Respiratory Flashcards
(47 cards)
Position for a thoracentesis?
Can’t do what during it?
What if they can’t sit up?
Good lung where?
Where is the fluid/blood/exudate being removed from and allowing what?
Sit up, leaning over or backwards on a chair
NO coughing of deep breathing
Lie on unaffected sided with HOB up 45 degrees
*Good lung DOWN
Removed from pleural space, allowing the lung to expand
Thoracentesis at risk for what?
Post op do what?
Fluid volume deficit: check vitals!
CXR
Reason for chest tube?
Where are they placed to remove air vs fluid?
Can they have both?
Collapsed lung
Air: 2nd IC space
Fluid: 8-9th IC space
YES - Y connected
May be midaxillary for air and drainage***: have to cut through pectoral muscles and have longer healing
What kind of dressing is over a chest tube?
What does the CDU do?
Air-tight
CDU: Restore normal vacuum pressure in the pleural space through a 1-way system
Purpose of water seal?
How much water is in it?
Prevent back flow of air by a 1-way flow
2cm water
Where does air vs drainage go in the CDU?
Drainage: 1st chamber
Air: Goes through water seal and vented out of suction chamber
Suction chamber
What kind of where is place how high?
What does this do?
Turn up the wall suction until when?
Sterile water to 20 cm line
This prevents too much negative pressure in the pleural space
Until you have slow, gentle, continuous suctioning
Report pulse ox when?
How often to report drainage?
Want this patient to do what to help reexpand the lungs?
When should you report to the physician?
Below 90%
First 24 hours, then every 8
Cough, deeb breathe, IS (prevent pneumonia/atelectasis)
*Assess BOTH lungs
REPORT IF there is over 100ml in the first hour, or if there is a change in color to bright red
S/S infection of chest tube
Fever, WBC, drainage
What to watch daily in chest tube patient?
CXR for lung re-expansion
What happens if the chest tube is not below the chest?
No gravity drainage and fluid will go back in
What does tidaling mean?
What does it mean when they stop?
There are no kinks or disruption in the tubing - tape all connections
The lung has re-expanded (usually)
May also stop if there is a kink/clot in the tubing, of if there is a defendant loop
What do you do if the chest tube tubing becomes disconnected?
Have another sterile connector at the bed side and reconnect is ASAP
What do you do if the CDU falls over and water leaks out or goes into the drainage department?
What happens if there isn’t water in the water seal chamber?
Have the patient do what?
Do WHATEVER to re-establish that water seal! Because we NEED water in that water seal to 2 cm! You can even stick the water seal tubing end in a glass of water
Air can cause LUNG COLLAPSE!
Have patient deep and cough in case any air went into the pleural space
What if the chest tube gets pulled out?
No gauze?
Sterile gauze 3 sided tape
Put your hand there and YELL
If nothing: every time they breathe, they will pull air into the pleural space
BUBBLING NORMALS
Suction chamber
Water seal
Suction Chamber: gentle continuous bubbling
Water Seal: intermittent in pneumo pt that is coughing, sneezing, or taking a deep breath
Continuous water seal: air leak
- MD may want you to clamp the tube
As long as the intermittent bubbling is there, air is still leaking out and the chest tube needs to remain
Never do what to a chest tube without an order? Why?
Clamp!! Could lead to a tension pneuma
NEED AN ORDER!!!!!
How to remove a chest tube
Have patient take a deep breath and hold
Place occlusive petroleum dressing over the site
S/S of hemo/pneumothorax
Lungs? Pain? Vitals? Movement? XR results show what?
SOB, cough Tachycardia Diminished lung and less movement on affected side Chest pain SC emphysema`in neck/face/chest
XR: Air or fluid/blood
RULE about a penetrating object
What about eye injury?
NEVER pull it out!!
Cover both eyes
How to treat hemo/pneumo?
Thracentesis, Chest tube, Daily CXR
Causes of a Tension Pneumo
What is happening?
Trauma
PEEP
Clamping a chest tube
Taping all 4 sides of pneumothorax
*Pressure causes collapsed lung, air can’t get out, pressure pushes everything to unaffected side
S/S Tention pneumo
How is this fatal?
SC emphysema
Absent breath sounds on affected side
RR distress
Thorax moved
Accumulating pressure compresses vessels, decreasing venous return, thus decreasing CO
How to treat a tension pneumo
Large Bore needle placed at 2nd ICS to allow air to escape
THEN the cause is found and patient gets a chest tube
