Pneumothorax Flashcards
➢ Pressure should always be negative. To provide lung expansion
➢ Air in the pleura
PNEUMOTHORAX
CLINICAL MANIFESTATION
㾎 Pleuritic chest pain and shortness of breath
㾎 Tachycardia – SNS Stimulation
㾎 Chest Wall Movement – asymmetrical, less movement of the affected side than the unaffected side.
㾎 Percussion – Hyper resonant because of so much air in the intercostal space
㾎 Auscultation – Breath sounds may diminished or absent
TO KNOW
- Will not have this unless open/close pneumothorax happens – if not treated can lead to tension pneumothorax
- Stabbed – air will enter (sucking wound) – air accumulates – lungs will collapse – OPEN PNEUMOTHORAX
- Broken rib – injured pleura – CLOSED PNEUMOTHORAX
- Air keeps coming in but cannot exit
- Pressure will increase and the mediastinum will push to the other side – pressure will go to the heart – unaffected side will also compress – less blood going to the heart because of compression of artery – cardiopulmonary arrest
- Tracheal deviation to the unaffected side (moving of the trachea because of pressure)
- Distended neck veins – causes pressure on blood vessels –SVC and IVC
- Respiratory distress – lung collapse increase pressure
- Cyanosis – less oxygenated blood
- Hypertonic sound on percussion
TENSION PNEUMOTHORAX
❖ If it is air it will go up, if blood it will go down
❖ Stabbed/shot – air goes up (2nd intercostal space) blood goes down (5th/6th intercostal space) – blood when lying down is on the side – side chest tube
❖ DOB when collapsed lung – 1 chest tube for air, 1 chest tube for blood
❖ Landmark – doctor immediately inserts chest tube in the 5th intercostal space, level of xiphoid
❖ Sutured then sterile dressing
HEMOPNEUMOTHORAX
REASONS FOR CHEST TUBE
Ω Remove air and blood
Ω To reestablish negative Interpleural pressure
BOTTLE DRAINAGE
㾎 Gravity, chest of patient
㾎 If wound is not that big
㾎 With water, the tube is immersed in 2cm water
㾎 Small tube – air vent (air goes out) – long tube (to prevent air from coming back: water seal straw)
ONE BD
BOTTLE DRAINAGE
- If wound is bigger
- Gravity or suction machine (may not require
- suction machine)
- 1st bottle 2 short tubes – 2nd bottle 1 long 1 short
- Drainage bottle – fluid goes there
- Water seal bottle – long straw; clear water can see bubbles – bubbles go out
- Bubbles should only be seen in exhalation, intermittent bubbling
TWO BD
BOTTLE DRAINAGE
- Suction machine
- 1st bottle 2 short tube – drainage bottle
- 2nd bottle 1 long in water 1 short – water seal bottle – (exhalation = intermittent bubbling)
- 3rd bottle – 2 short tube 1 long tube (control straw – immersed in 15-20cm water) – control bottle
- ^open, possible water can evaporate – add
- water! – sterile technique
- Control bottle – pressure is too much – can destroy lung tissue – control bottle will control that so the tube is immersed in 15-20 cm water to control pressure to prevent lung tissue damage – air is present and it will always have bubbles
THREE BD
FLUID FLUCTUATION STOPS WHEN
➢ The lung has re-expanded but do not depend (confirm for chest x-ray)
➢ Clamp tube = dyspnea, tachycardia should be observed! Done if patient cannot afford x-ray
➢ The tubing is obstructed by blood clots fibrin or kinks, a long dependent loop or suction motor not working properly
CLAMPING IS DONE WHEN:
Ω whenever changing bottles/replacing the
filled drainage
Ω To know air leak location
CHEST TUBE ACCIDENTALLY PULLED OUT:
➢ Quickly seal off using petroleum gauze cover with dry gauze
➢ No petroleum gauze – clean cloth in hand, close then report
INDICATIONS FOR CHEST TUBE REMOVAL
- Drainage of less than 50-100cc in 24 hours
- Observe patient
- Zero fluctuation – not reliable, confirm!
- 1-3 days post cardiac surgery, 2-6 days post thoracic surgery
NURSING CARE CHEST TUBE REMOVAL
㾎 Position patient to sitting
㾎 give medications
㾎 Perform deep breathing and hold breath – simultaneously pulling it out then bear down (to prevent reentrance of air)
NURSING CARE FOR TUBES
㾎 For any kind of tube = SEMI-FOWLER’S AND SITTING POSITION
㾎 Tube should always be potent, no kinks, no dependent loop, no lying on the tube
㾎 Long dependent loop can completely block fluid drainage within 30 minutes
㾎 Do not allow tube to lie on floor
㾎 Bottle should always be below the chest
㾎 Observe water fluctuation – 2-5cm is normal
㾎 If not normal there may be DOB and shortness of breath
㾎 Auscultate for crackles and rales – plenty of fluids in the lungs – 1st breathing exercises and if no improvement suction
㾎 0% fluctuation – there may be blood, kink, lying over tube, long dependent loop, lung has already re-expanded – chest x-ray to confirm
㾎 Observe for bubbles – continuous bubbling should only be in control bottle, continuous in water seal bottle may indicate that there is crack on the bottle/leak/rubber is not well sealed/rubber destroyed and air can pass
㾎 Observe amount and color of output
㾎 Clamping is only done 30 seconds when changing, remove cover not the tubes
㾎 Tube stripping (milking) should not be done – exert pressure
㾎 Milking, tapping, stripping does not improve drainage of fluid from the chest
㾎 The patient can ambulate see to it drainage is below the chest
PLEUR EVAC
㾎 Suction, drainage seal and water seal
㾎 Same mechanism as the bottled chest
* Drainage of less than 50-100cc in 24 hours
* Observe patient
* Zero fluctuation – not reliable, confirm!
* 1-3 days post cardiac surgery, 2-6 days post thoracic surgery
