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Fund 51 - lower respiratory chest trauma Flashcards

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1
Q

resp anatomy (resp is PMA)

A

Divided into lobes (5)
left lung is composed of the upper lobe, the lower lobe and the lingula (a small remnant next to the apex of the heart
right lung is composed of the upper, the middle and the lower lobes.
Pleura
Mediastinum
Alveoli

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2
Q

diagnostic tests

A

Pulmonary function tests, refer to Table 35.3
Arterial blood gases
Sputum tests
Chest x-ray
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Fluoroscopic studies and angiography
Radioisotope procedures—lung scans
Endoscopic bronchoscopy
Endoscopic thoracoscopy
Thoracentesis
Biopsies

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3
Q

bronchioscopy - use for (bronsen sees, moves objects and then showers)

A

Used for diagnostics and therapeutic interventions
Visualize airways, biopsies, retrieve foreign objects, bronchial lavage (washing)

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4
Q

bronchioscopy - small amount of blood

A

is ok

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5
Q

bronchioscopy pre procedure (think of vsim)

A

Assessment: VS with O2 sats and breath sounds
Written consent
Procedural sedation (opioid, sedative, oxygen)
Topical mucous membrane anesthetic (topical spray to decrease gag reflex)

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6
Q

bronchioscopy post procedure

A

Assessment: VS with O2 sats and breath sounds
Observe opioid/sedation recovery
Observe airway (edema, wheezing, stridor, cough)
Observe sputum (bleeding from biopsy)
Assess for return of gag reflex PRIOR to oral intake

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7
Q

Atelectasis

A

Closure or collapse of alveoli, acute or chronic, most common acute occurs in post op setting,. post op 10-20% an hour.

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8
Q

atelectasis symptoms - (addy has a fever)

A

Symptoms: insidious, increasing dyspnea, cough, and sputum production. will have a low grade fever. can lead to pneumonia.

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9
Q

atelectasis acute - symptoms - think freaking out on playground and think Vsim

A

tachycardia, tachypnea, pleural pain, and central cyanosis if large areas of lung are affected.

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10
Q

atelectasis chronic - symptoms and what might be present? (chronic atelectasis, chronic infection)

A

similar to acute, pulmonary infection may be present

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11
Q

atelectasis is (addy is mismatch)

A

a VQ mismatch.

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12
Q

atalectasis diagnosis - and pulse ox at what %?

A

Chest x-ray may suggest a diagnosis of atelectasis before clinical symptoms appear. Pulse oximetry (SpO2) may demonstrate a low saturation of hemoglobin with oxygen (less than 90%)

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13
Q

atelectasis prevention

A

Frequent turning
Early mobilization
Strategies to expand lungs and manage secretions
Incentive spirometer
Voluntary deep breathing
Secretion management
Pressurized metered-dose inhaler

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14
Q

atelectasis management - turn the lung

A

Improve ventilation and remove secretions. First line measures: Frequent turning, early ambulation, lung volume expansion maneuvers and coughing. endoctracheal intubation and mechanical ventilation. thoracentesis to relieve compression.

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15
Q

lung cancer

A

Leading cause of cancer death worldwide
Causes include smoking, second- hand smoke, radon exposure (2nd leading cause), genetic predisposition, prolonged exposure
Metastasizes to the adrenals, liver, brain & bone)
Primary (in lung) /secondary (from metastes) tumor types
radon gas causes it - gets trapped in houses built on top it. lung cancer starts where there was previous scarring.

