N240 Olol - Test 1 - Chest Trauma, Chest Tubes & Drowning

Front 1

CHEST TRAUMA
VALERIE SCHLUTER

Back 1

Two categories
+Blunt trauma – body is struck by a blunt object such as steering wheel. Can cause severe life threatening injury.
+Penetrating trauma – foreign body pierces body tissue.

Front 2

Pneumothorax

Back 2

Complete or partial collapse of a lung as a result of an accumulation of air in the pleural space. Suspect pneumothorax after any blunt trauma to the chest wall.
May be accompanied by hemothorax – blood collection in the pleural space.
Hemopneumothorax

Front 3

Pneumothorax

Back 3

Closed – no external opening to the pleural space. May occur spontaneously. Bleb rupture or barotrauma, injury from subclavian insertion, broken ribs.
Open – air in pleural space as a result of opening in chest wall. Stab wound, gunshot wound, surgical thoracotomy.
Sucking chest wound – open pneumothorax, can hear air enter chest through wound on inspiration.

Front 4

Pneumothorax

Back 4

Tension pneumothorax – tension in pleural space increases intrathoracic pressure. Mediastinum shifts toward the unaffected side and compresses it. CO is affected from decreased venous return and compression of the great vessels.
S/S tachycardia, dyspnea, respiratory distress, shallow rapid respirations, air hunger, chest pain, cough, absent Respiration over affected area and hyperresonance.
Diagnosed with chest x-ray

Front 5

Pneumothorax treatment

Back 5

If small no treatment needed. Will resolve spontaneously.
Needle venting can be used in emergency situation with tension pneumothorax.
Chest tubes connected to water seal drainage.
Repeated pneumothorax injection of doxyclcline or irritating agent can be used.

Front 6

Rib fracture

Back 6

Most common affected are ribs 4-9.
S/S pain on inspiration
X-ray evidence of fracture
Atelectasis can result

Front 7

Rib fracture treatment

Back 7

Narcotic analgesia
Nerve blocks for pain control
Deep breathing exercises to prevent atelectasis
Splinting during coughing
Semi fowlers position to promote lung expansion.

Front 8

Flail chest

Back 8

Multiple rib fractures causing instability of the chest wall. The affected (flail) area moves paradoxically to the rest of the ribs.
During inspiration the flail section is sucked in and during expiration it moves out.
Prevents adequate ventilation of the injured area resulting in hypoxia.
S/S rapid, shallow respiration, tachycardia, movement of chest asymmetrical and uncoordinated.

Front 9

Chest Tubes
Chest Anatomy

Back 9

Lungs have an innate tendency to collapse (elastic property).
Chest wall movement upward and outward with inspiration increases lung volume.
Lungs must maintain a relationship with the chest wall or they will collapse.
Integrity of the pleural space must be maintained.
If air or fluid enters the pleural space this relationship is affected and lungs will collapse

Front 10

Chest tubes

Back 10

Multifenestrated transparent tubes. All openings must be within the chest wall to prevent air leaks.
Can be placed in the pleural space or mediastinum for drainage such as after CABG.
Tubes are 16-20 F for air removal
Tubes are 20-36 F for fluid removal.

Front 11

Chest Tube Drainage System

Back 11

Purpose is to drain air or fluid from the pleural space and reexpand the lung.
Pleural space has a negative pressure so the chest tube system must prevent air from entering the pleural space from the outside.
Accomplished through a waterseal or an underwater drainage system.

Front 12

Two bottle system

Back 12

The first bottle is the collection container and the second bottle is the water seal.
Suction is applied to the waterseal bottle.
Entire system must be airtight except if a vent is in the second bottle (allows trapped air to escape).
Waterseal prevents air from entering the pleural space.

Front 13

Pleurovac

Back 13

Disposable chest tube drainage system that involves same principles.

