Respiratory Flashcards
Hemothorax / Pneumothorax Patho
blood or air accumulated in pleural space
lung collapsed
Hemothorax / Pneumothorax S/sx
SOB
increased HR
diminished breath sounds on affected side
chest pain
cough
CXR - shows air or blood
Subcutaneous emphysema (air trapped in tissue)
Hemothorax / Pneumothorax Treatment
Thoracentesis
Chest tube
daily CXR
Tension Pneumothorax Causes
trauma to much PEEP clamping a chest tube insertion of central venous line taping an open pneumothorax on all 4 sides without an air valve
Tension Pneumothorax Patho
pressure has built up in the chest / pleural space and has collapsed the lung –> pressure pushes everything to the opposite side (mediastinal shift)
Tension Pneumothorax S/sx
subcutaneous emphysema absence of breath sounds on one side asymmetry of thorax respiratory distress cyanosis distended neck veins (JVD) can be fatal as pressure compresses vessels --> decreases venous return --> decreases CO
Tension Pneumothorax Treatment
large bore needle placed into 2nd intercostal space. to allow air to escape
treat the cause (chest tube)
Open pneumothorax patho
sucking chest wound (GSW, stab)
opening through chest that allows air into pleural space
Open Pneumothorax Treatment
have client inhale and hold or Valsalva or hum
- increases intra-thoracic pressure so no more outside air can get into body
place piece of petroleum gauze over the area
- tape down 3 sides / 4th side is an air vent or flutter valve
have client sit up to expand lungs
- trauma clients stay flat until evaluated for other injuries
Thoracentesis Pre-procedure
stop anticoagulants
obtain baseline VS, O2, and pain
CXR done prior
sit on edge of bed, w feet supported, lean over bedside table
- can’t sit up = lie on unaffected side with HOB at 45 degrees
Thoracentesis Procedure
client must be very still; no coughing or deep breaths
fluid / blood / exudate is being removed from pleural space, making lung expand
check VS, O2, and pain
Thoracentesis Post-Procedure
another CXR
VS
listen to lungs for absent or reduced breath sounds on affected side
check puncture site and dressing for bleeding
monitor for subcutaneous emphysema, infection, tension pneumothorax
turn, cough, deep breathe
Chest Tube Insertion
if tube is in upper anterior chest (2nd intercostal space) its removing air
if its placed latterally in lower chest (8th or 9th intercostal space) then its for fluid
* they can have both fluid and air at same time
chest tube is sutured to chest wall and an air-tight dressing is applied around chest tube exit site
Drainage collection chamber of CDU
tube connects to 6 foot tube
if it fills up, get another CDU
Water seal chamber of a CDU
2 cm of water that acts as one-way valve
bubbling when client coughs, sneezes, or exhales is expected
Tidaling –> slight rise and fall of water in water seal tube as pt breathes
Suction Control Chamber in CDU
controls amount of pressure
sterile water is placed up to 20 cm line
turn on wall vacuum suction until you have slow, gentle continuous bubbling
Assessment of Closed Chest Drainage System
dressing - tight and intact
listen for breath sounds in both lungs
make sure O2 is >90%
check for subcutaneous emphysema
record chest drainage every hour for first 24 hrs and then every 8 hours
deep breathe, cough, use incentive spirometer
watch for fever, increased WBC, and drainage = infection
watch daily CXR for improvement / re-expansion
- Notify HCP if:
- 200 mL of drainage or greater in first hour
- 100 mL or greater any hour after first hour
- change in color (yellow to bright red)
- 20 g needle or smaller and tube will reseal itself
