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Pneumothorax Flashcards

1
Q

chest trauma types

A

blunt trauma
a) Deceleration, acceleration, shearing, and compression injuries
b) Open wound through the pleural space

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2
Q

fivetypes of chest injuries

A

fractured ribs
flail chest
pneumothorax
hemothorax
chylothorax

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3
Q

emergency management for chest injuries

A
  1. Initial interventions
    a) Circulation, airway, breathing
    b) O2 to keep SpO2>90%
    c) IVs and fluid resuscitation
    d) Assess injury
    e) Dressing to site
  2. On-going monitoring
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4
Q

what is a fractured rib

A

Can damage pleura and lungs, and surrounding vessels or organs

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5
Q

fractured ribs clinical manifestations

A

Pain with inspiration, coughing, splinting, shallow respirations

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6
Q

fractured ribs complications

A

atelectasis
pneumonia

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7
Q

management of fractured ribs

A

reduce pain
deep breathing and coughing
incentive spirometry

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8
Q

what is flail chest

A

a) 3 or more adjacent ribs fractured in 2 or more places
b) Paradoxical chest wall movement

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9
Q

manifestations of flail chest

A

rapid, shallow respirations; tachycardia, crepitus

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10
Q

management of flail chest

A

O2 as needed
pain management,
stabilize flail segment (mechanical ventilation, surgical fixation)

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11
Q

what is pneumothorax

A

a) Collection of air in the pleural space.
b) Positive pressure in cavity causes lung to collapse
c) Increased air in pleural space equals reduced lung volume

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12
Q

manifestations of pneumothorax (small and large)

A

Small pneumothorax – mild tachycardia and dyspnea

Large pneumothorax – respiratory distress, absent breath sounds over affected area

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13
Q

types of pneumothorax

A

spontaneous
iatrogenic
tension pneumothorax

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14
Q

describe spontaneous pneumothorax

A

Rupture of blebs (air-filled sacs)

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15
Q

describe latrogenic pneumothorax

A

Caused by medical procedures

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16
Q

describe tension pneumothorax

A

accumulation of air in pleural space that cannot escape resulting in increased intrapleural pressure

causes mediastinal shift and hemodynamic instability – decreased venous return and decreased CO

Medical emergency –needle decompression or insertion chest tube

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17
Q

manifestation of tension pneumothorax

A

severe dyspnea
tachycardia
tracheal deviation
decreased or absent breath sounds on affected side
JVD
cyanosis
diaphoresis

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18
Q

emergency management of pneumothorax

A

Cover wound with dressing secured on 3 sides

Do not remove impaled object

Chest tube insertion

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19
Q

what is hemothorax and its management

A

Presence of blood in the pleural space

Management: chest tube insertion, treat hypovolemia as needed

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20
Q

what is chylothorax and its management

A

Lymphatic fluid in pleural space

Management: chest tube, Octreotide, surgery, pleurodesis

21
Q

purpose of chest tube. and pleural drainage

A

to remove air, blood or fluid from pleural space (pleural tube) and reestablish negative pressure

