Flashcards in Respiratory Deck (23):
When doing a thoracentesis, what if the client cant sit up. how should you have them positioned?
lie on unaffected side with HOB at 45 degree
What has happened that the client needs a chest tube?
the lung has collapsed.
if the chest tube is placed in the upper anterior chest (2nd intercoastal space) then it is for removal of ___.
if the chest is placed laterally in the lower (8th or 9th intercoastal space) then it is for ____.
can the client have a chest tube that it for air and drainage?
yes. they are y-connected together and attached to a closed drainage unit (CDU)
the CDU is to restore the normal vacuum pressure in the pleural space. does this by removing all air and fluid in the closed one way system until the problem is corrected
if the CDU drainage collection chamber fills up, what should you do?
get new CDU. it hold 2,000 ml. rarely have to change
if a dry suction is used, water is not used to regulate the pressure therefore _____.
has NO bubbling. a dial is used to set the desired negative pressure. then once again increasing the vacuum wall suction will not increase the pressure.
when the CDU, notify the physician of ___ ml of drainage or greater in the 1st hr, and if there is a change in color to ____.
with CDU, do you want to see tidaling (fluctuations) ?
yes with respirations
fluctuations will stop when the lung has re-expanded, if there is a kink/clot in tubing, or a dependent loop is present in the system.
what if the chest tube is accidently pulled out?
re-establish the water-seal!!!
sterile vaseline gauze taped down on 3 sides. otherwise, every time they take a breath, they will pull air into pleural space.
when is bubbling normal with CDU?
chest tube connected to suction--gentle continuous bubbling is expected in the suction chamber
if a client with a pneumothorax is coughing, sneezing or just taking a deep breath and exhaling, you may see intermittent bubbling in the water seal chamber
as long as there is intermittent bubbling, the client needs the chest tube bc air is still leaking out of the pleural space.
when is bubbling in CDU a problem?
if there is continuous bubbling in the water seal chamber, then you have an air leak in the system,
never clamp a chest tube without an order!! it could lead to tension pneumothorax
what will show up on chest xray for pneumothorax or hemothorax?
air or blood
trauma,peep, clamping a chest tube, or taping an open pneumothorax on all 4 sides without an air valve.
this is an emergencyy!
if a pnuemothorax is present and the client has a chest tube, what type of bubbling would be expected in the water seal chamber?
open pnuemothorax patho and tx
sucking wound (see this with stabbing or gunshot)
opening through the chest that allows air into the plueral space.
-have the client inhale and hold or valsalva (these will increase the intra-thoracic pressure so no more outside air can get into the body,
- then place a piece of petroleum gauze over the area. tape down 3 sides. the 4th side will act as a air vent or flutter valve,
-have the client sit up, if possible to expand lungs
s/s of fractures of ribs and sternum
pain and tenderness
crepitus (bones rubing together)
flail chest s/s
paradoxical chest wall movements
tx flail chest
stabilize the area, intubate and ventilate
positive pressure ventilation and stabilize the area
the classic reason to use PEEP is ____.
acute respiratory distress syndrome (ARDS)
what lab value is increased with pulmonary embolism?
what is most widely used to diagnose pulmonary embolism?
VQ scan. (positive)
looks at the blood flow to the lungs. dye NOT used. remove jewelry from chest area so that it will not give false results.