respiratory Flashcards Preview

z Here you go, Alexis! > respiratory > Flashcards

Flashcards in respiratory Deck (73):
1

hemothorax/pneumothorax: definition

blood or air has accumulated in pleural space and lung has collapsed

2

hemothorax/pneumothorax: s/s

- shortness of breath
- diminished breath sounds (affected side)
- increased heart rate
- less movement on the affected side
- chest pain
- cough
- blood (dark) or air (light) shows up on the chest xray

3

subcutaneous emphysema

air trapped in the tissue (usually neck, face, chest)

4

hemothorax/pneumothorax: treatment

thoracentesis
chest tubes
daily chest xray

5

if pneumothorax is present and client has chest tube, what type of bubbling expected in water seal chamber?

intermittent

6

tension pneumothorax: causes

trauma
PEEP
clamping a chest tube
taping an open pneumothorax on all 4 sides without air valve

7

tension pneumothorax: pathophys

lung has collapsed due to pressure build up in chest/pleural space

pressure causes mediastinal shift

8

tension pneumothorax: s/s

SQ emphysema
absence of breath
sounds on one side of lung
asymmetry of thorax
respiratory distress

9

tension pneumothorax: can be fatal...

as accumulating pressure compresses vessels which decreases venous return and ultimately CO

10

tension pneumothorax: treatment

large bore needle in 2nd ICS
- allows excess air to escape

find the cause

chest tube insertion

11

open pneumothorax aka

sucking wound

12

open pneumothorax: pathophys

opening through chest allows air into pleural space

13

open pneumothorax: treatment

have client inhale and hold/Valsalva (hum)
- increases intrathoracic pressure so no more air can get inside

place petroleum gauze over area + tape down 3 sides
- 4th sied acts like air vent/flutter valve

have client sit up to expand lungs
- trauma clients stay flat until evaluated for other injuries

14

most common injuries from chest trauma

rib/sternum fracture

15

rib/sternum fracture: s/s

pain, tenderness
crepitus
shallow respirations
- will eventually lead to...
respiratory acidosis

16

rib/sternum fracture: treatment

non-narcotic analgesic
nerve block to assist with productive coughing
support injured area with hands

17

rib/sternum fracture: treatment NOT recommended + why

immobilization with chest binders/straps
- could lead to shallow breathing, atelectasis, pneumonia
- respiratory acidosis quickly

18

rib/sternum fracture: observe for which complications?

pneumothorax
hemothorax
flail chest

19

flail chest: definition

multiple rib fractures; paradoxical chest wall movement (see-saw chest) - chest sucks inwardly on inspiration and puffs out on expiration

20

to assess flail chest symmetry, do what

stand at foot of bed to observe how chest is rising and falling

21

flail chest: s/s

dyspnea
cyanosis
increased pulse
paradoxical chest wall movement

22

flail chest: treatment

stabilize area, intubate, ventilate

positive pressure ventilation stabilizes the area
- PEEP, BiPAP, CPAP

23

PEEP: definition

positive end expiratory pressure
- client is on vent
- on end expiration, vent exerts pressure into lungs to keep alveoli open
- improves gas exchange and decreases work of breathing

24

PEEP: uses

flail chest (expands and realigns the ribs so they can start growing back together)
pulmonary edema
severe hypoxemia
ARDS (acute respiratory distress syndrome) *classic*

25

BiPAP: definition

bi-level positive airway pressure
-exerts different levels of positive pressure support, along with oxygen

over nose and mouth

26

BiPAP: uses

ARDS in clients with COPD
heart failure
sleep apnea

27

CPAP: definition

continuous positive airway pressure
- pressure delivered continuously during spontaneous breathing for both inspiration and expiration

nasal cannula

28

CPAP uses

obstructive sleep apnea

29

any time you see PEEP, CPAP, Bi-PAP, priority nursing assessment is...?

checking bilateral lung sounds

30

pulmonary embolism: cause

can occur if dehydrated, venous stasis from prolonged immobility or surgery, birth control pills, clotting disorders, heart arrhythmias (a fib)

31

pulmonary embolism: s/s

hypoxemia, decreased PO2 (100% O2 will not work)
shortness of breath
cough
increased RR, HR
hemoptysis
pulmonary hypertension
sharp, stabbing chest pain

32

#1 sign of pulmonary embolism

hypoexmia

33

D-dimer test: purposes

reveals if there is a clot anywhere in the body
- often used for pulmonary embolism

34

pulmonary embolism: labs/diagnostics

D-dimer (increased)
VQ scan (positive
spiral CT or CT angiography (positive)
chest x-ray (shows atelectasis)

35

VQ scan: definition

ventilation/perfusion scan (blood flow to lungs) done by radiology that can detect embolus

