acute respiratory part 1- pulmonary embolism, pneumothorax, hemothorax, flail chest

2 this client has sustained a blunt or closed-chest injury. basic symptoms of a closed pneumothorax are shortness of breath and chest pain. a larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. hyper-resonance also may occur on the affected side. a sucking sound at the site of injury would be noted with an open chest injury.

the emergency department nurse is assessing a client who has sustained a blunt injury to the chest wall. which finding indicates the presence of a pneumothorax in this client? 1) a low respiratory rate 2) diminished breath sounds 3) the presence of a barrel chest 4) a sucking sound at the site of injury

c when using the airway, breathing, circulation priority approach to care, determine that the priority finding is related to the respiratory status. meeting oxygenation needs by administering oxygen therapy is the priority action.

a nurse is reviewing prescriptions for a client who has acute dyspnea and diaphoresis. the client states, "i am anxious and unable to get enough air." vital signs are heart rate 117/min, respirations 38/min, temperature 38.4 C, and blood pressure 100/54 mm Hg. which of the following nursing actions is the priority? a) notify the provider. b) administer heparin via IV infusion. c) administer oxygen therapy. d) obtain a CT scan.

pneumothorax

pleura is breached and pleural space is exposed to positive atmospheric pressure spontaneous or simple -rupture of bleb or bronchopleural fistula -air from airways enters the pleural cavity traumatic -air escapes from chest wall wound & enters pleural space -hemothorax -open pneumothorax tension pneumothorax -air enters but cannot leave the chest -with each breath, tension is increased -lung collapses and heart, great vessels and trachea shift to unaffected side -respiratory and circulatory function are compromised sudden pain tachypnea respiratory distress treatment -evacuate air or blood -chest tube

pleural infection

pleural effusion: fluid collection in pleural space usually secondary to pneumonia -HF, TB, pulmonary infection, PE tumors large effusions impair lung expansion, causing dyspnea decreased/absent breath sounds, dull, flat percussion treat underlying cause -thoracentesis or chest tube

prevention and treatment of pulmonary emboli

prevention -exercise to avoid venous stasis (early ambulation, sequential compression devices) treatment -anticoagulation -thrombolytic therapy -embolectomy -inferior vena cava filter

penetrating trauma

-foreign object penetrates chest wall

d bronchospasms can indicate the client is having difficulty maintaining a patent airway. the nurse should notify the provider immediately.

a nurse is assessing a client following a bronchoscopy. which of the following findings should the nurse report to the provider? a) blood-tinged sputum b) dry, nonproductive cough c) sore throat d) bronchospasms

sternal, rib fractures

-4-10 most common -control pain, avoid excessive activity, treat associated injuries

flail chest

-a free-floating segment of rib cage resulting from multiple rib fractures -chest wall instability = respiratory distress

pulmonary emboli contributing factors

-chronic atrial fibrillation -hypercoagulability -long bone fracture -long-term immobility -oral contraceptive or estrogen therapy -postoperative -PVD, DVT -sickle cell anemia -central venous catheter

pulmonary emboli

-dyspnea -tachypnea -sudden chest pain -anxiety -tachycardia -fever -cough -diaphoresis -hemoptysis -V/Q scan -CXR -ABGs -pulmonary angiography -CT scan -D-dimer

pulmonary emboli manifestations

-dyspnea -tachypnea -sudden chest pain -anxiety -tachycardia -hypotension -fever -sense of impending doom -crackles and cough -pleural effusion -decreased SaO2

blunt trauma

-hypoxemia -hypovolemia -cardiac failure

pulmonary embolism

A life-threatening hypoxic condition caused by a collection of particular matter (solid, gas, or liquid) that enters venous circulation and lodges in the pulmonary vessels causing pulmonary blood flow obstruction

3 the most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. the next most commonly reported symptom is dyspnea, which is accompanied by an increased respiratory rate. other typical symptoms of pulmonary embolism include apprehension and restlessness, tachycardia, cough, and cyanosis.

