Final Blueprint Pulmonary Flashcards
What is the chest tube management regarding the patient?
Ensure that the dressing on the chest around the tube is tight and intact.
Assess for difficulty breathing
Assess breathing effectiveness by pulse ox
Listen to breath sounds for each lung
Check alignment of traces
Check tube insertion site for contain of the skin. Palpate area for puffiness or crackling that may indicate subQ emphysema
Observe site for signs of infection (redness, purulent drainage) or excessive bleeding
Check to see if tube “eyelets” are visible
Assess for pain and its location and intensity, and admin drugs for pain as prescribed
Assist patient to deep breathe, cough, perform maximal sustained inhalations, and use incentive spirometry
Reposition the pt who reports a “burning” pain in chest
what is the chest tube management regarding the drainage system?
Do not “strip” the chest tube
Keep drainage system lower than the level of the pt chest
Keep the chest tube as straight as possible, avoiding kinks and dependent loops
Ensure the chest tube is securely taped to the connector and that the connector is taped to the tubing going into the collection chamber
Assess bubbling in the water seal chamber; should be gentle bubbling on pts exhalation, forceful cough, position changes
Assess for “tidaling”
Check h2o level in the h20 seal chamber, and keep at the level prescribed by surgeon
Clamp the chest tube only for brief periods to change the drainage system or when checking for air leaks
Check and document amount, color, and characteristics of fluid in the collection chamber, as often as needed according to the pts condition
Empty collection chamber or change the system before drainage makes contact with the bottom of the tube
When a sample of drainage is needed for culture or other lab test, obtain it from the chest tube; after cleansing chest tube, use 20g or smaller needle and draw up specimen into the syringe
what is a tension pneumothorax?
(complication of simple or traumatic)
Occurs as a complication of a simple or traumatic pneumothorax, where either a trauma or spontaneous injury has occurred, allowing air that has entered the pleural space to become trapped and creates positive pressure and tension to increase. This is a medical emergency and can be identified when the trachea is diverted from midline.
Needle decompression and chest tube
what is an open pneumothorax?
(“sucking” chest wound)
Treatment: taping from 3 sides, it creates a valve that allows air out, but not in. A chest tube will be inserted once the patient is stabilized.
what is a traumatic pneumothorax?
(occurs as a result of injury)
Occurs when an injury to the lung occurs and allows air to escape the lung and enter the pleural space. The lung trauma may be from blunt force in which rib fractures cause lung injury or penetrating trauma like gunshot or stabbing cause injury. If a penetrating trauma causes an external wound large enough to allow air to pass freely to and from the thoracic cavity, then it’s called an open pneumothorax or sucking chest wound. This is a medical emergency and requires a 3 sided dressing to essentially create a one way valve.
what is a simple pneumothorax?
(occurs spontaneously)
Most often from a ruptured air-filled bleb, allowing air to enter the pleural space.
what are the treatments for a pneumothorax and its CMs?
Pneumothorax treatment: if suspected = medical emergency (needle in midclavicular line, chest tube in anterior axillary line)
Pneumothorax symptoms: chest pain, SOB, hypoxia, decreased air entry on auscultation and hyper resonance on percussion.
what are the normals for pH, PaCO2, and HCO3?
pH: 7.35 (A)-7.45 (B)
PaCO2: 35 (B)- 45 (A)
HCO3: 22 (A) -26 (B)
what is important to know about fully compensated, uncompensated, and partially compensated?
Fully compensated: pH is within normal range
Uncompensated: pH is out of range, either the PaCO2 or HCO3 is in range.
Partially compensated: pH, PaCO2, and HCO3 are all out of range
what is important to know about vent safety?
HOB elevated 30-40 degrees
Good hand hygiene
Sterile technique
Thorough oral care
Admin ordered ABX
PEEP settings
Prevent barotrauma
what are the prevention of complications for mechanical vent?
Gastric ulcers = proton pump inhibitors and enteral nutrition
Venous thromboembolism (VTE) = pneumatic compression devices and anticoagulation prophylaxis
Acute Kidney Injury (AKI) = monitor intake and output, weights, and labs, be mindful of fluid status, and administer IV fluids and diuretics
