W3 Respiratory B Flashcards
(162 cards)
1
Q
What are restrictive respiratory disorders?
A
Disorders that impair the ability of the chest wall and diaphragm to move with respiration
2
Q
What is pleural effusion?
A
Abnormal collection of fluid in the pleural space
3
Q
What is pneumothorax?
A
Accumulation of air or gas in the pleural cavity
4
Q
What are the two classifications of pleural effusions?
A
- Transudative
- Exudative
5
Q
What causes transudative pleural effusions?
A
Conditions impacting fluid flow, such as congestive heart failure, liver disease, or renal disorders
6
Q
What are common signs and symptoms of pleural effusion?
A
- Dyspnoea
- Cough
- Sharp chest pain worse on inspiration
- Decreased movement of the chest on affected side
- Dullness to percussion
- Diminished breath sounds
7
Q
What is empyema?
A
Collection of purulent fluid (pus) in the pleural space
8
Q
What is chylothorax?
A
Collection of lymphatic fluid in the pleural space due to trauma or malignancy
9
Q
What are the factors contributing to fluid buildup in pleural effusion?
A
- Increased capillary pressure
- Decreased oncotic pressure
- Increased pleural membrane permeability
- Obstruction of lymphatic flow
10
Q
What is the nursing assessment process for patients with restrictive respiratory conditions?
A
- Health history assessment
- Primary assessment
- Secondary assessment
- Focused assessment
11
Q
Fill in the blank: A thoracentesis is the aspiration of _______ for diagnostic or therapeutic purposes.
A
intrapleural fluid
12
Q
What are the risks associated with post thoracentesis?
A
- Pneumothorax
- Bleeding
- Infection
13
Q
What is a tension pneumothorax?
A
A life-threatening condition where air enters the pleural space and causes lung collapse
14
Q
What types of pneumothorax are classified as spontaneous?
A
- Closed pneumothorax
- Iatrogenic pneumothorax
15
Q
What is the immediate management for a sucking chest wound?
A
Place a semi-occlusive dressing over the wound with three sides covered
16
Q
What are the clinical manifestations of a pneumothorax?
A
Similar to closed pneumothorax if there is no external opening
17
Q
What is the purpose of the pleural fluid?
A
Acts as a lubricant between the chest wall and the lung
18
Q
What is the normal volume of pleural fluid in the pleural space?
A
5-15 ml
19
Q
True or False: Pleural effusion is a disease.
A
False
20
Q
What is the role of the intercostal catheter (ICC)?
A
Facilitate drainage of fluid in pleural effusions
21
Q
What are the nursing management strategies for pleural effusions?
A
- High fowler’s position
- Tripod position if needed
- Breaks/rest between activities
- Respiratory hygiene
- Oxygenation when indicated
22
Q
What can lead to a haemothorax?
A
Bleeding from ruptured blood vessels due to trauma
23
Q
What is a sucking chest wound?
A
A sucking chest wound is where air gets pulled into the pleural space through the chest wall during each inspiration and may be seen as bubbles.
24
Q
What can cause fractured ribs resulting in pneumothorax?
A
Fractured ribs can result from blunt trauma, lacerating the lungs and allowing air to enter the pleural space from inside.
25
What is a flail segment in the context of rib fractures?
A flail segment occurs when multiple ribs are broken in more than one place, causing opposite movement of the rib cage section during breathing.
26
What are the management strategies for a flail segment?
Management consists of pain control and often splinting of the chest wall to minimize movement.
27
What distinguishes a simple pneumothorax from a tension pneumothorax?
A simple pneumothorax allows air to escape at the same rate it enters, while a tension pneumothorax occurs when air cannot escape, leading to increased pressure.
28
What is a tension pneumothorax?
A tension pneumothorax results from air entering the pleural space and not being able to exit, causing lung collapse and mediastinal shift.
29
What are the signs of a tension pneumothorax?
Signs include severe hypoxaemia, marked tachycardia, neck vein distension, cyanosis, profuse sweating, tracheal deviation, and hypotension.
30
What is a haemothorax?
A haemothorax is an accumulation of blood in the pleural space due to injury to the chest wall, diaphragm, lung, blood vessels, or mediastinum.
31
How do you manage a haemothorax?