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16
Q

lung cancer - immune system

A

Immune system- WBCs and lymph system tissue. The immune system needs to find, recognize and identify the cancer cells and then tag the cancer cells before it can signal the cytotoxic T-cells and natural killer cells to attack an remove the cancerous cells. Cancer cells hide by decreasing surface antigen expression, altering the microenvironment by decreasing host immunity

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17
Q

lung cancer how is it diagnosed

A

Diagnosis
Chest X ray
Bronchoscopy
Mediastinoscopy
Endoscopic ultrasound (EUS)
Needle & Open lung biopsy
CT, PET (positron emission tomography) CT scan

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18
Q

lung cancer types - non-small cell lung cancer (don’t be small, it’s not common)

A

Non-small cell lung cancer (most common, 80%)
Symptoms – persistent cough, hemoptysis, wheezing, hoarseness, unintended weight loss, SOB, recurrent respiratory infections (bronchitis, pneumonia)

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19
Q

large lung cancer (so large it hits the edge)

A

Large cell carcinomas – (15%) occur in the outer edges of lung fields, grow rapidly
Mesothelioma (originates in the pleura)
Metastatic (breast, colon, bladder, prostate, sarcoma, Wilms tumor and neuroblastoma)

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20
Q

cancer staging

A

TNM - tumor size, lypmph nodes and how far away they are, and metastasis.

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21
Q

lung cancer treatment (treat the location or system)

A

Treatment is either:
Local (where it originates) – surgery, radiation
Systemic (wherever it happens to be) – surgery, radiation (specific or stereotactic body radiation therapy, and immunotherapy
Adjunctive
Clinical Trials

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22
Q

lung cancer therapy

A

combo surgery and chemo and radiation. T-cell mediated response enhancing immunotherapies. oncolytic virus therapies.

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23
Q

lung cancer surgeries (wedge the pneumo)

A

wedge resection, Pneumonectomy (lung removal)

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24
Q

if whole lung is taken out (post pneumonectomy) - what moves and ask for what?

A

within 4 days, diaphram moves up there. ask and need an order about how to position the patient.

