Respiratory

Question 1

Patho of Hemo/Pneumo

Answer 1

Blood or air in the pleural space in which the lung has collapsed

Question 2

S/s of hemo/pneumothorax

Answer 2

SOB, Increase HR, Diminished breath/ less movement/sounds on affect side
Chest pain
Cough
Subq emphysema

Question 3

Txt hemo/pneumo

Answer 3

Thoracentesis
Chest tube
Daily chest xray

Question 4

Causes of Tension Pneumothorax

Answer 4

Trauma 
PEEP
Clamping a chest tube
Insertion of central venous line
taping an open pneumothorax on all 4 sides

Question 5

What is the patho of tension pneumo

Answer 5

pressure in the chest which collapses the lung and pushes everything to the opposite side

Question 6

S/s of tension pneumothorax

Answer 6

Subq emphysema
When examining the the lungs thorax may be asymmetry, breath sounds may be absent and the pt looks to be distressed, cyanosis with distended veins. your vitals should have decreased cardiac output

Question 7

Open pneumothorax

Answer 7

Opening through chest allows air into the pleural space such as a gunshot wound.

Question 8

Open pneumothorax txt

Answer 8

Tell client to valsava why?
then place petroleumo gauze and tape down 3 sides the other side will act as as vent client should sit up to allow lungs to expand.

Question 9

Thoracentesis

Answer 9

Removes fluid or air and analysis fluid to determine cause

Question 10

What is the pre-procedure of thoracentesis

Answer 10

Check for consent, stop anticoagulant meds, get a baseline of vitals, make sure chest xray has been done. Pt should sit edge of bed with feet supported and lean over bed, if cannot sit up pt should lie on unaffected side HOB 45 degree

Question 11

What happens during of thoracentensis

Answer 11

No coughing or deepbreaths, stay still and obstruction remove from pleural space and then lung should reexpand, check vital signs and compare to previous baseline

Question 12

Post Procedure for thoracentesis

Answer 12

Obtain x-ray, monitor vitals, and listen for absent lung sounds and check site for bleeding, monitor for subq emphy, turn cough and deep breathing

Question 13

Where is the chest tube insertions?

Answer 13

chest tube is placed in upper anterior chest to remove the air, if is is place lateral lower chest it is for drainage. Air rises, drain settles. The y connected to a CDU, and is sutred to chest wall with patroleum jelly

Question 14

What is a purpose of CDU?

Answer 14

To restore normal pressure in pleural space one way system

Question 15

Three chambers of CDU?

Answer 15

Drain collection chamber 6 feet to drain, if full get a new CDU.

Water seal, is to promote one way into pleural space and prevent air moving backward. both drain collection and water seal connect to a small tube and the air will go down into the water of water seal chamber

bubbling is when patient breaths etc, slight rise is when they breathe and fluctuation is tidling which normal. if it stops then lung has rexpanded

Suctional Control Chamber this controls the pressure to remove air or fluid and requires sterile water up to 20 cm line, must be slow and gently continuous bubbling.

Question 16

Assessment of CDU to Chest tube

Answer 16

Assess the dressing, tight and intact
Listen for lungs (bad vs good lungs), oximetry, palpate insertion to check for subq emphysema, record drain every hr for 24hrs, and then every 8 hrs

Question 17

When to notify primary health care provider from CDU assessment?

Answer 17

200 ml in 1hr , 100ml after 24hrs, yellow bright red, use of DB, fever, increase of WBC, and if chest xrays show rexpanded.

Question 18

How to maintain CDU

Answer 18

Keep it below chest level

straight free of kinks, tape all connections and monitor water levels

Question 19

If fluctuations stop in cdu what does that mean?

Answer 19

there is a kink, clot, loop or the lung reexpanded.

Question 20

When is bubbling a problem?

Answer 20

continuous bubbling in water seal means air leak, do not clamp because it will lead to tension pnuemothorax

Question 21

what do you do if tubing becomes disconnected?

Answer 21

use sterile connector or reconnect as fast as you can

Question 22

What if CDU falls and water leaks out?

Answer 22

Do what you can to reestablish, check chamber and fill water seal with 2cm water. find the nearest water. client should be instructed to deep cough. if no water in water seal the air will collapse the lung.

Question 23

what if chest tube is accidentally pulled out?

Answer 23

place gauze tape on 3 sides or use your hand and use call bell

Question 24

Instructions for client when removing chest tube?

Answer 24

Valsalva and place occlusive dressing.

Question 25

What is blunt chest trauma?

Answer 25

Fractures of ribs 5-9 s/s pain tenderness, crepitutus, shallow respirations, and resp acidosis

Question 26

Txt for chest trauma

Answer 26

non narcotic meds, spirometry, nerve block to assist with productive cough, support with hands, observe for complications.

Question 27

What is NOT recommended for blunt trauma immobilization?

Answer 27

binders and straps because it leads to shallow breathing atelectasis and pneumonia

Question 28

What is filal chest? s/s

Answer 28

``` multiple rib fractures s/s anxious SOB pain Paradoxical chest, assess symmetry, dyspnea, cynosis, increase HR ```

Question 29

Txt for filal chest?

Answer 29

Humidified oxygen pain mangement stabilize area intubate and ventilate

Question 30

Positive End Expiratory Pressure

Answer 30

Client is on ventilator at the end of expiration the vent will exert pressure down to keep alveoli open, improving gas exchange and decrease breathing work it expands and realigns the ribs to allow growth. can be used for pul edema, hypoxemia, ARDS

Question 31

CPAP

Answer 31

Pressure delivered with inspiration and expiration for sleep apnea and infants with underdeveloped lungs

Question 32

BIPAP

Answer 32

Two pressure setting pressure on inhilation and lower on exhalation. Used with non obstructive sleep apenea

Question 33

BIPAP AND CPAP are both

Answer 33

Non invasive positive pressure, used for ards, copd, PE, improves ventil and oxygenation requires priority lung assessment

Question 34

Pulmonary Embolism

Answer 34

Thrombus or blood clo, air, fat in amniotic fluid in mat client Thrombosis broken off into lung artery

Question 35

Causes of PE

Answer 35

``` Dehydration Venous stasis (surgery) obesity birth control clotting disorder heart arythmia afib ```

Question 36

DVT

Answer 36

Thrombosis of veins in legs

Question 37

VTE

Answer 37

When it is both

Question 38

S/S Of PE

Answer 38

``` Hypoxemia PaO2 low, sob increased RR, restlessness, petechia on chest, cyanosis, hemoptysis, pulse up chest pain, atelactis on xray BP up pulm. hyp ```

Question 39

Diagnosis of PE

Answer 39

D-DIMER showing clot anywhere in body CTA - Comput tomog angiogram utilizes a dye so watch for renal fx. Positive VQ Scan - measures both air flow and blood Pulmonary angiography

Question 40

Prevention of PE

Answer 40

Reposition, prevent stasis flexing 2-4 hrs, walk 4-6 hrs, ted hose, compression stolking not to be worn with suspected DVT, fluids

Question 41

Txt of PE

Answer 41

Bed rest with affected leg elevated, decrease pain and administer anticoag vit k warfarin, thrombin (enoxaparin), limit leafy green maintain target INR, bleeding precautions, fibrinolytics like tPA, pulmonary embolectomy may be performed, inferior vena cava filtration to prevent clots from getting into pulmonary system.