chest tubes and traces Flashcards
(84 cards)
1
Q
what are some signs of airway obstruction due to swelling in the neck?
A
- Use accessory muscles to breathe
- Suprasternal and intercostal retractions
- Stridor
- Wheezing
- Restlessness
- Tachycardia
- Cyanosis
2
Q
describe an endotracheal (ETT)
A
- Don’t require incision
- Quick insertion
- used for short term mechanical ventilation
- Useful for administering inhaled gases
3
Q
describe a tracheostomy
A
- more invasive/ versatile
- used for short or long term ventilation
- permanent or temporary
4
Q
how is a tracheostomy put in?
A
- surgical incision made into the trachea
- creates stoma > airway managed by this
5
Q
if a person has an underlying problem and is being treated with a tracheostomy and its corrected what could potentially happen?
A
- removal of tube
- tracheostomy closed
6
Q
what are the components of a cuffed tracheostomy ?
A
- tracheostomy tube
- inner cannula
- obturator
7
Q
describe the inner cannula of the cuffed tracheostomy
A
- smaller tube that fits into the tracheostomy
- can be removed easily to get gummed up respiratory secretions out
- usually disposable
- replaced every day or more often if client has thick secretions
8
Q
describe the obturator of the cuffed tracheostomy
A
- used to insert tracheostomy then removed
- kept at beside
9
Q
describe the cuff on the cuffed tracheostomy
A
- connected to a little tube and port where syringe can be attached
- uses a luer lock connection > used to fill the cuff with air > no air can flow past tracheostomy tube once in client
- has a pilot light
10
Q
what is a pilot light in a cuffed tracheostomy?
A
- located close to where syringe is attached
- small balloon
- when inflated means cuff is filled
- when deflated means cuff is deflated
11
Q
what does a pilot light on a cuffed tracheostomy tell a healthcare worker?
A
whether tracheostomy cuff is inflated or not just by looking at it
12
Q
describe a laryngectomy
A
- surgical removal of larynx (contains vocal cords)
- can look like tracheostomy from outside
- end of trachea sutured to edges of stoma > once healed plastic tube may not be needed
13
Q
when is a laryngectomy performed?
A
when person had advanced cancer of the larynx that can’t be managed by a more conservative treatment
14
Q
Why is it important to now if someone has a laryngectomy if you have to give CPR?
A
- airway is completely separated from mouth, nose and esophagus
- need to ventilate through stoma in neck
- use smaller paediatric bag valve mask
15
Q
What additional safety equipment is needed at the bedside when a client has a new tracheostomy?
A
- replacement trach tube
- obturator
- spare inner cannula
- suction supplies
- spare trach ties/ trach collar
- equipment to replace trach tube if dislodged
16
Q
when a client has a new tracheostomy, what safety equipment needs to be close by and not necessarily right at bedside?
A
manual resuscitation device (proper size/ mask)
17
Q
what are the clinical manifestations of respiratory failure?
A
- increased RR
- increased work of breathing
- use of accessory muscles to breathe
- decreased oxygen saturation
- cyanosis
- anxiety
18
Q
What are clinical manifestations of bleeding at the tracheostomy site?
A
- noticeable bleeding > caused by elevated BP or coughing
- decreased BP
- blood in respiratory secretions
19
Q
what are the clinical manifestations of infection at the tracheostomy site?
A
- increased pain
- swelling
- redness
- exudate
- increased drainage
- elevated temp
- chills
- rigors
- elevated WBC count
20
Q
what are the clinical manifestations of a pneumothorax ?
A
- decreased breath sounds or decreased air entry in 1 or both of lung fields
- chest pain
- dyspnea
- elevated RR
- decreased oxygen saturation
21
Q
What is subcutaneous emphysema?
A
air leaks into subcutaneous tissues around tracheostomy
22
Q
What are clinical manifestations of subcutaneous emphysema?