a client has experienced pulmonary embolism. the nurse should assess for which symptom, which is most commonly reported? 1) hot, flushed feeling 2) sudden chills and fever 3) chest pain that occurs suddenly 4) dyspnea when deep breaths are taken

3 flail chest results from multiple rib fractures. this results in a "floating" section of the ribs. because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical chest movement. this means that the force of inspiration pulls the fractured segment inward, while the rest of the chest expands. similarly, during exhalation, the segment balloons outward while the rest of the chest moves inward. this is a characteristic sign of flail chest.

a client with a chest injury has suffered flail chest. the nurse assesses the client for which most distinctive sign of flail chest? 1) cyanosis 2) hypotension 3) paradoxical chest movement 4) dyspnea, especially on exhalation

b to ensure accurate results, the client should not smoke tobacco for 6 to 8 hr prior to the test.

a nurse at a provider's office is reviewing information with a client scheduled for pulmonary function tests. which of the following information should the nurse include? a) "do not use inhaler medications for 6 hr following the test." b) "do not smoke tobacco for 6 to 8 hr prior to the test." c) "you will be asked to bear down and hold your breath during the test." d) "the arterial blood flow to your hand will be evaluated as part of the test."

b, c, d, e the client can have cyanosis, hypotension, and paradoxical chest movement as manifestations when experiencing flail chest.

a nurse in the emergency department is assessing a client who has sustained multiple rib fractures and has a flail chest. which of the following findings should the nurse expect? (select all that apply.) a) bradycardia b) cyanosis c) hypotension d) dyspnea e) paradoxical chest movement

a, b, e the client who has a pneumothorax can experience tachypnea, deviation of the trachea, and pleuritic pain.

a nurse is assessing a client following a gunshot wound to the chest. for which of the following findings should the nurse monitor to detect a pneumothorax? (select all that apply.) a) tachypnea b) deviation of the trachea c) bradycardia d) decreased use of accessory muscles e) pleuritic pain

b, c gentle bubbling in the suction control chamber and a rise and fall of the fluid level in the water seal chamber upon inspiration and expiration are expected findings.

a nurse is assessing a client who has a chest tube and drainage system in place. which of the following are expected findings? (select all that apply.) a) continuous bubbling in the water seal chamber b) gentle constant bubbling in the suction control chamber c) rise and fall in the level of water in the water seal chamber with inspiration an expiration d) exposed sutures without dressing e) drainage system upright at chest level

b, d, e expect the client to have a pleural friction rub, petechiae, and tachycardia.

a nurse is assessing a client who has a pulmonary embolism. which of the following manifestations should the nurse expect? (select all that apply.) a) bradypnea b) pleural friction rub c) hypertension d) petechiae e) tachycardia

d the nurse should place an occlusive dressing over the site once the tube is removed and observe the site for drainage.

a nurse is assisting a provider with the removal of a chest tube. which of the following actions should the nurse take? a) instruct the client to lie prone with arms by the sides. b) complete a surgical checklist on the client. c) remind the client that there is minimal discomfort during the removal process. d) place an occlusive dressing over the site once the tube is removed.

b the priority action when using the airway, breathing, circulation approach to client care is to establish and maintain the client's respiratory function. obtaining a large-bore IV needle for decompression is the priority action by the nurse.

a nurse is assisting the provider to care for a client who has developed a spontaneous pneumothorax. which of the following actions should the nurse perform first? a) assess the client's pain. b) obtain a large-bore IV needle for deompression. c) administer lorazepam. d) prepare for chest tube insertion.

a, c, d dyspnea, fever, and hypotension should be notified to the provider immediately.

a nurse is caring for a client following a thoracentesis. which of the following manifestations should the nurse recognize as risks for complications? (select all that apply.) a) dyspnea b) localized bloody drainage on the dressing c) fever d) hypotension e) report of pain at the puncture site

b using the airway, breathing, and circulation priority-setting framework, application of a sterile gauze to the site should be the first action for the nurse to take. this allows air to escape and reduces the risk for development of a tension pneumothorax.

