respiratory Flashcards
hemothorax patho
blood/air accumulated in pleural space
collapsed lung
hemothorax s/s
SOB high HR diminished breath sounds on affected side less movement on affected side chest pain cough air/blood on CRX
hemothorax treatment
thoracentesis
chest tube
daily chest xray
tension pneumothorax causes
trauma too much PEEP clamping a chest tube insertion of central venous lines taping an open pneumothorax on all 4 sides without an air valve
tension pneumothorax patho
pressure build up in chest/pleural space
collapsed lung
pressure pushes everything to the opposite side (mediastinal shift)
tension pneumothorax s/s
subQ emphysema absence of breath sounds on one side asymmetry of thorax respiratory distress cyanosis distended neck vein or JVD
tension pneumothorax treatment
large bore IV into 2nd intercostal space to allow excess air to escape
treat the cause
chest tube
open pneumothorax patho
opening through chest that allows air into the pleural space
open pneumothorax treatment
inhale and hold valsalva hummmmm place petroleum gauze over area and tape down on 3 sides sit up if possible to expand lungs
thoracentesis
used to remove fluid or air from pleural space
pre procedure: consent stop anticoag meds VS O2 pain chest xray sit on edge of bed with feet supported and lean over the bedside table OR lie on unaffected side with HOB at 45 degrees
procedure: still no coughing or deep breaths as fluid is removed, lung will re-expand VS O2 pain
post procedure:
chest xray
VS
lung should be absent or reduced breath sounds on affected side
assess for bleeding
monitor for SubQ emphysema, infection, and tension pneumothorax
turn, cough and deep breath
chest tube insertion
pg. 156
needed because a collapsed lung
upper anterior chest (2nd ICS) = remove air
lateral in lower chest (8th or 9th ICS) = drainage removal
chest tube is sutured to the chest and an airtight dressing is applied around the tube exit site
chest tube is connected to the closed chest drainage unit
purposed of CDU (closed drainage unit):
restore normal vacuum pressure in pleural space by removing all air/fluid in a closed one-way system until corrected
3 chambers of CDU
drainage collection chamber
water seal chamber
suction control chamber
drainage collection chamber
chest tube connected here
get a new CDU if it fills up
water seal chamber
used to promote one-way flow out of the pleural space to prevent air from moving back up the system and into the pleural space
connected to DCU by a small tube that allows drainage to remain in the first chamber and the air to go down into the water of the water seal chamber
chamber contains 2cm of water which acts as a one-way valve to prevent backflow
** may see intermittent bubbling when they cough, sneeze, or exhale
** will see a slight rise/fall of water as they breath (tidaling)
**if tidaling has stopped, it usually means that the lung has re-expanded
suction control chamber
if they need suction to remove air/fluid then this chamber controls the pressure applied
- ***sterile water is placed up to 20cm
- **turn on the wall vacuum suction until you have slow, gentle, continuous bubbling
- **vigorous bubbling = BAD
if there is a dry suction then water is not used and has no bubbling