Management requires the insertion of a drain tube to drain the blood while preventing air from entering the pleural cavity.
32
What is a chylothorax?
A chylothorax occurs when lymphatic fluid collects in the pleural space due to abnormal circulation, often from surgery, trauma, or lung cancer.
33
What is the definitive diagnosis for pneumothorax or haemothorax?
Definitive diagnosis occurs with a chest x-ray (CXR).
34
What are common signs and symptoms of pneumothorax or haemothorax?
* Dyspnoea
* Tachypnoea
* Tachycardia
* Chest pain
* Hypoxia
* Reduced or absent breath sounds
35
What assessment should be included for patients with restrictive respiratory conditions?
Assessment should include health history, primary assessment, secondary assessment (including pain), and focused assessment of trachea position.
36
What is subcutaneous emphysema?
Subcutaneous emphysema is when air escapes into subcutaneous tissue, felt as crepitus on palpation.
37
What is the immediate management for a pneumothorax?
Immediate management may involve observation or insertion of an Intercostal Catheter (ICC) with connection to underwater-seal drainage (UWSD).
38
What is the role of an Intercostal Catheter (ICC)?
An ICC is used to remove air, fluid, pus, or blood from the pleural space.
39
What is the purpose of the underwater seal drainage (UWSD) system?
The UWSD system collects fluid/air and restores normal respiratory function.
40
What should be monitored in a patient with an ICC and UWSD?
* Vital signs
* Drainage volume and color
* Swinging and bubbling in the water-seal chamber
41
What is a Heimlich Valve?
A Heimlich Valve is a one-way valve that maintains negative pressure by allowing air to escape but not re-enter the pleural space.
42
What should be done if there is sudden cessation in swinging of the fluid in the UWSD?
It may indicate occlusion in the tubing or kinks that prevent effective drainage.
43
What is the recommended position for the collection chamber of a UWSD?
The collection chamber must always be in the upright position to maintain the water seal.
44
What should be avoided when transporting a patient with an ICC?
Clamps should not be used during transportation as they can lead to tension pneumothorax.
45
What is the purpose of adjusting the suction in a UWSD system?
To maintain a negative pressure of -20mmHg
## Footnote
Suction is adjusted either at the system suction control or by the water level, depending on the system used.
46
What should be documented with each set of vital signs regarding drainage?
Volume and colour of the drainage
## Footnote
The level of the fluid should be marked at least once per day.
47
What are some emotional considerations for a patient with a chest drain?
Fear, anxiety, discomfort
## Footnote
Patients may experience emotional distress due to the presence of a chest drain.
48
What are potential complications of an ICC and UWSD?
Infection, obstruction, pneumothorax
## Footnote
These complications may arise from the insertion or management of the devices.
49
What structures can be affected by upper airway obstructions?
Trachea, larynx, pharynx
## Footnote
These obstructions can result from inflammation, trauma, loss of muscle tone, or growths.
50
True or False: Complete airway obstruction is a medical emergency.
True
## Footnote
Complete obstruction prevents breathing and requires immediate intervention.
51
What causes significant inflammation of the oropharynx, epiglottis, larynx, and trachea?
Infection, trauma, allergic reactions
## Footnote
This can lead to complete obstruction of the airway.
52
What is pharyngitis and its potential complications?
Inflammation of the pharynx; can lead to peritonsillar abscess
## Footnote
Symptoms include sore throat, fever, and difficulty swallowing.
53
What are the clinical manifestations of epiglottitis?
High fever, sore throat, drooling, tripod position, difficulty breathing
## Footnote
Intubation may be required to maintain a patent airway.
54
What is laryngitis?
Inflammation of the larynx resulting in hoarseness and cough
## Footnote
Significant laryngeal edema can become a medical emergency.
55
What are potential causes of upper airway trauma?
Burns, gunshots, knife wounds, blunt trauma
## Footnote
These can lead to life-threatening airway obstruction.
56
What nursing management is essential for patients with upper airway trauma?
Careful monitoring of respiratory function
## Footnote
Patients may require a tracheostomy if healing is prolonged.
57
What is a tracheostomy?
An artificial opening established in the trachea
## Footnote
It bypasses the existing airway for various medical needs.
58
List the reasons for performing a tracheostomy.
