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Respi Flashcards

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1
Q

Pathophysiology of hemo/pneumothorax

Blood or air has accumulated in the _____ space.
What has happened to the lung?

A

Pleural

Collapsed

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2
Q

Signs and symptoms of hemothorax/pneumothorax?

Discc L

A 
Diminished breath sounds on affected side
Increased HR
SOB
Cough
Chest pain

Less movement on affected side

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3
Q

What will show up on the xray of hemo or pneumo thorax?

A

Air for pneumo

Blood for hemo

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4
Q

Subcutaneous emphysema is

A

Air trapped in the tissue usually in the neck face and chest

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5
Q

Treatment for pneumothorax and hemothorax

A

Thoracentesis
Chest tube
Daily chest x-ray

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6
Q

Tension pneumothorax

Causes 
TTTIC
Trauma
Too much
Taping
Insertion of
Clamping

Patho

A 
Trauma 
Too much PEEP
Taping open pneumothorax on 4 sides w/o air valve
Insertion of central venous line
Clamping chest tube

Pressure built up in chest/pleural space and lungs will collapse. Which then the pressure pushes everything to the opposit side called mediastinal shift

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7
Q

S/S of tension pneumothorax

DA CARS
Distend
Assymetry
Cya
Absence
Respi
Subcutaneous
A 
Distended neck veins
Absence of breath sounds on one side
Cyanosis
Asymmetry of thorax
Respiratory distress
Subcutaneous emphysema
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8
Q

Tension pneumothorax can be fatal because

A

The pressure compresses vessels which decreases venous return thus decreases cardiac output

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9
Q

Treatment for tension pneumothorax

A

Large bore inserted by primary health care provider at 2nd intercostal space to allow air to escape

Treat the cause

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10
Q

Open pneumothorax

Treatment:

VTS

A

Opening through chest to allow air into pleural space. Also known as sucking chest wound.

Treatment:
Valsalva and hummm- increases thoracic pressure outside air cant get inside

Tape petroleum gauze on 3 sides 4th side acts like an airvent

Sit up to expand lungs. But Trauma clients stay flat for it to be evaluated for other injuries

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11
Q

Thoracentesis

A

To remove fluid or air from pleural space

Lung fluids are analyzed

Normally we have 20 ml of fluid in pleural space

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12
Q

Pre procedure of thoracentesis

Check
Stop
V/S
Position:
Sit 
Cant Sit
A

Check signed consent
Stop anticoagulant meds
Baseline V/S
Chest xray to assist surgeon in inserting needle
Position:
Sit on Edge of bed with feet supported and lean over bedside table (nurse is in front of client to prevent table from moving)

If cant sit up. Lie down on UNAFFECTED SIDE with HOB elevated to 45 degrees

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13
Q

During thoracentesis

A

Client must be very still, no coughing or deep breaths

As fluid is removed lung is expanding

Check V/S and compare to baseline and pain level

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14
Q

Post thoracentesis

A

Another chest xray to see if lungs re expand
V/S
Assess lungs for absent or reduced breath sounds on affected side
Check puncture site for bleeding
Monitor for complications such as infection, tension pneumothorax and subcutaneous emphysema
Turn cough and Deep breathe

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15
Q

Chest tube is needed because

Placement of chest tube

Can both be placed?

Other placement

A

Collapsed lung

Upper anterior chest or 2nd intercostal space for air

Laterally in lower chest or 8th or 9th intercostal space for fluid/drainage

Air rises and fluid or drainage settles. Chest tube is sutured to chest wall with an AIR TIGHT DRESSING.

Yes. With y connected and attached to closed CDU( chest drainage unit )

Mid axillary one tube for air while other for drainage. Anterior chest tube is not usually used because it requires prolonged healing

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16
Q

CDU means

Purpose of CDU

3 chambers of CDU

A

Chest drainage unit

Restore normal vacuum in pleural space by removing air and fluid in a one way system.

Drainage collection chamber
Water seal chamber
Suction control chamber

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17
Q

Drainage chamber

A

First chamber

The drainage is connected by a 6 foot tube to allow patient to move and turn around.

And if the chamber fills up, get another CDU but make sure to get one before it fills up. It usually holds 2000 mL of of fluid so it rarely gets full.

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18
Q

Water seal chamber

Study These Flashcards
A

Promotes one way flow out of the pleural space which prevents air from going back to pleural space.