A
- swelling of the neck
- extending up into the jaw or down into chest
- on palpation tissue feels crackly
23
Q
what are the long term complications of having a tracheostomy?
A
- tracheal stenosis
- tracheomalacia
- granuloma formation
- tracheoesophageal fistula
24
Q
in regards to long term complications of having a tracheostomy, describe a tracheal stenosis
A
- narrowing of the trachea
- caused by irritation at the trach site from cuff being inflated to much
25
in regards to long term complications of having a tracheostomy, describe a tracheomalacia
1. trachea becomes weak/ flaccid
2 structure of trach changes
- collapse during high flow
- coughing, crying, eating
3. caused by poorly fitted tube
- damages tracheal tissues
26
in regards to long term complications of having a tracheostomy, describe a granuloma formation
- hyper granulation tissue grows at trach site > may occur distal to site inside trach
- hyper granulation tissue friable/ bleeds easily
27
in regards to long term complications of having a tracheostomy, what causes a granuloma formation?
- ill-fitting tube
| - chronic inflammation/ infection
28
in regards to long term complications of having a tracheostomy, describe tracheoesophageal fistula
- fistula between esophagus and trachea
| - gastric content can enter resp tract and air can enter stomach > cause pneumonia and abdominal distension
29
what is a fistula?
abnormal connection between 2 different parts of the body
30
What causes a tracheosophageal fistula?
- friction between cuff of trach tube and nasogastric tube in esophagus
- injury > when trach was originally created
31
How often does a trach need to be cared for?
- twice a day or more frequent if needed
32
What does routine tracheostomy care entail?
- changing trach dressing if soiled/ wet
- changing trach ties if soiled/ wet
- cleansing around trach site with sterile saline
- changing/ cleansing inner cannula
33
What type of trach has a reusable inner cannula?
cuff less tracheostomy
34
How often do inner cannulas need to be cleaned?
- check for patency every 12hrs
- disposable inner cannula > changed every 24hrs
- non-disposable inner cannulas > cleaned every 24hrs
35
what do you do in the case of accidental decannulation?
- do not replace tube
- assess ABCs
- stay with patient
- ask someone to cal RT STAT and call doctor
- if client can't breathe maintain satisfactory O2STAT and call code blue
36
What is the process of weaning a patient off of a tracheostomy?
- takes about 2-7 days
- deflate trach cuff
- replacing cuff tube with a smaller uncured tube
- capping/ corking trach tube
- removing (decannulating) trach tube
37
in regards to the process of weaning a patient off of a tracheostomy describe replacing cuffed tube with a smaller uncuffed tube
- client should maintain adequate breathing and oxygenation
| - client is breathing through trach and mouth/nose
38
in regards to the process of weaning a patient off of a tracheostomy describe capping/ corking the trach tube
- cap that covers opening in trach tube
- client is only breathing through mouth/nose
- if client feels SOB and O2STAT drops remove cap> allows client to breath through trach again
39
in regards to the process of weaning a patient off of a tracheostomy describe removing (decannulating) trach tube
- tube is removed
- stoma covered with sterile folded gauze/ tape
- stoma starts to heal/ permanently close
40
describe ches tubes
- drainage tubes used to remove air/ fluid from chest cavity
- usually placed in pleural space
- if needed > placed into mediastinal space (around heart)
41
What are indications for chest tubes?