* Bypass an upper airway obstruction
* Facilitate removal of secretions
* Allow long-term mechanical ventilation
* Protect the airway in patients with swallowing difficulties
59
What are the benefits of a tracheostomy compared to endotracheal intubation?
* Less risk of vocal cord damage
* Increased comfort
* Ability to eat and drink
* Potential for speech
60
How does a tracheostomy tube affect air quality?
Bypasses the upper airway, leading to colder and drier air
## Footnote
This can impact the lower airway.
61
What is the impact of a tracheostomy on communication?
Patients may not be able to speak
## Footnote
Bypassing the larynx affects vocal sound production.
62
What are cuffed tracheostomy tubes used for?
* Mechanical ventilation
* Patients unable to protect their airway
63
What complications can arise from a tracheostomy?
* Airway leak
* Airway obstruction
* Altered body image
* Aspiration
* Bleeding
* Infection
* Tube displacement
64
What is the minimal occlusive pressure (MOV) in the context of tracheostomy tubes?
The minimum volume required to stop air leaks around the cuff
## Footnote
Measured in volume and pressure (mmHg or cmH2O).
65
What is the purpose of securing a tracheostomy tube?
To prevent tube displacement
## Footnote
Tubes are initially secured with sutures and tapes.
66
What type of tubes have a larger surface area that lowers the incidence of damaging the tracheal mucosa?
High volume, low pressure tubes
## Footnote
These tubes decrease the risk of tracheal necrosis or fistula formation.
67
What should be closely monitored to prevent complications in tracheostomy care?
Volumes and pressures within the cuff
## Footnote
The frequency of monitoring depends on hospital policy and manufacturer recommendations.
68
What is the primary difference between a tracheostomy and a laryngectomy?
A tracheostomy involves creating an opening in the trachea, while a laryngectomy involves the removal of the larynx
## Footnote
This distinction is important for emergency airway management.
69
What is the first priority in assessing a patient with a tracheostomy?
Airway
## Footnote
The tracheostomy is considered the patient's airway.
70
What basic care practices keep patients with tracheostomies safe?
* Utilise correct PPE
* Maintain a safe and equipped bed environment
* Provide regular tracheostomy care including suctioning, humidification, and dressing changes
## Footnote
Many problems for these patients are predictable and preventable.
71
What personal protective equipment (PPE) is recommended when caring for a patient with a tracheostomy?
* Goggles
* Masks
* Gloves (clean or sterile)
* Apron (optional)
## Footnote
PPE protects against blood and body fluid exposure.
72
What equipment is essential for ensuring safety in tracheostomy care?
* Humidification equipment
* Functioning suction equipment
* Sterile water for cleaning
* Cuff pressure checking devices
* Spare tracheostomy tubes
* Inner cannulas
* Bag-valve-mask device
* Tracheostomy dressing and tapes
* Sterile gloves
## Footnote
This equipment should be available at the bedside.
73
What are the benefits of supplemental humidification for patients with a tracheostomy?
* Maintains cilial and mucosal function
* Warms and moistens inspired air
* Decreases secretion viscosity
* Decreases airway trauma
* May reduce sputum plugging
* May reduce risk of secretion retention
## Footnote
Humidification is crucial as it avoids drying out of the respiratory mucus membrane.
74
What are the two types of humidification devices used for tracheostomy patients?
* Active heated humidifiers
* Passive humidification devices (HME)
## Footnote
Active humidifiers heat water to increase moisture content, while passive devices recycle expired moisture.
75
What are the signs that a patient with a tracheostomy requires suctioning?
* Noisy and/or moist airway secretions
* Increased respiratory effort
* Restlessness
* Reduced oxygen saturation
* Increased or ineffective coughing
* Patient request
## Footnote
These signs indicate the need for suctioning to maintain airway patency.
76
What complications can arise from improper suctioning technique in tracheostomy care?
* Bronchospasm/laryngospasm
* Transient hypoxia
* Tracheal trauma or bleeding
* Excessive coughing
* Cardiac arrhythmias
* Pain and/or anxiety
* Nosocomial pneumonia
* Increased intracranial pressure
## Footnote
Proper suctioning technique is essential to avoid these complications.
77
How often should the inner cannula of a tracheostomy tube be cleaned or changed?
Once every 8-hour shift
## Footnote
This frequency depends on the amount of secretions the patient has.
