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Flashcards in respiratory Deck (30)
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1

hemothorax patho

blood/air accumulated in pleural space
collapsed lung

2

hemothorax s/s

SOB
high HR
diminished breath sounds on affected side
less movement on affected side
chest pain
cough
air/blood on CRX

3

hemothorax treatment

thoracentesis
chest tube
daily chest xray

4

tension pneumothorax causes

trauma
too much PEEP
clamping a chest tube
insertion of central venous lines
taping an open pneumothorax on all 4 sides without an air valve

5

tension pneumothorax patho

pressure build up in chest/pleural space
collapsed lung
pressure pushes everything to the opposite side (mediastinal shift)

6

tension pneumothorax s/s

subQ emphysema
absence of breath sounds on one side
asymmetry of thorax
respiratory distress
cyanosis
distended neck vein or JVD

7

tension pneumothorax treatment

large bore IV into 2nd intercostal space to allow excess air to escape
treat the cause
chest tube

8

open pneumothorax patho

opening through chest that allows air into the pleural space

9

open pneumothorax treatment

inhale and hold
valsalva
hummmmm
place petroleum gauze over area and tape down on 3 sides
sit up if possible to expand lungs

10

thoracentesis

used to remove fluid or air from pleural space

pre procedure:
consent
stop anticoag meds
VS
O2
pain
chest xray
sit on edge of bed with feet supported and lean over the bedside table
OR
lie on unaffected side with HOB at 45 degrees

procedure:
still
no coughing or deep breaths
as fluid is removed, lung will re-expand
VS
O2
pain

post procedure:
chest xray
VS
lung should be absent or reduced breath sounds on affected side
assess for bleeding
monitor for SubQ emphysema, infection, and tension pneumothorax
turn, cough and deep breath

11

chest tube insertion

pg. 156

needed because a collapsed lung
upper anterior chest (2nd ICS) = remove air
lateral in lower chest (8th or 9th ICS) = drainage removal
chest tube is sutured to the chest and an airtight dressing is applied around the tube exit site
chest tube is connected to the closed chest drainage unit

purposed of CDU (closed drainage unit):
restore normal vacuum pressure in pleural space by removing all air/fluid in a closed one-way system until corrected

12

3 chambers of CDU

drainage collection chamber
water seal chamber
suction control chamber

13

drainage collection chamber

chest tube connected here
get a new CDU if it fills up

14

water seal chamber

used to promote one-way flow out of the pleural space to prevent air from moving back up the system and into the pleural space
connected to DCU by a small tube that allows drainage to remain in the first chamber and the air to go down into the water of the water seal chamber
chamber contains 2cm of water which acts as a one-way valve to prevent backflow
**** may see intermittent bubbling when they cough, sneeze, or exhale
*** will see a slight rise/fall of water as they breath (tidaling)
***if tidaling has stopped, it usually means that the lung has re-expanded

15

suction control chamber

if they need suction to remove air/fluid then this chamber controls the pressure applied
****sterile water is placed up to 20cm
***turn on the wall vacuum suction until you have slow, gentle, continuous bubbling
***vigorous bubbling = BAD

if there is a dry suction then water is not used and has no bubbling

16

assessment of closed chest drainage system

dressing (tight and intact)
breath sounds
report any O2 less than 90
palpate chest tube insertion site for subQ emphysema (could indicate poor tube placement)
record chest drainage hourly for 24hrs and then q8hrs

***notify HCP if:
200ml of drainage or greater in 1 hour
100ml or greater any hour after the first
change in color (yellow to bright red)

deep breath, cough, IS
watch for fever, high WBC, and drainage
daily chest xray to check for re-expansion

17

maintaining CDU

keep below the level of the chest (if too high the fluids/air will go back into the pleural space
keep tube straight and free of kinks/loops
tape all connections (closed system)
monitor water levels in the system
want to see tidaling with respirations in the water seal chamber (they will stop when the lung has re-expanded, or if there is a kink/clot in the tubing)

when is bubbling a problem?:
continuous bubbling in water seal chamber (air leak)
never clamp a chest tube without a prescription (could lead to tension pneumothorax)
***only clamp for a short period of time

