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z Here you go, Alexis! > respiratory > Flashcards

respiratory Flashcards

(73 cards)

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1
Q

hemothorax/pneumothorax: definition

A

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

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2
Q

hemothorax/pneumothorax: s/s

A
  • 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
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3
Q

subcutaneous emphysema

A

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

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4
Q

hemothorax/pneumothorax: treatment

A

thoracentesis
chest tubes
daily chest xray

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5
Q

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

A

intermittent

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6
Q

tension pneumothorax: causes

A

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

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7
Q

tension pneumothorax: pathophys

A

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

pressure causes mediastinal shift

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8
Q

tension pneumothorax: s/s

A 
SQ emphysema
absence of breath
sounds on one side of lung
asymmetry of thorax
respiratory distress
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9
Q

tension pneumothorax: can be fatal…

A

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

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10
Q

tension pneumothorax: treatment

A

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

find the cause

chest tube insertion

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11
Q

open pneumothorax aka

A

sucking wound

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12
Q

open pneumothorax: pathophys

A

opening through chest allows air into pleural space

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13
Q

open pneumothorax: treatment

A

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

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14
Q

most common injuries from chest trauma

A

rib/sternum fracture

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15
Q

rib/sternum fracture: s/s

A 
pain, tenderness
crepitus
shallow respirations
- will eventually lead to...
respiratory acidosis
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16
Q

rib/sternum fracture: treatment

A

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

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17
Q

rib/sternum fracture: treatment NOT recommended + why

A

immobilization with chest binders/straps

  • could lead to shallow breathing, atelectasis, pneumonia
  • respiratory acidosis quickly
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18
Q

rib/sternum fracture: observe for which complications?

A

pneumothorax
hemothorax
flail chest

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19
Q

flail chest: definition

A

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

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20
Q

to assess flail chest symmetry, do what

A

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

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21
Q

flail chest: s/s

A

dyspnea
cyanosis
increased pulse
paradoxical chest wall movement

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22
Q

flail chest: treatment

A

stabilize area, intubate, ventilate

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

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23
Q

PEEP: definition

A

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
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24
Q

PEEP: uses

A

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

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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

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