78
What is required for the care of a tracheostomy stoma?
* Regular cleaning with normal saline
* Keeping the site dry
* Inspecting for signs of irritation or infection
## Footnote
The stoma is considered an open wound and requires appropriate dressing.
79
What is the purpose of securing the tracheostomy tube?
To prevent dislodgment and ensure the airway remains patent
## Footnote
Dislodgment may result in a medical emergency if the stoma closes.
80
What is decannulation?
The planned removal of the tracheostomy tube
## Footnote
This is based on the patient's ability to maintain their own airway and clear secretions.
81
What factors determine how often suctioning should be performed on a patient with a tracheostomy?
The patient's condition and health service policy
## Footnote
At a minimum, suctioning should occur at the start of each shift.
82
What is decannulation?
The planned removal of the tracheostomy tube by experienced nursing or medical staff.
83
What factors determine the decision to decannulate a patient?
The patient's ability to maintain their own airway, clear secretions, and breathe adequately without a ventilator.
84
Which professionals may be involved in the decannulation process?
* Physiotherapist
* Speech Pathologist
* Respiratory physician
* Specialist Nurse
* Intensivist or anaesthetist
85
True or False: Decannulation is a procedure that can be performed by any healthcare staff.
False
86
What is the Passy Muir Speaking Valve?
A medical device that redirects airflow through the vocal folds, mouth, and nose, enabling vocal sounds and improved communication.
87
List some clinical benefits of the Passy Muir Valve.
* Voice/speech production
* Swallowing
* Secretion management
* Oxygenation
* Restoration of positive airway pressure
* Weaning
* Decannulation
* Olfaction
* Infection control
* Paediatric speech/language development
* Quality of life
88
What does TRAMS stand for?
Tracheostomy Review and Management Service
89
How can interprofessional collaboration benefit patients with restrictive respiratory disorders?
It ensures holistic and comprehensive support for the patient.
90
What role do pharmacists play in the care of patients with ICC and UWSD systems?
They provide advice and ongoing education for the patient regarding analgesia and medications.
91
Fill in the blank: The role of _______ is vital in pulmonary hygiene for a patient with an ICC and UWSD.
Physiotherapists
92
What support can social workers provide to patients?
Support for home assistance and connections to support groups.
93
What type of assessments might speech pathologists perform for tracheostomy patients?
Assessment and support related to swallowing difficulties and communication.
94
What is one of the responsibilities of a general practitioner after a patient is discharged?
Monitoring ongoing progress and any further investigations.
95
What is an important consideration when managing a patient with a tracheostomy?
Ensuring their care goals are met holistically.
96
What is the importance of the cough and gag reflex in tracheostomy patients?
It protects the airway when eating.
97
True or False: The Passy Muir Valve is only beneficial for communication.
False
98
What is the role of occupational therapists for patients post-discharge?
Providing home supports and communication equipment.
99
List some respiratory professionals involved in the care of tracheostomy patients.
* Respiratory physician
* Head and neck surgeon
* ENT surgeon
100
A________________ is the presence of excess fluid in the ________________. The most common cause is the migration of fluids and other blood components through the walls of intact ____________ bordering the pleura.
A **pleural effusion** is the presence of excess fluid in the **pleural space**. The most common cause is the migration of fluids and other blood components through the walls of intact **capillaries** bordering the pleura.
101
Types of fluid that can accumulate include transudate, a ____________ that diffuses out of capillaries beneath the pleura when people have cardiovascular, kidney or liver disease. ____________, which consists of cells and proteins, as a result of infection, ________________ or malignancy of the pleura.
Types of fluid that can accumulate include transudate, a **watery fluid** that diffuses out of capillaries beneath the pleura when people have cardiovascular, kidney or liver disease. **Exudate**, which consists of cells and proteins, as a result of infection, **inflammation** or malignancy of the pleura.
102
Pus (____________) is fluid/debris that collects from ____________________, abscesses or wounds. Blood that leaks into the pleural space is called a ________________ and can result from traumatic injury, surgery, rupture or malignancy that damages blood vessels.
Pus (**empyema**) is fluid/debris that collects from **pulmonary infections**, abscesses or wounds. Blood that leaks into the pleural space is called a **haemothorax** and can result from traumatic injury, surgery, rupture or malignancy that damages blood vessels.
