fund 51 chest tube management Flashcards
(67 cards)
community acquired pneumonia
community or ≤48 hours after hospital admission or institutionalization of patients
health care associated pneumonia
Hospitalization for ≥2 days in an acute care facility within 90 days of infection
*Residence in a nursing home or long-term care facility
*Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection
*Hemodialysis treatment at a hospital or clinic
*Home infusion therapy or home wound care
*Family member with infection due to multidrug-resistant bacteria
hospital acquired pneumonia
Pneumonia occurring ≥48 hours after hospital admission that did not appear to be incubating at the time of admission
ventilator associated pneumonia
A type of HAP that develops ≥48 hours after endotracheal tube intubation
VAP (being vapid until you’re 96)
VAP occurring within 96 hours of the onset of mechanical ventilation is usually due to antibiotic-sensitive bacteria that colonize the patient prior to hospital admission, whereas VAP developing after 96 hours of ventilatory support is more often associated with MDROs.
pneumona tactile fremitis and percussion
increased tactile and dull percussion (fluid is dull)
thorocentisis (just single bottle small, double big)
Thoracentesis – insertion of a needle into the pleural space to drain fluid or air
Single bottle system is used to drain air or small amounts of fluid from the pleural space
Two chamber system work as a single bottle chest drainage system, but it decreases the workload of breathing
chest drainage systems have
A suction source
A collection chamber for pleural drainage
And a mechanism to prevent air from reentering the chest with inhalation. Used in removal of air and fluid from the pleural space and re-expansion of the lungs. Wet (water seal) or dry suction control
normal amount of suction is
20 mL, might be orders for something different.
chest drain nursing management -
Know indication(s) & supplies
Chest drainage system set up, chest tube (type & size)
Patent IV access
types of chest tubes (CHD had a chest tube)
Types of plastic (PVC or silicone)
Coated or non coated
Heparin
Decreased friction
nursing responsiblities
assess VS, breath sounds, SaO2, IV access, give 204 L o2 via nasal cannula, HOB up 30 degrees, assess LOC, orientation, anxiety, cyanosis, restlessness, watch ECG for PAC or PVCS, monitor chest x-ray, ABGs
chest tube insertion - supplies - types of gauze
Tube sutures in place
Sterile, occlusive dressing
Petrolatum – Dry gauze -
Prepare drainage system in advance
Physical assessment of breath sounds and improved ventilation
CXR to confirm placement
Supplies
chest tube nursing care - check for what type of emphsyema?
Check for sub-Q emphysema
Examine chest tube site (occlusive, securement, leaks)
Monitor water seal, chamber (tidaling, air leak)
Monitor collection chamber
Mark level on CDU
Drainage amount & characteristics
Encourage C & DB with splinting
Administer pain meds
Don’t strip the tubing
Emergency supplies in place
maintain drainage system how?
below chest level
occlusive dressing when?
at all times and change per unit policy
monitor how often? (4 chambers in the chest)
at least every 4 hours
chest tube removal (seal the suction)
Switch from suction to water seal
Resolution of pneumothorax
Patient advocate
Preemptive analgesia, supplies (suture removal, sterile gloves, PPE, occlusive dressing, order CXR, positioning
Assist physician
Immediate application of occlusive dressing
Physical assessment of breath sounds, RRED, oxygenation, comfort, pain
correct tracheal cuff pressure
22
When weaning the client from the tracheostomy tube, the nurse initially should plug the opening in the tube for how long? (Plugged up for 5 min)
5 - 20 min
70% and the FEV1 is 65%
COPD II
take pancreatic enzyme with
meals
70% and the FEV1 is 85%
COPD I
emergent supplies for chest tube drainage
clamps, occlusive dressing (to prevent infection), suction, replacement drainage system