Front 14

Chest Tube insertion

Back 14

Performed at the bedside under local anesthesia.
Pt is placed in semi fowlers position.
Drainage system assembled maintain sterility.
Physician makes a small incision in the skin and uses a hemostat to puncture the pleural space. The opening is dilated with a finger or the hemostat and the chest tube is inserted into the pleural space. The tube is sutured in place and the insertion site is dressed with vasoline gauze dressing, drain sponge and taped inclusively.
All connections are taped to keep them air tight.

Front 15

Nursing care for drainage system

Back 15

Set up drainage system
Position the pt for insertion.
Reinforce physician’s explanation of procedure and answer questions.
After insertion promote lung expansion with semi fowlers position, turn, cough, deep breathing every 2 hrs.
Administer pain medication as needed.
Lift latex tubing occasionally to drain contents into collection container.

Front 16

Nursing care for Drainage systems con't

Back 16

Never lift collection container higher than chest level.
Monitor amount and consistency of drainage. A sudden increase can indicate hemorrhage. A sudden decrease can indicate obstruction. Check tubing for kinks.
Check water seal every 8 hrs to make sure it is maintained at 20 cm.

Front 17

Nursing care for Drainage systems con't

Back 17

Check for fluctuation in the drainage tube. Expected on inspiration and expiration.
Check drainage system for bubbling. Some bubbling on expiration expected if an air leak is present in the lung.
Continuous bubbling indicates break in the system.

Front 18

In general, chest tubes are not used for the pt undergoing?

Back 18

pneumonectomy
because the accumulation of fluid in the empty hemithorax prevents mediastinal shift.

Front 19

When performing endotracheal sunctioning, the nurse applies suctioning while withdrawing and gently rotating the cath 360 degrees for which time period?

Back 19

10-15 sec:b/c hypoxia and dysrythmias may develop , leading to cardiac arrest.

Front 20

Which of the following ranges identifies the amt of pressure within the endotracheal tube cuff that is believed to prevent injury and aspiration?

Back 20

`20-25 mmhg water pressure

Front 21

Which of the following results in decreased gas exchange in older adults?

Back 21

the aveolar walls contain fewer capillaries and becomes thinner

Front 22

A pt presents to the ER with a closed pneumothorax. The nurse knows that this could have been caused from?

Back 22

Bleb rupture or baratrauma, injury from subclavian insertion, or broken ribs

Front 23

A pt presents in the ER with a blunt injury. He is showing the following signs: tachycardia, dyspnea, resp. distress, shallow rapid respirations, air hunger, chest pain,cough and absent respirations over the right lung. The doctor orders an x-ray and the nurse understands that he may have?

Back 23

tension pneumothorax
mediastinum shifts toward the unaffected side and compresses it. CO is affected from decreased venous return and compression of the great vessels

Front 24

The nurse knows that this pt with a tension pneu. will be treated with?

Back 24

needle venting in an emergency with chest tubes connected to water seal drainage. He will receive repeated injections of doxyclcline or another irritating agent

Front 25

What aveoli damage can occur from rib fractures?

Back 25

Atelectasis

Front 26

What position will a pt with a rib fracture be put in and why?

Back 26

Semi-Fowlers to promote lung expansion

Front 27

The nurse hears the intern say the pt just admitted to the ER has Flail chest. She knows this to be?

Back 27

multiple rib fractures causing instability of the chest wall

Front 28

What signs does the nurse see in this pt that would let her know that Flail chest is the diagnosis?

Back 28

rapid,shallow respiration, tachycardia, movement of chest asymmetrical and uncoordinated

Front 29

An ER physician asks the nurse for chest tubes for air removal in the pt with a pneumothroax. She knows to get what size gauge?

Back 29

16-20

20-36 if they were removing liquid

Front 30

What is an important nursing intervention for a pt with a chest tube because of a pneumothroax?

Back 30

turn, cough and deep breath q 2 hrs.

Front 31

A student nurse is caring for a pt with a drainage system. She monitor the drainage, checks the tubing for kinks, checks the water seal q 8 hrs, raises the drainage system to eye level to record the level, maintains the pt in a semi-fowler position and lifts the tubing occasionally to drain the contents into the container. The preceptor stops her from doing one of the interventions. Which one?

Back 31

never lift the container above the level of the pts chest