103
Common signs and symptoms of pleural effusion can include shortness of breath or ____________, cough and occasional sharp, non-radiating ____________ that is worse on ________________ (pleuritic chest pain).
Common signs and symptoms of pleural effusion can include shortness of breath or **dyspnoea**, cough and occasional sharp, non-radiating **chest pain** that is worse on **inspiration** (pleuritic chest pain).
104
On assessment the patient may have ____________ movement of the chest on the affected side and ________________________ over the affected area. A patient with an ____________ may have a ________, night sweats, cough and weight loss.
On assessment the patient may have **decreased** movement of the chest on the affected side and **diminished breath sounds** over the affected area. A patient with an **empyema** may have a **fever**, night sweats, cough and weight loss.
105
Diagnosis of an effusion may require a ____________ and CT to reveal the volume and location of the effusion, or a aspiration of the fluid otherwise known as a __________________.
Diagnosis of an effusion may require a **chest x-ray** and CT to reveal the volume and location of the effusion, or a aspiration of the fluid otherwise known as a **thoracentesis**.
106
Treatment of the effusion is generally to treat the underlying cause. For example, patients with heart failure will be treated with ____________ while thoracentesis will provide ________________ of the symptoms for patient.
Treatment of the effusion is generally to treat the underlying cause. For example, patients with heart failure will be treated with **diuretics** while thoracentesis will provide **temporary relief** of the symptoms for patient.
107
What is a pleural effusion?
An abnormal collection of fluid in the pleural space, usually resulting from other disease processes.
108
Name the two types of pleural effusion.
Transudative and exudative.
109
What is the role of the pleural space in breathing?
Acts as a lubricant between the chest wall and lungs, facilitating smooth respiratory movement.
110
Which of the following best describes a transudative pleural effusion?
A. High protein content
B. Caused by infections
C. Low protein content and few cells
D. Contains pus
C. Low protein content and few cells
111
True or False: A tension pneumothorax can cause mediastinal shift and reduced cardiac output.
True
112
Pleural effusions result from a combination of factors including increased capillary pressure, decreased ______ pressure, increased pleural membrane permeability, and obstruction of lymphatic flow.
oncotic
113
A patient with chest trauma presents with dyspnoea, absent breath sounds on one side, and tracheal deviation. What condition do you suspect and what is your immediate action?
Tension pneumothorax; immediate decompression is needed, often via needle thoracostomy followed by chest drain.
114
What is a pneumothorax?
An accumulation of air or gas in the pleural cavity causing partial or complete lung collapse.
115
What is a tension pneumothorax?
A life-threatening condition where air enters the pleural space and cannot escape, causing increased pressure and mediastinal shift.
116
Name three clinical signs of a pleural effusion.
Dyspnoea, decreased chest movement on affected side, and diminished breath sounds.
117
What is the purpose of a thoracentesis?
To aspirate intrapleural fluid for diagnostic or therapeutic purposes.
118
What is the main function of an Intercostal Catheter (ICC)?
To drain air, fluid, or blood from the pleural space to restore lung expansion.
119
Which of the following is NOT a typical cause of exudative pleural effusion?
A. Infection
B. Cancer
C. Liver disease
D. Autoimmune disorders
C. Liver disease
120
Which type of pneumothorax involves air entering through a chest wound?
A. Closed
B. Open
C. Spontaneous
D. Iatrogenic
B. Open
121
True or False: A haemothorax is a collection of air in the pleural cavity.
False
122
True or False: Cuffed tracheostomy tubes are used to protect the airway and support mechanical ventilation.
True
123
A collection of pus in the pleural space is called ______.
empyema
124
A tracheostomy bypasses the patient's ______ and ______.
nose and mouth
125
You are caring for a patient with an ICC and UWSD. You notice continuous bubbling in the water-seal chamber. What does this indicate?
An air leak, possibly from the ICC insertion site or within the UWSD system.
126
A patient with laryngeal oedema post-extubation presents with expiratory stridor and distress. What is your immediate priority?
Stay with the patient and call for assistance—it’s a medical emergency.
127
What is the function of the cuff in a tracheostomy tube?
To seal the airway and ensure air is delivered through the tracheostomy tube only.
128
List two benefits of a tracheostomy compared to endotracheal intubation.
