Respiratory System-Week 3

Question 1

What is a pleural effusion?

Answer 1

A pleural effusion is the abnormal accumulation of fluid in the pleural space, often due to infection, malignancy, heart failure, or inflammatory conditions.

Question 2

What are the clinical manifestations of pleural effusion?

Answer 2

Dyspnoea, diminished or absent breath sounds, dullness to percussion, chest heaviness, and reduced chest expansion on the affected side.

Question 3

What is a pneumothorax?

Answer 3

A pneumothorax is the presence of air in the pleural space, leading to partial or complete lung collapse.

Question 4

What are the clinical signs of a pneumothorax?

Answer 4

Sudden sharp chest pain, dyspnoea, hyperresonance on percussion, reduced or absent breath sounds, and possible tracheal deviation (in tension pneumothorax).

Question 5

What is the systematic approach to assessing pleural effusion or pneumothorax?

Answer 5

DRSABCDE: Danger, Response, Send for help, Airway, Breathing (RR, effort, sounds), Circulation (HR, BP), Disability (conscious state), Exposure (inspection and palpation of chest).

Question 6

What diagnostic tools help identify a pleural effusion or pneumothorax?

Answer 6

Chest X-ray, ultrasound, and CT scan are commonly used to detect and assess severity

Question 7

Who are the interprofessional team members in managing respiratory impairment?

Answer 7

Respiratory physicians, nurses, physiotherapists, radiologists, respiratory therapists, and occasionally thoracic surgeons.

Question 8

What is a tracheostomy and why is it used?

Answer 8

A tracheostomy is a surgical opening in the trachea to facilitate long-term airway access, used in cases of obstruction, prolonged ventilation, or secretion management.

Question 9

What are the key nursing considerations for a tracheostomy?

Answer 9

Maintain patency via suctioning, provide humidified oxygen, prevent infection, and assess stoma and tube position.

Question 10

What are potential complications of a tracheostomy?

Answer 10

Blockage, dislodgement, bleeding, infection, tracheal stenosis, and subcutaneous emphysema.

Question 11

What is an intercostal catheter (ICC)?

Answer 11

A flexible tube inserted into the pleural space to remove air (pneumothorax), fluid (pleural effusion), or blood (haemothorax).

Question 12

What is the function of an underwater seal drainage system (UWSD)?

Answer 12

It allows for air or fluid to be evacuated from the pleural space while preventing backflow into the chest cavity.

Question 13

What nursing assessments are essential for a patient with an ICC and UWSD?

Answer 13

Check drainage volume, colour, and consistency; ensure the system remains below chest level; assess for air leaks and respiratory status.

Question 14

What are complications of an ICC with UWSD?

Answer 14

Infection, tube dislodgement, blockage, subcutaneous emphysema, and tension pneumothorax if clamped incorrectly.

Question 15

What signs suggest the UWSD is not functioning properly?

Answer 15

Continuous bubbling (air leak), absence of fluctuation (blockage), or sudden increase in drainage volume (possible hemorrhage).

Question 16

What is subcutaneous emphysema and how is it identified?

Answer 16

It’s air trapped in subcutaneous tissue, often felt as crepitus (like bubble wrap). It can occur after chest trauma or pneumothorax.

Question 17

What are the two classifications of pleural effusions?

Answer 17

Transudative (low protein, due to systemic conditions like heart failure) and exudative (high protein, due to infections, malignancy, or inflammation).

Question 18

What are the four factors leading to pleural effusion?

Answer 18

Increased capillary pressure, decreased oncotic pressure, increased pleural permeability, and impaired lymphatic drainage.

Question 19

What is empyema?

Answer 19

A pleural effusion filled with pus, often due to pneumonia, TB, or lung abscess.

Question 20

What position promotes optimal breathing in patients with pleural effusion?

Answer 20

High Fowler’s or tripod position.

Question 21

What is the primary purpose of a thoracentesis?

Answer 21

To aspirate pleural fluid for diagnostic or therapeutic purposes.

Question 22

What are key nursing assessments post-thoracentesis?

Answer 22

Monitor vital signs, inspect for respiratory distress, assess drainage site, encourage deep breathing.

Question 23

What is the mechanism of a pneumothorax?

Answer 23

Air enters the pleural space, disrupts negative pressure, and causes partial or full lung collapse.

Question 24

What is the most dangerous form of pneumothorax?

Answer 24

Tension pneumothorax — causes mediastinal shift, tracheal deviation, compromised cardiac output, and can be fatal.

Question 25

What is a haemothorax?

Answer 25

Blood in the pleural space, usually from trauma or surgery.

Question 26

What is a chylothorax?

Answer 26

Lymphatic fluid accumulation in the pleural space due to trauma or malignancy.

Question 27

How does a Heimlich valve function?

Answer 27

It allows air to exit the pleural space but prevents re-entry, maintaining negative pressure.

Question 28

What is a UWSD and its primary function?

Answer 28

Underwater seal drainage system: allows air or fluid to leave pleural space while preventing return, maintaining pressure balance.

Question 29

What assessments are done for a patient with an ICC and UWSD?

Answer 29

Check drainage volume/colour, ensure seal, assess bubbling or fluctuations, inspect insertion site, monitor respiratory status.

Question 30

What is minimal occlusive volume (MOV) in tracheostomy care?

Answer 30

The minimum volume needed to seal the cuff to prevent air leak, measured in mmHg or cmH₂O.v

Question 31

What is tracheal stenosis?

Answer 31

Narrowing of the trachea, often from prolonged pressure or inflammation, reducing airway patency.

Question 32

What is tracheal necrosis?

Answer 32

Tissue death of the tracheal wall, commonly due to prolonged high cuff pressure.

Question 33

What is a tracheo-innominate artery fistula?

Answer 33

A rare but life-threatening complication where the tracheostomy erodes into a major artery, causing massive bleeding.

Question 34

What is the difference between cuffed and uncuffed tracheostomy tubes?

Answer 34

Cuffed tubes seal the airway for ventilation and aspiration protection; uncuffed allow airflow around the tube and better speech.

Question 35

What is the impact of a tracheostomy on communication?

Answer 35

Bypassing the larynx prevents vocalisation; unless using fenestrated tubes or a speaking valve.

Question 36

Why do patients with tracheostomies require humidified air?

Answer 36

The upper airway normally warms and moistens air; bypassing it means air is cold and dry, which can irritate lower airways.

Question 37

How can nurses prevent tube displacement in a tracheostomy?

Answer 37

Secure with sutures (initially) and tracheostomy tapes, monitor cuff pressure, and avoid over-manipulation.

Question 38

What symptoms suggest a dislodged or obstructed tracheostomy tube?

Answer 38

Sudden distress, stridor, reduced air entry, high peak pressures on ventilator, or visible tube movement.

Question 39

How should suction be performed on a tracheostomy patient?

Answer 39

Using sterile technique, limit suction to 10–15 seconds, and only when clinically indicated to clear secretions.

Question 40

What should be included in a tracheostomy focused assessment?

Answer 40

Respiratory rate/effort, oxygenation, site integrity, cuff pressure, tube security, and patient's ability to communicate.