Pneumothorax, Crushed Chest, Gunshot, Stab Wounds....
A chest tube is put in a pt’s chest when the pt has a pneumothorax because? It removes air from the pleural space which reinflates the lung by reestablishing negative pressure – know it is reinflated when nurse hears breath sounds
Crepitus- air trapped in tissues that crackles
When is a chest tube not used? For pneumonectomy
Following a right pneumonectomy, the pt is cool and clammy, resp. are labored, his skin is pale, he sits straight up in bed? What does the nurse do? Auscultates the left lung – a mediastinal shift with airway obstruction may occur b/c pressure builds up on the operative side, causing the trachea to deviate toward the unoperative side; ASSESSMENT of the airway takes priority
What should the nurse do first when a pt wakes after a pneumonectomy? Encourage deep breathing – helps keep the airway patent and prevents atelectasis of the remaining lung by raising intrapleural pressure
What positions should the pt be in following a right pneumonectomy? Supine or right side-lying position – permit ventilation of the remaining lung and prevent fluid from draining into the sutured bronchial stump
What should the nurse look for in a pneumonectomy pt? signs of cardiac overload
The best coughing routine for a pneumonectomy pt is? Q hr for 1st 24 hrs then q 2 hrs
Pt has ph of 7.32, Pco2 of 53 and hco3 of 25. What should the nurse do? Encourage the client to cough productively and take deep breaths-resp. acidosis can be caused by the depressant effects of anesthesia or a partially obstructed airway; these activities clear the airway and blow off CO2
If a water chamber in the pleu-evac stops fluctuating, the nurse should? Look for obstructions in the tube, the water should rise and fall with breathing, called tidaling
How does a nurse measure and document the amt of drainage from a chest tube? Mark the time and fluid level on the outside of the drainage chamber of the closed chest drainage system
What is happening when a water-sealed drainage system has excessive bubbling? Check the system for air leaks
When a gunshot pt is expected in the ER, what equipment should be prepared? Chest tube equipment because the priority is to stabilize the respiratory status
In a crushing chest injury, what shows that treatment is working? Increased breath sounds, chest tube normalizes intrathoracic pressure, drains fluid and air from the pleural space and improves pulmonary function.
What to do when a pt pulls out a chest tube? Cover wound with cleanest material available, resp status is priority over risk for infection
When a chest tube separates from the drainage system what should the nurse do? Reconnect it immediately to prevent pneumothorax
Why does a trach need suctioning? It interferes with the ability to cough effectively
What is highest priority assessment for a pt with a crushing chest wound? Quality of respirations and presence of pulses –
What is the treatment for hypoxia among postop pts, when the pt complains of chest pain and shortness of breath? O2 – supplemental O2 supports the body while the cause of the problem is sought; O2 support is the first therapy in all cases of hypoxia and can be instituted without a physician’s order in an emergency
The primary responsibility of the nurse when caring for a client with a chest tube attached to a 3 chamber underwater seal drainage system would be to? Maintain the closed system – an airtight system is needed to reestablish negative pressure and reinflate the lung
A pt with a left chest stab wound should be positioned how? Left side with head elevated – needs to lay on the affected side so they unaffected lung can expand to its fullest potential, elevation of the head facilitates respirations by reducing the pressure of the ab organs on the diaphragm and allowing the diaphragm to descend with gravity
When assessing a stab wound pt the 1st priority is? quality of depth of respirations, – should evaluate unilateral chest movements that may indicate pneumothorax and tachypnea, which are associated with hypercapnia and acidosis
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