- pneumothorax
- pleural effusion
- hemothorax
- empyema
- chylothorax
- thoracic or chest surgery
42
in regards to chest tubes, describe a pneumothorax
- air in pleural space
| - mainly air and some pleural fluid coming out
43
in regards to chest tubes, describe a pleural effusion
- fluid in the pleural space
- yellow or amber
- clear or cloudy
44
in regards to chest tubes, describe a hemothorax
- blood in pleural space
- caused by trauma
- blood draining from chest tube
45
in regards to chest tubes, describe empyemma
- pus or purulent drainage builds up in pleural space
- caused by condition > pneumonia or lung abscess
- drainage from chest tube would appear purulent
46
in regards to chest tubes, describe a chylothorax
- lymphatic fluid leaks into pleural space
- due to trauma or complication of chest surgery
- chest tube drainage appears milky white
47
in regards to chest tubes, describe a thoracic or chest surgery
- surgery of heart or lungs
- tubes placed after surgery in the pleural or mediastinal space to drain air, blood, or serous fluid resulting from surgery
48
What can cause a pleural effusion
- to much hydrostatic pressure in blood vessels
- not enough plasma proteins (albumin) in blood stream
- inflammatory or infectious process in lungs
49
in regards to a pleural effusion describe to much hydrostatic pressure in blood vessels
- forces fluid to be pushed out of blood vessels into pleural space
- happens in HF especially left sided
50
in regards to a pleural effusion describe not enough plasma proteins (albumin) in blood stream
- helps maintain plasma oncotic pressure
- not enough cause fluid to leak out of blood vessels
- happens when person is malnourished, or liver failure
51
in regards to a pleural effusion describe inflammatory or infectious process in lungs
- produces exudate
| - can be caused by pulmonary emboli, lung infections, lung cancer
52
describe a thoracotomy
- chest open to perform surgery on lungs
- used when person has lung cancer > all or part of lung removed
- chest tubes placed at bottom of lung
- incision curves with rib
53
describe pigtail drains
small- bore chest tube
- curled end
- smaller in diamater
- less painful than some larger diameter tubes
- used to drain air and pleural fluid
- thick fluid can clog pigtail
54
describe tension pneumothorax
- build up of air in pleural space
- every breath causing increased pressure in pleural space
- compresses affected lung, airways and blood vessels
- if not treated ASAP can prevent heart from filling/ pumping/ cause both lungs to collapse
caused from kinked chest tube
55
What does a tension pneumothorax result in?
structures being shoved to opposite side of chest
56
describe an atrium oasis closed drainage system with water seal drain
- used after trauma or surgery
| - has 3 compartments
57
what are the compartments of the atrium oasis closed drainage system wit water seal drain?
- one chamber that collects drainage
- one chamber with a water seal > allows air to escape from chest tube but doesn't allow air to get back in
- suction control chamber that allows nurse to regulate amount of suction that's applied the chest tube
58
describe a pneumostat chest drain valve
- one way valve
- has a very small collection chamber
- only used when physician doesn't anticipate much drainage
- can't be attached to suction
- small/ portable > makes mobilizing easier
59
What types of cancers are malignant pleural effusion associated with?
- lung
- breast
- leukemia
- lymphoma
60
describe malignant pleural effusions
- most common in last 4-6 months of life
- inflammation around cancer causes fluid to build up in pleural space
- cancer can prevent normal drainage of pleural fluid
61
When is a PleurX chest drain used?
when a client has chronic condition that continuously causes fluid to build in chest > needs to be drained periodically
62
What does a PleurX chest drain look like?
- tunneled indwelling pleural catheter with intermittent drainage
- chest tube is meant to stay in place for long time
- egg shaped drain sealed to maintain vacuum until punctured by T-plunger
63
how do clients use a Pleura chest drain?
- fluid builds up in pleural space and starts causing pain/ difficulty breathing
- drain connected to PleurX catheter and fluid drains
- when drainage is done catheter is disconnected from drain and catheter is coiled up on client's chest/ covered with sterile dressing until needed again
64
Who is a pleurX chest drain meant for?
people living in community who need chest tube
65
What is included in a chest tube drainage system assessment?