Less risk of long-term vocal cord damage, and more comfort for the patient.
129
What are two key goals of nursing care for a patient with upper airway obstruction?
Airway protection and symptom management.
130
Name one condition that can cause upper airway obstruction due to inflammation.
Epiglottitis, pharyngitis, or laryngitis.
131
Why is humidification important for patients with tracheostomies?
To compensate for bypassing the upper airway which normally warms and humidifies inspired air.
132
Which of the following is a common sign of epiglottitis?
A. Sneezing
B. Hoarse voice
C. Drooling and tripod positioning
D. Diarrhoea
C. Drooling and tripod positioning
133
What device is used to allow speech in a patient with a tracheostomy?
A. Suction catheter
B. Heat moisture exchanger
C. Passy Muir valve
D. Heimlich valve
C. Passy Muir valve
134
True or False: Heat moisture exchangers (HME) are a type of active heated humidifier.
False
135
True or False: Subcutaneous emphysema can occur as a complication of both pneumothorax and tracheostomy.
True
136
The ______ is the 'lid' that covers the larynx during swallowing to prevent aspiration.
epiglottis
137
A ______ tracheostomy is created by dilating a small incision and inserting the tube at the bedside.
percutaneous
138
You are doing a primary assessment of a tracheostomy patient. What should be your first priority?
Airway—ensure the tracheostomy tube is patent.
139
A patient post-tracheostomy is struggling with thick secretions. What nursing interventions can help?
Increase humidification, provide suctioning, and consider nebulised saline if ordered.
140
Your patient is anxious and restless with a moist-sounding tracheostomy. What should you do?
Check oxygen saturation and assess need for suctioning.
141
Which team member would help with swallowing assessments in tracheostomy patients?
Speech Pathologist
142
Which team member would help manage pain and medications post-ICC insertion?
Pharmacist
143
Who assists with pulmonary hygiene through breathing exercises and splinting?
Physiotherapist
144
Who helps with social support, home care planning, or support groups?
Social Worker
145
Who might assess home modifications such as rails or communication tools?
Occupational Therapist
146
# True or False
A spontaneous pneumothorax can present as a tension pneumothorax.
True
147
# True or False
Pneumothorax can occur spontaneously or secondary to chest trauma from injuries such as result from rib fractures, COPD or chest stabbings or shootings .
True
148
# Fill in the blanks
In tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on ____________ but preventing its escape by closing up during ____________. As more and more air enters the pleural space, pressure ____________ and pushes against the already recoiled lung, causing compression and complete or partial collapse of a lung. The build up of pressure against the mediastinum compresses and displaces the heart, aorta, vena cava, pulmonary artery and the pulmonary veins.
In tension pneumothorax, the site of pleural rupture acts as a one-way valve, permitting air to enter on **inspiration** but preventing its escape by closing up during **expiration**. As more and more air enters the pleural space, pressure **builds up** and pushes against the already recoiled lung, causing compression and complete or partial collapse of a lung. The build up of pressure against the mediastinum compresses and displaces the heart, aorta, vena cava, pulmonary artery and the pulmonary veins.
149
# Fill in the blanks
____________________ is life-threatening whereas ____________________ is not life threatening.
An open pneumothorax occurs when there is air in the pleural space. This is different to tension pneumothorax as the pressure does not build up. Instead, air that passes into the pleural space is ____________ during expiration.
**Tension pneumothorax** is life-threatening whereas **open pneumothorax** is not life threatening.
An open pneumothorax occurs when there is air in the pleural space. This is different to tension pneumothorax as the pressure does not build up. Instead, air that passes into the pleural space is **forced out** during expiration.
150
# True or False
Tracheal deviation can occur in patients with tension pneumothorax, and occurs towards the side of the chest with the tension pneumothorax.
False
151
# True or False
Nursing assessment may identify unequal or absent chest expansion when patient has a condition limits ait entry, such as atelectasis, pneumothorax or pain.
True
152
# Fill in the blanks
Chest tubes are inserted to ____________ the lung for patients who have a pneumothorax, haemothorax or pleural effusion.
Chest tubes are inserted to **re-expand** the lung for patients who have a pneumothorax, haemothorax or pleural effusion.