22
Q

chest tube insertion equipment

A

chest tube, drainage system, sterile water, insertion tray

23
Q

pleural drainage devices

A

flutter (Heimlich) valve
PleurX catheter
Drainage system with suction

24
Q

what is a flutter (Heimlich) valve

A

One-way valve that allows air or drainage to collect in vented drainage bag

25
what is a drainage system with suction and its 4 compartments
Collect fluid, air, or blood from chest cavity compartments: 1. suction control chamber/dry. suction. regulator (area A) 2. water seal chamber (area B) 3. air leak monitor (area C) 4. collection chamber (area D)
26
describe Drainage system with suction. compartment: Suction control chamber or dry suction regulator
controls amount of suction (wet suction – sterile water – 20 cm of suction, gentle bubbling) (dry suction – dial regulator – no water)
27
describe Drainage system with suction. compartment: water seal chamber
contains 2 cm of water, acts as one-way valve preventing backflow of air to the pt.
28
describe Drainage system with suction. compartment: air leak monitor
observe for bubbling air leak during inspiration
29
describe Drainage system with suction. compartment: collection chamber
collects fluid & air vents to Area B/C
30
nursing management for chest tubes and. pleural drainage
(1) Set up and insertion (a) Consent, setup drainage unit (dry or water suction) (2) Assess vital signs, lung sounds, pain, amount drainage, insertion site , presence of subcutaneous emphysema, presence of air leak (3) Maintain drainage system (4) Chest tube dressings (Change according to agency policy and procedure (-petroleum gauze mostly used)) (5) Monitor for complications: re-expansion pulmonary edema, hypotension, subcutaneous emphysema (6) Troubleshoot Chest tube and drainage system as needed (7) Chest tube removal
31
how to maintain a drainage system
(a) Tight, taped connections (b) Secure chest tube to chest wall (c) Keep tubing loosely coiled on bed (no dependent loops) (d) Check frequently for kinks or loops (e) Observe for: tidaling (fluctuation in the water seal column), bubbling during expiration, air leak, fluid leak (f) Keep drainage system below the level of chest (g) Mark and measure drainage (hourly initially) ***Report greater than 200 mL/hr in first hour; and 100 mL/hr thereafter; replace unit when full (>150 mL/hr with mediastinal tubes). (h) No milking or stripping chest tubes (i) Clamping chest tube only clamped briefly to change drainage unit (j) Avoid overturning unit (k) Breakage of unit – place distal end of chest tube in 2 cm in sterile water in sterile container; replace unit
32
chest tube removal
(a) When removed (b) Pre-medicate prior to removal. (c) Have client Valsalva maneuver during removal (e) Apply occlusive dressing (if needed) (f) Monitor for respiratory distress.
33
complications chest trauma.
a) Tension pneumothorax b) Cardiac tamponade c) Bleeding d) Infection e) Subcutaneous emphysema f) Unplanned removal of chest tube
34
nursing diagnoses for chest trauma
(1) Impaired gas exchange (2) Acute pain (3) Decreased cardiac output
35
assessment for chest trauma
(1) Vital signs, oxygen saturation (2) Level of consciousness (3) Respiratory effort (4) Chest tube – type, amount & color of drainage, water seal chamber (air leak), presence or absence of subcutaneous emphysema, dressing (5) Pain (6) ABGs
36
actions for chest trauma
(1) Elevate head of bed (2) Encourage cough and deep breathing (3) Encourage ROM exercise and early ambulation (4) Administer prescribed medications
37
teaching for chest trauma
(1) Use of pain medications (2) Importance of coughing and deep breathing, using incentive spirometer, splint with pillow when coughing (3) Health promotion - Motor vehicle safety – use seat belts, avoid distracted driving, no drinking and driving
38
what are the different kinds of surgical procedures for chest surgery
1. decortication 2. exploratory thoracotomy 3. lobectomy 4. pneumonectomy 5. segmental resection 6. wedge resection 7. other procedures: lung volume reduction surgery, video-assisted thoracic surgery
39
what is decortication
Surgical removal or stripping of thick, fibrous tissue membrane from visceral pleura
40
what is exploratory thoracotomy
incision into thorax to look for injured or bleeding tissues
41
what is lobectomy
Removal one lobe of lung
42
what is pneumonectomy
a) Removal of entire lung b) Position on operative side to promote expansion of remaining lung
43
what is segmental resection
Remove 1 or more lung segments
44
what is wedge resection
Removal of small wedge shaped section of lung tissue
45
preoperative care for chest surgery
Assess cardiovascular status Teaching: surgical procedure, pain management – splinting, exercises T,C & DB, incentive spirometer, range of motion
46
postoperative care after chest surgery
(A) Pain management – PCA, epidural, nerve blocks (B) Assess vital signs pulse oximetry (C) Assess respiratory status (D) Prevent/detect infection – temperature, incision care (E) Monitor for complications – hemorrhage, atelectasis, hypoxia, dysrhythmias, infection (F) Early mobilization (1) Range of motion, up in chair, ambulation (2) Lobectomy or wedge resection positioning; Turn to either side (side-back-side) (3) Pneumonectomy positioning; Supine or operative side only (G) Manage chest tube system (1) Pneumonectomy – usually no chest tube. If chest tube, NO SUCTION (H) Teaching (1) Breathing exercises (2) Smoking cessation (3) Medications
47
what is thoracentesis
aspiration of intrapleural fluid
48
preparation for thoracentesis
a. Verify consent b. Position – sit on side bed and lean forward c. Fluid is withdrawn with needle and syringe d. Collect fluid sample for analysis e. Usually not withdraw more than 1000-1200 mL at a time
49
during and post thoracentesis
a. Monitor vital signs, pulse oximetry b. Assess respiratory status and observe for resp distress c. Obtain chest x-ray

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