Small tube is connected to the first chamber that allows drainage to remain in first chamber while air goes to water seal chamber.

Contains 2 cm of water which acts as one way valve

Bubbling is normal when client is coughs,sneezes or exhales.

Tidaling is normal. It is the rise and fall of water. If it stops, the lung has re-expanded.

19
Q

Suction Control Chamber

Study These Flashcards
A

Third chamber.
When suction is needed, this chamber controls the amount of suction pressure applied

Sterile water is used and maintained at 20 cm.

Suction must be slow,gentle and continuous bubbling.

Pressure is not controlled by wall suction but is controlled by WATER LEVEL so always maintain prescribed water level.

20
Q

If dry suction system is used

Study These Flashcards
A

There is no water therfore no bubbling.

Dial is used to control suction not the wall suction even if the wall suction is increased.

21
Q

Management priorities of closed chest drainage system

PEEP

Study These Flashcards
A

Promote comfort
Ensure integrity of system
Ensure CT patency
Prevent complications

22
Q

Assessment of CDU

Dressing
Listen
Oximetry
Palpate for
Record
Notify
DBE
Wbc
Daily
Study These Flashcards
A

Assess dressing if it is intact and tight
Listen for breath sounds in both lungs. Compare good vs bad lungs.
Report anything <90% of pulse oximetry
Palpate chest tube site for subcutaneous emphysema, this could indicate poor tube placement
Record chest drainage every hour for 24 hours and then q8 hours
Notify physian if >200 ml in one hour and > 100 ml any hour after first hour. Change in color like yellow and bright red
Deep breathe cough and incentive spirometer
Infection should be monitored at insertion site so monitor wbc and fever
Dail chest x-ray for lung re expansion

23
Q

Where would you obtain chest drainage for wbcs? Drainage collection chamber or chest tube?

Study These Flashcards
A

Chest tube. Because the tube is self sealing.

24
Q

Maintaining CDU

Level
Straight
Tape
Dye
Clamp
Study These Flashcards
A

System must be below the chest. If too high, fluids or air will go back to pleural space. Gravity drainage is promoted.
Tubing should be straight and free of kinks and dependent loops.
Tape all systems, must be closed.
Monitor for water level in the system. Dye is done to make it easier to see.
Never clamp a chest tube without prescription. It could lead to tension pneumothorax.