153
# Fill in the blanks
Fluid removed from the patient moves through tubing and into the ____________. Nurses record this volume of fluid. This is referred to as ______.
Fluid removed from the patient moves through tubing and into the **collection chamber**. Nurses record this volume of fluid. This is referred to as **drainage**.
154
# Fill in the blanks
Air removed will not be seen in the collection chamber (for obvious reasons). The air that is removed continues into the ________________. This provides a space for the drained air from the patient to be collected and there is a ________ chamber so that the air cannot pass through the sterile water and head back into the patient.
Air removed will not be seen in the collection chamber (for obvious reasons). The air that is removed continues into the **water seal chamber**. This provides a space for the drained air from the patient to be collected and there is a **one way** chamber so that the air cannot pass through the sterile water and head back into the patient.
155
# Fill in the blanks
________________ connects the UWSD device to the ____________ outlet, which turns the suction on. There is a ________________ on the UWSD device that is used to determine the level of suction to the patient.
**Suction tubing** connects the UWSD device to the **wall suction** outlet, which turns the suction on. There is a **suction regulator** on the UWSD device that is used to determine the level of suction to the patient.
156
# Fill in the blanks
____________ bubbling in the water seal chamber is indicating collected air in the pleural space is being removed. ____________ bubbling is not normal (unless it has just been inserted) and is indicating that air is leaking from the tubing or drainage system and should be reported immediately.
**Intermittent** bubbling in the water seal chamber is indicating collected air in the pleural space is being removed. **Constant** bubbling is not normal (unless it has just been inserted) and is indicating that air is leaking from the tubing or drainage system and should be reported immediately.
157
# Fill in the blanks
It is ________ for the water in the water seal chamber to rise and fall with the patient’s breathing.
It is **normal** for the water in the water seal chamber to rise and fall with the patient’s breathing.
158
# Fill in the blanks
Safety precautions for the UWSD device include that it should always be kept ________ than the level of the patient, and fluid draining from the patient that collects in the tubing should not be forced into the collection chamber. The chest tube from the patient to the drainage device should ____________ unless you are instructed to do so.
Safety precautions for the UWSD device include that it should always be kept **lower** than the level of the patient, and fluid draining from the patient that collects in the tubing should not be forced into the collection chamber. The chest tube from the patient to the drainage device should **not be clamped** unless you are instructed to do so.
159
# Fill in the blanks
Nursing care for patients who have a chest tube in situ includes assess:
1. ________________
2. Pain assessment
3. ____________ for ↓ or absent breath sounds
4. ____________ (escalate if drainage is increasing)
5. Inspect ____________ for intact dressing, infection, poor wound healing or subcutaneous emphysema
6. Encourage the patient to do ____________ exercises to facilitate ____________________ or to use incentive spirometry every hour while awake to prevent ________ or pneumonia.
Nursing care for patients who have a chest tube in situ includes assess:
1. **Vital signs**
2. Pain assessment
3. **Auscultation** for ↓ or absent breath sounds
4. **Drainage/blood loss** (escalate if drainage is increasing)
5. Inspect **insertion site** for intact dressing, infection, poor wound healing or subcutaneous emphysema
6. Encourage the patient to do **deep breathing** exercises to facilitate **lung expansion** or to use incentive spirometry every hour while awake to prevent **atelectasis** or pneumonia.
160
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________________ reflects the changes in pleural pressure on breathing, and will gradually lessen and stop as lung _________________.
**Swing/Oscillation** reflects the changes in pleural pressure on breathing, and will gradually lessen and stop as lung **re-expands**.
161
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Drainage is the fluid draining from the ____________, and is dependent on what the collection is. If there is a lack of drainage – check the ICC for ____________________________.
Drainage is the fluid draining from the **pleural space**, and is dependent on what the collection is. If there is a lack of drainage – check the ICC for **kinks, disconnections or obstructions**.
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____________ represents the amount of air draining out of the pleural space, and usually occurs during expiration or coughing, so is described as ________________. It may also occur on ____________ if a big air leak is present. If bubbling completely stops check for __________________________.
**Bubbling** represents the amount of air draining out of the pleural space, and usually occurs during expiration or coughing, so is described as **intermittent bubbling**. It may also occur on **inspiration** if a big air leak is present. If bubbling completely stops check for **kinks, disconnections or obstructions**.
