penetrating wound
- GSWs and stab wounds

blunt
- car accident

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5
Q

What is hemothorax?

A

blood in pleural space from injury to chest wall, diaphragm, lung, blood vessels, or mediastinum

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6
Q

What is hemopneumothorax?

A

blood and air in the pleural space

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7
Q

What is chylothorax?

A
  • lymphatic fluid in the pleural space
  • seen in children often

risk factors
- post op thoracic sx
- congenital abnormalities of thoracic cavity
- empyema

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8
Q

What is tension pneumothorax?

A
  • caused by trauma or disease
  • air enters in the pleural space but can’t leave from penetrating injury
  • leads to mediastinum shifts (CXR) and tracheal deviation and JVD
  • heart becomes compressed–cardiogenic shock–death
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9
Q

What are the clinical manifestations of pneumothorax?

A

pleural pain
tachycardia
flared chest
dyspnea
respiratory distress
absent breath sounds
hyperresonance or dullness (trapped air)
subcutaneous emphysema
decreased cardiac output

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10
Q

What is subcutaneous emphysema?

A
  • crepitus
  • air accumulating in SQ tissue
  • trapped usually in upper chest
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11
Q

What diagnostic studies are there for pneumothorax?

A

ABG - PaO2 < 80 mmHg
CXR - confirms
thoracentesis

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12
Q

What should a nurse tell a patient who is about to have a thoracentesis? What will the nurse do after?

A

pre- pt will feel pressure, but no pain
post- monitor status (VS, O2, inj. site)

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13
Q

What is the treatment for pneumothorax?

A
  • spontaneous resolution
  • urgent needle decompression (tension pneumothorax)
  • thoracentesis
  • chest tube (primary tx)
  • pleurodesis (rx chemically destroys area that keeps rupturing–sealed)
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14
Q

What medications can be given for pneumothorax? Why?

Why should they be used cautiously?

A

benzodiazepines (lorazepam or midazolam)
opioid (norco - hydrocodone/acetaminophen)

used for treatments that can cause anxiety/pain

caution: can cause resp. depression

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15
Q

What are the nursing interventions for pneumothorax?

A

O2 therapy
semi-fowler’s
VS and lung sound monitor Q4
IV therapy for circulatory support
chest tube drainage care
respiratory/pulmonary consult

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16
Q

What is the order of supplemental oxygen devices?

A

Nasal cannula 2-6 L
Simple mask 6-10 L
Nonrebreather 10-15L

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17
Q

What is a chest tube?

A

catheter attached to drainage system

18
Q

What does a chest tube do?

A

remove air or fluid from pleural and/or mediastinal space

re establish negative pressure

re-expand lung (primary goal)

19
Q

What is a pigtail tube and heimlich valve?

A

one way system that allows air to exit pleural space

20
Q

What are the components of a pleural drainage system?

A

collection chamber
water seal chamber
suction control chamber (wet or dry)

21
Q

In the water seal chamber, what is tidaling? What does it indicate? What does it mean when there is no tidaling?

A

movement of fluid level with respirations (expected finding)

indicates proper function/patency

no tidaling = lung has re expanded

22
Q

In the water seal chamber, how will one know if there in an air leak?

A

continuous bubbling = large leak

intermittent bubbling = air leak b/w pt and drainage system

23
Q

In the suction control chamber for a wet suction system, what does the water do? How is it regulated?

A

uses water to control the amount of suction from the wall regulator

regulated by adding water to the suction control chamber

24
Q

What does it mean when it is a dry system in suction control chamber? How is it regulated?

A

no water

self-regulated with an internal barometer

25
Q

When is continuous bubbling acceptable in the suction control chamber?

A

when wall suction is turned on for a wet system in the suction control chamber only

26
Q

Where should the drainage device be placed in the room? Why?

A

below the patient due to risk of air coming back

avoid kicking

27
Q

What items must be present in a patient’s room when a chest tube is placed?

A

4x4s
vaseline gauze
kelly clamps/forceps
paper or medipore tape
sterile water or normal saline

28
Q

What are the nursing interventions for a patient’s clinical status who just had a chest tube placed?

A

monitor VS, lung sounds, and pain
monitor for complications:
- re-accumulation of air/fluid in lung
- bleeding
- infection
- subcutaneous emphysema

28
Q

What are the nursing interventions for set up and insertion for a chest tube?

A

verify informed consent
position patient
gather and set up equipment

29
Q

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

A

do not elevate above pt
maintain patency
secure all connections
monitor tidaling
monitor fluid level in collection chamber
reestablish water-seal if disconnects
have client cough and deep breath

30
Q

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

A

observe sterile technique
use sterile occlusive dressing

31
Q

What will a nurse teach a client who just had a chest tube placed?

A

encourage:
CDB
incentive spirometer
ROM on affected side

32
Q

What are the nursing interventions for the removal of a chest tube?

A

premedicate client
ask client to bear down
apply occlusive dressing
monitor respiratory distress
obtain CXR

33
Q

What is pleural effusion? What is heard through auscultation and percussion?

A

collection of fluid in the pleural space

ausc: crackles
percus: dullness

34
Q

What are the types of pleural effusion?

A

transudative
- rare
- clear pale yellow
- fluid that comes from movement of blood, noninflammatory

exudative
- most common
- from infection
- inflammatory reaction

empyema
- pus
- caused by pneumonia, TB

35
Q

What are the clinical manifestations of pleural effusion?

A

dyspnea
cough
non-radiating chest pain (worse on inhalation)
diminished breath sounds
decreased chest movement
dullness on percussion
empyema

36
Q

What are the clinical manifestations of empyema?

A

same as pleural effusion

Also includes:
fever
night sweats
weight loss

37
Q

What is the treatment for pleural effusion?

A

thoracentesis
chemical pleurodesis

empyema
- chest tube
- antibiotic
- decortication

38
Q

What is decortication?

A

the removal of fibrous tissue from the surface of the lungs

39
Q

What might indicate the chest tube is dislodged?

A

crepitus around the chest tube insertion site

Med Surg 2 (7 decks)

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