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25
thoracic surgery - gives access to...
the lungs, heart, thoracic aorta, anterior spine, and esopohagus
26
thoracic surgery - indications (just keep this in mind)
Lung Cancer surgeries Esophageal cancer surgery Heart/aortic surgery Chest trauma Persistent pneumothorax Management of COPD TB Biopsy for diagnostics & evaluation of mediastinal mass Surgery to anterior spine Emergent or resuscitative thoracotomy
27
thoracic surgery - reasons emergent thoracotomy - (just stabbing and tamponade)
Thoracic trauma – 25-50% of all traumatic injuries and leading cause of death from chest trauma (blunt, penetrating, stab wounds) Release of pericardial tamponade (pericardium fills with blood) Control of intrathoracic vascular or cardiac hemorrhage Aortic cross clamping Open cardiac massage Air embolus
28
thoracic surgery nursing management
monitoring - Monitoring respiratory and cardiovascular status (airway, breathing , hemodynamics, gas exchange) Improving gas exchange and breathing (positioning, promote chest tube drainage) Improving airway clearance (T, Deep breathe, Cough, incentive spirometer, mobilize) Relieving pain, anxiety and discomfort Promoting mobility and shoulder exercises Maintaining fluid volume and nutrition Monitoring and managing potential complications (ABG, drainage, VS) want to prevent frozen shoulder
29
pleural conditions - worse on inspiration or expiration? (the pleural form of inspiration)
disorders that involve The membranes covering the lungs (visceral pleura) and the surface of the chest wall (parietal pleura) Disorders affecting the pleural space. pelurisy (inflammation of the parietal and visceral) - can get it from pneumonia trauma to chest wall, cancer, etc., more pain during inspiration - like a knife. pleural effusion, empyema, pulmonary edema
29
pleurisy - what can be heard during auscultation? (leather for my pp)
Key characteristic of pleuritic pain is its relationship to respiratory movement. Pleural friction rub can be heard with the stethoscope. Diagnostic tests may include chest x-rays, sputum analysis, thoracentesis. Treat underlying cause, provide analgesia, teaching to splint the rib cage when coughing
30
pleural effusion
Build up of fluid between the layers of the pleura Absorbed by the lymphatic system Accumulation of the fluid is effusion 100,000 cases/year in US
31
pleural effusion types (transcend the effusions)
transudative exudative
32
pleural effusion symptoms - what about cough and tracheal positioning? (emphysema and effusion are friends)
Fever, chills, pleuritic pain (sharp or pressure), dyspnea, dry non-productive cough, orthopnea, activity intolerance May have tracheal deviation away from affected side
33
pleural effusion breath sounds (not crackles)
Decreased or absent breath sounds; decreased fremitus; and a dull, flat sound on percussion
34
lung collapse - percussion sound
hyper-resonance - just hallow
35
empyema
Accumulation of thick, purulent fluid in pleural space. complication of bacterial pneumonia or lung abscess. Acutely ill and has signs and symptoms similar to those of an acute respiratory infection or pneumonia.
36
thoracentesis
evacuate fluid, expand lung capacity, enhance ventilation
37
thoracentesis nursing management
Nursing Care Priorities Monitoring (VS, breathing, oxygenation) Indication of instability or complications Assist physician Provide comfort and pain management Specimen collection and transport
38
chest trauma - flail chest? (failing at 3)
blunt trauma, sternal rib fracture, flail chest, (more than 3 ribs broken), pulmonary contusion, penetrating trauma (open, sucking air into thoracic cavity).
39
hemothorax and pleural effusion - what amount? (effusion is like the hemme, sort of)
massive - over 1500 mL of blood
40
specific chest injuries
An accumulation of air in the pleural space resulting in collapse of a portion of the lung. Causes A "paper bag" effect may occur upon sudden compression of the chest. Penetrating trauma Thoracotomy Spontaneous Lung over inflation
41
pneumothorax - specific chest injury
Signs and symptoms include: Chest pain, worse with inspiration Dyspnea Tachypnea Decreased or absent breath sounds on affected side
42
Specific Chest Injury-Open Pneumothorax - what to do if chest tube dislodges (just what to do if you have a hole in your chest - close it up)
Caused by an open chest wound that allows air to enter the pleural space with inspiration. Can be from a chest tube that has dislodged. The open wound must immediately be occluded, first by your gloved hand, and then by an occlusive dressing.
43
Specific Chest Injury-Tension Pneumothorax
immediately life threatening. Air accumulates in the pleural space with no route of escape, increasing pressure in the thoracic cavity.The pressure shifts the structures within the chest and reduces blood return to the heart. Death can occur rapidly from from respiratory failure and hypotension
44
tension pneumothorax (air) goals - need to know these (the tension movie)
Evacuation of air Reduce intrathoracic pressure Restore ventricular filling Re establish ECV mottling - check this
45
hemothorax - can result in what?
A collection of blood in the pleural space compresses the lung. May occur in open and closed injuries. The amount of blood loss can result in shock.
46
signs and symptoms of hemo and tension pneumonthorax - what about chest movement?