25
When is bubbling a problem? Fluctuations upon respiration stops?
If there is continuous bubbling in the water seal chamber then there is air leak. First check connection sites before calling primary health provider. May order you to clamp to determine air leak. Dont clamp for too long and dont leve client when clamping is done If tidaling stops it means the lung has re expanded or there is a kink or clot (in hemothorax) in tubing or a dependent loop is present.
26
If tubing becomes disconnected? If cdu falls over and leaks out or shifts to the drainage compartment? If water is not present in water seal chamber?
Keep another sterile connector at bedside Reconnect as fast as you can. Re establish water seal. Set cdu upright and check water levels. Fill water seal chamber to 2cm Have client deep breathe or cough in case air went into pleaural space Air can collapse the lung
27
What if chest tube is accidentally pulled out? In removing chest tube...
Occlusive sterile dressing is placed or taped down on 3 sides. If occlusive dressing is not present, cover with your hand and call someone to bring you one, otherwise every time they take a breath they will pull air into pleural space. Have client valsalva or hummmmm and place occlusive dressing.
28
Fractures of ribs and sternum S/S CRePS
Most common injuries in chest trauma, usually ribs 5 to 9 which are least protected by chest muscles. Crepitus ( bones grating together ) Respiratory acidosis Pain and tenderness Shallow breathe
29
Treatment for fractures of ribs and sternum ``` Complications Incentive Immobilizing chest Non narcotic Nerve block Support area ```
Complications are observed such as hemo and pneumo thorax and flail chest Incentive spirometry to preventrespirstory acidosis and pneumonia Immobilizing chest is not recommended as it leads to shallow breathing and pneumonia Non-narcotic analgesic just enough for client to cooperate Nerve block to assist with productive cough Support injured area with hands or pillow
30
Flail chest S/S SAD PIC
Occurs with multiple fractures SEE-SAW chest. Paradoxical chest wall movement. Chest sucks inwardly on inspiration and outwardly on expiration. Anxious and shortness of breath Dyspnea Pain Increased pulse Cyanosis
31
Treatment for flail chest V SHIPP
Ventilate ``` Stabilize the area Humidified oxygen Intubate Pain management PEEP stabilizes the area and promotes lung expansion ```
32
2 types of PEEP
Invasive and non-invasive
33
Invasive PEEP ``` Ventilator Alveoli open Gas exchange Expands Classic for ```
Client is assisted with ventilator At the end of expiration ventilator puts pressure on alveoli to keep it open Improves gas exchange and decrease work of breathing Expands and realigns ribs so they can start to grow back together Used to treat classic ARDS, pulmonary edema and severe hypoxemia
34
Non-invasive PEEP has 2 types Apply Used for
CPAP and BiPAP Continuous positive airway pressure Bilateral Positive airway pressure Pressure to the lungs and improve oxygenation and ventilation Both are used for sleep apnea, ards, copd and pulmonary edema Clients may be moved to these devices when they are weaned from the ventilator
35
CPAP BiPAP Priority assessment
Continuous pressure is delivered on expiration and inspiration. Used for obstructive sleep apnea and infants with underdeveloped lungs. Pressure is applied on two different settings. One pressure on inhalation and a LOWER pressure upon expiration. Used on non-obstructive sleep apnea because it is tolerated better since they dont need to exhale against a high pressure Anytime PEEP, CPAP BiPAP is used always assess for bilateral lung sounds every 2 hours. They could pop due to high pressure on lungs.
36
Pulmonary Embolism Causes BOCH DV - these things make blood thick or promote stasis
A thrombus or blood clot, can also be air, fat or amniotic fluid in maternity client Birth control pills Obesity Clotting disorders Heart arrythmias like A-Fib Dehydration Venous stasis from prolonged immobility or surgery
37
DVT PE VTE
Deep vein thrombosis is thrombosis in deep veins of the legs or arms Pulmonary embolism is thrombosis that is broken off into lung artery Venous thromboembolism that happens when you have both PE or DVT
38
S/S of PE ``` HH PaPePu CCRAPS Hypoxemia Hemoptysis Partial oxygen Petchiae Pulse Cyanosis Chest pain Restlessness Atelectasis HPN SOB ```
Hypoxemia is number 1 sign. Death can occur within an hour of hypoxemia. Hemoptysis or coughing up blood PaO2 is low Petechiae over Chest Pulse increased ``` Cyanosis Chest pain which is sharp and stabbing Restlessness Atelectasis on chest xray Pulmonary HPN or cor pulmonale Shortness of breath ```
39
Patho of PE Priority assessment
Blood clot leads to no gas exchange and backed up blood increases blood pressure in lungs that results in pulmonary HPN aka cor pulmonale this affects the Right ventricle leading to Right sided HF Check CVP
40
Diagnosis of PE D-dimer CTA VQ scan Angiography
D-dimer will be increased. This will tell clot anywhere in the body not just in the lungs Computerized tomography angiogram is the most frequently used test to diagnose PE. Dye is used so check for renal function. VQ scan is positive. This is done in radiology. Measures both airflow and blood flow to the lungs. Pulmonary angiography is the most sensitive and specific test but is very expensive and invasive.
41
Prevention of PE ``` Position Stasis Walk Fluids Compression ```
Change position every 2 hrs Prevent stasis by flexing and extending feet, hips and knees every 2 to 4 hrs Walking is needed 4 to 6 times a day Hydrate by forcing fluids Pneumatic compression devices will not be used if DVT is suspected because it can lead to PE
42
Treatment for PE ``` Rest Oxygen and pain Anticoagulants Precautions Fibrinolytics Surgery ```
Bed rest and affected leg may be elevated to promote blood flow and prevent stasis Administer oxygen according to ABGs and Decrease pain Administer anticoagulants. It has 3 types. 1.Vitamin K antagonists like warfarin 2.Thrombin inhibitors like heparin, enoxaparin(Lovenox) or dabigatran (pradaxa) 3. Factor Xa inhibitors like rivaroxaban(xarelto) or fondaparinux (arixtra) These drugs prevent clot from getting bigger. Limit green leafy vegetables while on warfarin(coumadin) Bleeding precautions Fibrinolytic agents to help dissolve embolus Pulmonary embolectomy is done when fibrinolytic is not used. Inferior vena cava filtration device is used to prevent clots from going into pulmonary system
43
Can a patient take warfarin and heparin at the same time?
Yes. Heparin is being tapered down while increasing warfarin. Warfarin takes 48 to 72 hours to work and several more days to get to a therapeutic level

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