Chest trauma and restrictive respiratory

Question 1

define pneumothorax

Answer 1

presence of air in the pleural space resulting in complete or partial collapse of the lung

Question 2

what is closed vs open pneumothorax

Answer 2

closed: no associated external wound
open: opening in chest wall (like trauma or injury)

Question 3

define hemothorax

Answer 3

accumulation of blood in the intrapleural space

Question 4

define chylothorax

Answer 4

presence of lymphatic fluid in the pleural space bc of leak in the thoracic duct

Question 5

what dressing do you put on a open pneumothorax?

Answer 5

a dressing with a vented dressing (secured on 3 sides) to allow air to escape from the vent

Question 6

define tension pneumothorax

Answer 6

pneumothorax with rapid accumulation of air in the pleural space

Beverly high inrapleural pressures

basically this is a medical emergency with both respiratory and card affected. pt can die from inadequate CO/hypoxemia

Question 7

what are clinical manifestations of pneumothorax

Answer 7

1) no air in affect area. so auscultating is highly important
2) rapid shallow respirations
3) hyper-resonance

Question 8

what are clinical manifestations of tension pneumothorax

Answer 8

1) trachea deviation to the unaffected side
2) the pt can go into cardiac arrest if the issue is not relieved. NO OTHER INTERVENTION WILL WORK OTHER THAN RELEASING THE AIR through needle decompression

Question 9

discuss fractured ribs

Answer 9

• ribs 5-10 mostly common fractured bc they are less protected by the chest muscles
• pt will experience pain especially with inspiration at the site thus the pt might be reculant to take deep deep breaths which can lead to atelectasis
• usually use splints to help

Question 10

discuss flail chest

Answer 10

multiple rib fractures causing instability of the chest wall

• affected flail are will move paradoxically to the intact portion of the chest during respiration. this movement prevents adequate ventilation

Question 11

what are clinical manifestations of flail chest

Answer 11

crepitus of the rib (ribs will feel like rice crisps)

Question 12

what does chest tubes and pleural drainage do? and know how to insert it and the positions pt need to be in and the chest tube machine**

Answer 12

remove air and fluid from the pleural space

Question 13

what are some other tools use to drain the pleural area

Answer 13

1) heimlich valves
2) small chest tubes aka pigtail catheters

Question 14

what are some nursing chest drainage managements?

Answer 14

1) keep tubing loosely coiled below chest level.
2) keep all connections between chest tubes, draining tubing, and drainage collection tight and tape at connections
3) observe for air fluctuations (tidalling) and bubbling in water seal chamber. if tidalling is observed then the drainage system is blocked, lungs are re-expanded, or the system is attached to suction
4) suspect a system leak when bubbling is continuos. if bubbling continues, theres an air leak or leak from the pt

Question 15

how do you check for a leak?

Answer 15

momentarily clamp the tubing . if the bubbling stops then the leak is above the clamp

if it continues, notify MD

Question 16

is a chest tube usually clamped or changed?

Answer 16

no it is not routinely clamped nor changed. physician order needed

Question 17

what is the chest tube complications?

Answer 17

malposition is the most common complication.
- observe for tidalling
-ausultate breath sounds
-measure amount of draining

Question 18

which cancer is the most preventable?

Answer 18

lung cancer (smocking cessation)

Question 19

where does cancer originate?

Answer 19

the epithelium of the bronchus and grows slowly (8-10 years to reach 1cm in size)

Question 20

what surgeries are used?

Answer 20

1) thoracotomy - always results in 1-2 chest tubes
2) video-assisted thoracoscopic surgery - may or may not require chest tube
3) lobectomy - remove one lobe
4) pneumonectomy - remove entire lung
5) segmental resection - remove segments of lungs

Question 21

define restrictive respiratory disorders

Answer 21

characterized by a restriction in lung volume caused by decrease of lungs or chest wall

Question 22

define pleural effusion

Answer 22

a collection of fluid in pleural space

1) transudative pleural effusion - non-inflammatory conditions
2) exudate pleural effusion - from are of inflammation
3) empyema - pleural effusion that contains pus

type of effusion is determined by thoracentesis (removal of the fluid in the pleural space)

Question 23

what’s the max draining when doing thoracentesis?

Answer 23

1000 - 1200 mL at one time

Question 24

discuss pleurisy

Answer 24

inflammation of the pleura usually caused by pneumonia, tb or chest trauma

Question 25

discuss atelectasis

Answer 25

complete or partial collapse of lung or segment of lung that occurs when the alveoli become deflated

Question 26

discuss interstitial lung disease

Answer 26

pulmonary inflammation and fibrosis

occupational and environmental exposures are the MOST COMMON cause.

develops into 2:
1) idiopathic pulmonary fibrosis: scar tissue in the connective tissue of the lungs due to inflammation or irritation
2) sarcoidosis: chronic multi-systen granulomtous disease of unknown cause

Question 27

what will you hear with pulmonary edema

Answer 27

crackles

Question 28

define pulmonary embolism

Answer 28

blockage of pulmonary artery by a thrombus, fat or air embolus.

embolus travels through vessels until it lodges and obstructs perfusion of the alveoli

Question 29

what are clinical manifestations of pulmonary embolism

Answer 29

1) pain on inspiration
2) crackles
3) hypoxemia and LOW PaCO2

Question 30

discuss complication of pulmonary embolism

Answer 30

death of the lung tissue aka pulmonary infarction and pulmonary hypertension

Question 31

what testing tools are used for diagnostic pulmonary embolism?

Answer 31

D-dimer (using dye)
Spiral CT scan

Question 32

what are some care for pulmonary embolism

Answer 32

prevent PE with venous thromboembolism prophylaxis and use incentive spirometer

medications: fibrolytic and anticoagulative medications.

Question 33

what is the blood work for pulmonary edema?

Answer 33

aPTT - how long it takes blood to slow

if it is:
low - quick clotting
normal - 25-25 seconds
high - longer time to clot