- respiratory assessment
- assess for subcutaneous emphysema
- check dressing
- check tubing: eliminate dependent loops
- check tubing: connection are taped
- follow tubing to wall suction (if ordered)
- assess amount and type of drainage
- assess bubbling in the water seal chamber
- assess for tidying (fluctuating)
- check water level in the water seal chamber
- check amount of suction matches doctor order
- check drainage system is secured (prevent tipping)
66
in regards to the assessment for a chest tube drainage system, describe respiratory assessment
- trachea is midline
- chest expansion is symmetrical
- lung auscultation
- air entry > may be decreased if lung partially collapsed
67
in regards to the assessment for a chest tube drainage system, describe assess for subcutaneous emphysema
- air leaks out through tissues around chest tube into subcutaneous tissues
- observe/ palpate for swelling and crepitus (crunching sensation) in tissues around chest tube
68
in regards to the assessment for a chest tube drainage system, describe chef tubing: eliminate dependent loops
check tubing from chest tube to drainage system/ eliminate any loops
69
in regards to the assessment for a chest tube drainage system, describe follow tubing to wall suction
- follow suction tubing from drainage system to wall suction
| - wall suction needs to be strong enough to activate suction in the drainage container (around 80mmHg)
70
in regards to the assessment for a chest tube drainage system, describe assess amount and type of drainage
- should be light yellow, straw coloured fluid
- some blood is fine
- record amount of drainage
71
in regards to the assessment for a chest tube drainage system, describe assess bubbling in the water seal chamber
- get client to take deep breath and blow out
| - if air leak in client or system will cause bubbles to escaper through water seal chamber
72
in regards to the assessment for a chest tube drainage system, describe assess for tidalling (fluctuating)
- level of fluid is fluctuating up/ down as they breathe
- any fluid in tubing of drainage system will fluctuate as well
- indicates changing pressures in pleural space
73
in regards to assessing tidalling (fluctuating) explain what happens with a collapsed lung when it re-expands
- fluctuations should become less and less
| - once client is healed/ close to nurse shouldn't be able to see any tidalling when client takes deep breath
74
in regards to the assessment for a chest tube drainage system, describe check water level in the water seal chamber
- should be right at 0 mark
- water can evaporate if client has chest tube drainage system for long time > bubbling causes this
- water to low/ high nurse can adjust with sterile water
75
in regards to the assessment for a chest tube drainage system, describe check amount of suction matches doctor order
- suction ordered nurse sets specific suction on front of drainage system
76
in regards to the assessment for a chest tube drainage system what happens if suction is greater or less than 20cm?
- suction > 20cm red bellow expand across window
- suction <20cm not strong enough to pull red bellows all the way across > should still be ablate see
- no suction ordered nurse should disconnect system from wall suction
77
in regards to the assessment for a chest tube drainage system, describe check drainage system is secured (prevent tipping)
- ensure bellow chest tube site
- can be taped to floor > not normally done
- normally taped to bottom of IV pole > make mobilizing easier for patient
78
in regards to the assessment for a chest tube drainage system, what happens if drainage system falls over?
- stand upright
| - tilt over to right side > get drained fluid back into correct columns
79
describe an air leak in a client with a chest tube
- air is escaping out from the chest tube drainage system through water seal chamber
- will look like bubbles
80
what can cause an air leak in a client with a chest tube?
- break/ crack in collection devise
- crack/ break or disconnection in tubing
- inside client (pneumothorax)
81
nursing education to promote health and avoid complications with chest tubes
- adequate nutrition
- staying hydrated
- managing pain effectively
- monitor for signs of infection
- changing positions frequently to prevent skin breakdown
82
What do you do if a chest tube is pulled out?
- put on clean gloves/ cover site with gloved hand
- call for help
- have assistant get non-adherent dressing (mepitel), 4X4 gauze and tape
- apply dressing over site, cover with gauze, tape on 3 sides > creates 1 way valve
- once dressing in place, one nurse stay with client to ensure they don't go into distress, other nurse calls doctor ASAP/ reports
83
describe toothless Kelly clamps in regards to chest tubes
- always have 2 at bedside
| - used when looking for air leak
84
What might the doctor get the nurse to do with Kelly clamps if they're thinking about removing chest tube?
- get nurse to clamp tubing overnight or longer
| - if client can stand this chest X-ray ordered to see lungs remaining fully expanded/ underlying problem resolved