18

trouble shooting CDU

tubing becomes disconnected:
keep another sterile connector at bedside
reconnect asap

CDU falls over and water leaks out or shifts to drainage compartment:
re-establish the water seal
set CDU up, check chambers, and fill water seal to 2cm of water
have them deep breathe and cough in case any air went into the pleural space
***if there is no water in the water seal chamber, then air can collapse the lung
****need water in water seal chamber

chest tube pulled out:
sterile occlusive dressing taped down on 3 sides (can always put a glove on & put hand over it)

19

chest tube removal

have them take a deep breath and hold (valsalva) and place an occlusive dressing over the site

20

fractures of ribs/sternum

s/s:
pain
tenderness
crepitus (bones grating together)
shallow respirations
respiratory acidosis

treatment:
non-narcotic analgesic
IS
nerve block to help with cough
support injured area with hands
immobilize the chest with binders/straps NOT recommended
observe for complications

21

flail chest

s/s:
anxious
SOB
pain
paradoxical wall movement (saw chest), chest sucks inward on inspiration and puffs out on expiration
stand at food of bed to observe how it is rising and falling
dyspnea
cyanosis
high pulse

treatment:
humidified O2
pain management
stabilize the area
intubate
ventilate
positive pressure ventilation

22

positive pressure ventilation

invasive:
PEEP (positive end expiratory pressure)
on ventilator
end of expiration the ventilator exerts pressure down into the lungs to keep alveoli open
improves gas exchange
decrease work of breathing
expands and realigns the ribs to start growing back together

non invasive:
BiPAP and CPAP apply pressure to lungs to open up alveoli and improve ventilation and O2

CPAP (continuous positive airway pressure)
continuous pressure during inspiration and expiration
obstructive sleep apnea and infants with underdeveloped lungs

BiPAP (bi-level positive airway pressure)
pressure at two different pressure settings (one on inhalation and lower pressure on exhalation)
non obstructive sleep apnea


***check bilateral lung sounds for both

23

pulmonary embolism causes

thrombus/blood clot

dehydration
venous stasis from prolonged immobility or surgery
obesity
birth control pills
clotting disorders
heart arrhythmias

24

pulmonary embolism s/s

hypoexmia
low PaO2
SOB
cough
high RR
restless
apprehension
petechiae over chest
cyanosis
hemoptysis (coughing up blood)
high pulse
chest pain (sharp, stabbing)
atelectasis
high BP in lungs (pulmonary HTN)

25

pulmonary embolism diagnosis

high D-dimer (will tell if there is any clots not just in the lungs)

CTA (computerized tomography angiogram)
dye is used so check kidney function

positive VQ scan (ventilation/perfusion scan that can detect an embolus)
measures both airflow and blood flow in the lungs
no dye used

pulmonary angiography

26

pulmonary embolism prevention

early mobilization:
change position q2hours
prevent stasis (flex and extend q2-4hours)
walk 4-6x/day
TED hose
pneumatic compression device will not be used if they suspect a DVT
hydrate

27

normal aPTT

30-40sec

28

PT normal

11-12.5

29

INR normal

0.8-1.1

30

pulmonary embolism treatment

bed rest
elevate above heart
O2
decrease pain

anticoagulants:
Vitamin K antagonist (Warfarin)-- limit greens
thrombin inhibitors (Heparin, Enoxaparin, Dabigatran)
factor Xa inhibitors (Rivaroxaban, Fondaparinux)
prevent clots from getting bigger

bleeding precautions
fibrinolytic agents (tPA or alteplase) dissolve the clot
pulmonary embolectomy
inferior vena cava filtration (prevents clots from getting into the pulmonary system