36

VQ scan: teaching point

remove jewelry from chest area to avoid false results

37

D-dimer test is not ideal for post-surgical patient PE diagnosis why?

because it detects clots and there is definitely a clot in a post-surgical patient

38

95% of PE come from

DVT

39

100% O2 application works and doesn't work for...?

works: COPD, coding patient
doesn't: pulmonary embolism

40

pulmonary embolism: treatment

oxygen
ABG
decrease pain
heparin, warfarin/Coumadin, enoxaparin/Lovenox + bleeding precautions
surgery
bedrest

41

pulmonary embolism: prevention

ambulate and hydrate
SCDs
isometric exercise (decreases stasis)

42

decrease risk of DVT

increase venous blood return + decrease pooling
- elevate extremities
- TED hose
- SCDs

with known clot, used TED/SCD on unaffected extremity or not at all

43

warm, moist heat on DVT why?

improves circulation by decreasing inflammation

44

DVT: never put cold on a vein, why?

excessive vasoconstriction

45

DVT: never put hot on a vein, why?

excessive vasodilation

46

thoracentesis: definition

removal of fluid/blood/exudate from pleural space
- as fluid is removed, lung should re-expand

47

thoracentesis: monitor for ? and how

you are removing fluid: monitor for fluid volume deficit by monitoring vitals

48

thoracentesis: pre-procedure and post-procedure

pre
- chest x-ray
- baseline vitals

post
- chest x-ray

49

thoracentesis: positioning x3

- sitting up leaning over bedside table
- sitting in chair backwards, propped up over back
- can't sit up: lie on unaffected side with HOB 45*

50

why are chest tubes inserted?

collapsed lung

51

chest tube: placed where for removal of AIR?

upper anterior chest, 2nd intercostal space

air rises!

52

chest tube: placed where for removal of BLOOD?

laterally in lower chest, 8th or 9th intercostal space

drainage settles!

53

can client have chest tubes placed for both air and blood?

yes - they are y-connected together and attached to CDU

54

chest tube securement how?

sutured to chest wall
vaseline or air tight dressing applied around exit site
then connected to CDU

55

CDU: definition

closed chest drainage unit; restores normal vacuum pressure in pleural space by removing all air and fluid in a closed one-way system until problem is corrected

56

CDU: three chambers + purpose

1 - drainage collection
duh

2 - water seal
promotes one way flow out of pleural space which prevents air moving from system and back into chest

3 - suction control
controls the amount of pressure applied if client needs suction to remove air and fluid: suction regulator - NOT WALL VACUUM SUCTION

57

what happens if drainage collection chamber of CDU fills up?

get a new CDU

58

what bubbling is normal in the water seal chamber of a CDU?

intermittent bubbling when client coughs, breathes deeply, sneezes, exhales

59

tidaling

seen with CDUs: slight rise and fall of water in water seal tube as client breathes

60

tidaling ceases - indicates what?

usually means that lung has re-expanded

OR

kink/clot in tubing or dependent loop present in system

61

CDU assessment

- dressing intact and air tight
- bilateral lung sounds
- pulse ox

62

CDU: drainage + notify provider

record drainage q hour for 24 hours then q 8'

notify provider:
- greater than 100 mL drainage in 1 hour (think: if this, 1200 a shift!)
- change in color to bright red

63

CDU: watch patient for

fever, increased WBC, drainage: could develop infection at insertion site

daily chest x-rays for lung re-expansion

64

CDU level: where and why?

below level of chest

why: gravity drainage. if lifted too high, drainage will go back in!

65

CDU: what do you do if tubing becomes disconnected?

reconnect as fast as you can (air into pleural space results in collapsed lung)

keep another sterile connector at bedside

66

CDU: what do you do if CDU falls over and water leaks out or shifts to drainage compartment?

do whatever you can to maintain water seal (bedside cup with water in it if you have to trololololol)

set CDU upright, check all chambers, fill water seal chamber to 2cm water

have client deep breathe and cough in case any air went into pleural space

67

CDU: if there is not water in the water seal chamber then air can do what?

collapse lung

68

what if chest tube is accidentally pulled out?

sterile vaseline gauze taped down on 3 sides (otherwise with every breath air will be pulled into pleural space)

69

CDU: when is bubbling normal?

chest tube connected to suction - gentle continuous bubbling in suction chamber

client with pneumothorax coughs, sneezes, deep breath and exhalation - intermittent bubbling in water seal chamber

70

client still needs the chest tube if...

intermittent bubbling; air is still leaking out of pleural space

71

CDU: when is bubbling a problem?

continuous bubbling in water seal chamber (air leak in system) - try to fix before calling provider

72

never clamp a chest tube without an order why?

risk of tension pneumothorax

73

chest tube removal - how?

have client take a deep breath and hum (Valsalva)
place occlusive petroleum dressing over site