a nurse is caring for a client who has a chest tube and drainage system in place. the nurse observes that the chest tube was accidentally removed. which of the following actions should the nurse take first? a) obtain a chest x-ray. b) apply sterile gauze to the insertion site. c) place tape around the insertion site. d) assess respiratory status.

b the greatest risk to the client is the possibility of bleeding from a peptic ulcer. the priority intervention is to notify the provider of the finding.

a nurse is caring for a client who has a new prescription for heparin therapy. which of the following statements by the clients should indicate an immediate concern for the nurse? a) "i am allergic to morphine." b) "i take antacids several times a day for my ulcer." c) "i had a blood clot in my leg several years ago." d) "it hurts to take a deep breath."

a positioning the client in an upright position and bent over the bedside table widens the intercostal space for the provider to access the pleural fluid.

a nurse is caring for a client who is scheduled for a thoracentesis. prior to the procedure, which of the following actions should the nurse take? a) position the client in an upright position, leaning over the bedside table. b) explain the procedure. c) obtain ABGs. d) administer benzocaine spray.

a, c, d oxygen equipment, pulse oximetry, and a sterile dressing are necessary to have in the client's room.

a nurse is caring for a client who is scheduled for a throacentesis. which of the following supplies should the nurse ensure are in the client's room? (select all that apply.) a) oxygen equipment b) incentive spirometer c) pulse oximeter d) sterile dressing e) suture removal kit

a the client who has undergone a major surgical procedure within the last 3 weeks should not receive thrombolytic therapy because of the risk of hemorrhage from the surgical site.

a nurse is caring for a client who is to receive thrombolytic therapy. which of the following factors should the nurse recognize as a contraindication to the therapy? a) hip arthroplasty 2 weeks ago b) elevated sedimentation rate c) incident of exercise-induced asthma 1 week ago d) elevated platelet count

a, c, e the client who has a BMI of 30, has a fractured bone, and has turbulent blood flow in the heart, is at increased risk of a blood clot.

a nurse is caring for a group of clients. which of the following clients are at risk for a pulmonary embolism? (select all that apply.) a) a client who has a BMI of 30 b) a female client who is postmenopausal c) a client who has a fractured femur d) a client who is a marathon runner e) a client who has chronic atrial fibrillation

a, b, e the nurse should instruct the client to cough and deep breathe, check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level, and obtain a chest x-ray following the procedure to verify chest tube placement.

a nurse is planning care for a client following the insertion of a chest tube and drainage system. which of the following should be included in the plan of care? (select all that apply.) a) encourage the client to cough and deep breathe. b) check for continuous bubbling in the suction chamber. c) strip the drainage tubing every 4 hr. d) clamp the tube once a day. e) obtain a chest x-ray.

a, b, c, e oxygen, sterile water, hemostat clamps, and a gauze dressing can be necessary.

a nurse is preparing to care for a client following chest tube placement. which of the following items should be available in the client's room? (select all that apply.) a) oxygen b) sterile water c) enclosed hemostat clamps d) indwelling urinary catheter e) occlusive dressing

d the client should notify the provider of a productive or persistent cough. this can indicate that the client might need treatment of a respiratory infection.

a nurse is reviewing discharge instructions for a client who has COPD and experienced a pneumothorax. which of the following statements should the nurse include? a) "notify your provider if you experience weakness." b) "you should be able to return to work in 1 week." c) "you need to wear a mask when in crowded areas." d) "notify your provider if you experience a productive cough."

pulmonary contusion

damage to the lung tissue resulting in hemorrhage and edema -causing interference of gas exchange development of infiltrates associated with flail chest

true an initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain.

is the following statement true or false? an initial characteristic symptom of a simple pneumothorax is sudden onset of chest pain.

false tachypnea is the most common sign for a possible pulmonary embolism.

is the following statement true or false? bradypnea is the most common sign for a possible pulmonary embolism.

pulmonary infections

severe acute respiratory syndrome -coronavirus viral, no cases reported since 2004, CDC transmitted- respiratory droplets symptoms -fever, coughing, difficulty breathing, HA, body aches, diarrhea no treatment- supportive control -standard precautions, negative-pressure isolation rooms, PPE, hand hygiene