blunt or penetrating chest trauma, unequal chest rise, use of accessory muscles, flail chest, decreases spO2, decreased ability to ventilate, tachypnea, dyspnea, crepitus, cyanosis, chest pain, hyper resonance on affected side, hypotension, tracheal deviation to the contralateral side (late)
47
pulmonary emboli
Obstruction of the pulmonary artery or one of its branches by a thrombus (or thrombi) that originates somewhere in the venous system or in the right side of the heart. Inflammatory process obstructs area, results in diminished or absent blood flow. Bronchioles constrict, further increasing pulmonary vascular resistance, pulmonary arterial pressure, and right ventricular workload. Ventilation–perfusion imbalance, right ventricular failure, shock occurs.
48
risk factors for pulmonary emboli (think DVT and a surprise one too)
trauma, surgery, pregnancy heart failure, hypercoagulability, immobility, veinous stasis, immobile, liposuction, breaking a bone.
49
Prevention and Treatment of Pulmonary 
Emboli (just socks and compression and walking)
Early ambulation Sequential Compression Devices Anti-embolism stockings (ONLY work if you're moving)
50
treatment of pulmonary emboli
Measures to improve respiratory and vascular status Anticoagulation and thrombolytic therapy Surgical interventions
51
ARDS (drowning)
Characterized by sudden, progressive pulmonary edema, increasing bilateral lung infiltrates visible on chest x-ray. Rapid onset of severe dyspnea. Hypoxemia that does not respond to supplemental oxygen therapy
52
ARDS management (arden has peeps)
keep alveoli open, identify cause, Intubation, mechanical ventilation with PEEP to keep alveoli open, Hypovolemia treated, frequent repositioning to safeguard integumentary system, nutritional support enteral feeding, reduce anxiety
53
atlectisis breath sounds AND lung sounds (Addy cracks me up)
Decreased breath sounds and crackles over the affected area (end-inspiratory). Characterized by increased work of breathing and hypoxemia.
54
significant symptom of pulmonary arterial hypertension? (arteries don't work, so what about breathing?)
dyspnea
55
reason for chest tube?
Draining secretions, air, and blood from the thoracic cavity is necessary.
56
Which technique does a nurse suggest to a patient with pleurisy for splinting the chest wall?
turn on the affected side
57
What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment (an embolus is tachy)
tachypnea
58
Post Pneumonectomy precautions - how long does the new lung need to adjust to flow?
Chest tube unlikely- drainage congeals Verify postoperative positioning Minimize systemic volume overload Remaining lung needs 2-4 days to adjust to receiving all pulmonary blood flow
59
thoracic surgery - to relieve what conditions?
Lung abscesses Lung cancer Cysts Benign tumors Emphysema Emergent –occur at the bedside, in the ED or in the OR as part of the initial resuscitation process
60
pleural effusion - what causes it? (think fluid)
TB, pneumonia, cancer of bronchitis, mesotheleoma
61
pleural effusion - transudative cause (CHF is trans)
CHF (congestive heart failure)
62
pleural effusion - exudative cause (the infection exudes)
Infection (pneumonia) Malignancy
63
pleural effusion - fluid types (Chlorox seriously kills an empanda)
Serum (protein fluid) Empyema (purrulent) Chylothorax (lymph)
64
emypema - breath sounds (it's fluid, so...)
Chest auscultation demonstrates decreased or absent breath sounds over the affected area. Chest CT and a diagnostic thoracentesis.
65
empyema treatment - meds for how long?
Drain fluid and administer antibiotics for 4 to 6 weeks
66
types of pneumothorax (pneumo needs to stt down)
Spontaneous or simple Traumatic Tension pneumothorax
67
A client is prescribed postural drainage because secretions are accumulating in the upper lobes of the lungs. The nurse instructs the client to Take prescribed albuterol (Ventolin) when?
before performing postural drainage
68
frequent sign of pulmonary embolus does the nurse anticipate finding on assessment (think, there is a block in the heart, so what will it do?)
Tachypnea
69
PaCO2 higher than
50 is hypercapnia
70
with a chest tube, encourage what?
encourage coughing and deep breathing
71
most common symptom of pulmonary emboli - the emboli blocks my breath!!!
dyspnea is most common symptom.
72
lung cancer types - Adenocarcinomas (A for adeno)
Adenocarcinomas (40%) – former smokers, young adults, women, non smokers Early symptoms are subtle- SOB with activity, feel ill
73
lung cancer types - Squamous cell carcinomas - (squares in the tubes)
Squamous cell carcinomas (25%) starts in the bronchiole tubes Persistent cough, recurrent respiratory infections, hemoptysis
74
ARDS - which side has no atrial pressure? (ARD is the outcast)
absence of an elevated left atrial pressure.
75
atalectisis - what ventilation machines to use?
PEEP, CPAB, bronchoscopy. CPT.
76
PEEP is for
expiration
77
when giving O2 for ARDS, what position is best for administration? (Alden has to be an outcast)
Prone positioning is best for oxygenation,
78
transudative vs. exudative (trans with a straw) (exudative exudes)
Transudative effusions are caused by some combination of increased hydrostatic pressure and decreased plasma oncotic pressure. Exudative effusions result from increased capillary permeability, leading to leakage of protein, cells, and other serum constituents

XIO (400 decks)

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