Module 8

Name 2 prescriptions for pneumothorax

Oxygen Chest tube

Name 2 manifestations of Tension Pneumothorax

Hypotension Tracheal deviation

Name 3 complications of chest trauma

Flail Chest Pneumothorax Cardiac tamponade

Signs and symptoms associated with a flail chest include A.tracheal deviation toward the unaffected side. B. jugular venous distention. C. paradoxical respiratory movement. D. respiratory alkalosis.

C

MVC patient w/dyspnea, tachycardia, hypotension, JVD, L trach dev., dec. R breath sounds. What is most likely diagnosis? A. Tension pneumothorax B. Cardiac tamponade C. Simple pneumothorax D. Ruptured diaphragm

A

Patient's condition has declined: flat neck veins, absent L breath sounds, and hypotension. The nurse suspects a A. cardiac tamponade. B. hemothorax. C. open pneumothorax. D. ruptured diaphragm.

B

Describe Becks Triad

JVD Hypotension Muffled heart sounds

Name 4 important facts in caring for chest drainage systems

Keep below chest level No milking No clamping Air leak is fast cont. or interm. bubbling

A patient who was an unrestrained driver in a high-speed, head-on motor vehicle collision presents with dyspnea, tachycardia, hypotension, jugular venous distention, tracheal deviation to the left, and decreased breath sounds on the right side. What is the most likely diagnosis? A. Tension pneumothorax B. Cardiac tamponade C. Simple pneumothorax D. Ruptured diaphragm

A

Which statement is true about a blunt cardiac injury/cardiac contusion? A. It will probably be diagnosed by pericardiocentesis. B. Hemodynamic parameters most likely show a low CO & low SVR. C. It will most likely impact cardiac impulse conduction. D. Check CPK level to accurately evaluate cardiac contusion.

C

Which type of condition does the nurse anticipate in a patient whose diagnostic testing shows blood in the pleural space? A. Hemothorax B. Hemopneumothorax C. Open pneumothorax D. Tension pneumothorax

A A hemothorax is comprised of blood in the pleural space. A hemopneumothorax is comprised of blood and air in the pleural space. An open pneumothorax is comprised of a large open thoracic wound. A tension pneumothorax is caused by an injury that perforates the chest wall or pleural space. During inspiration, air flows into the pleural space and becomes trapped.

A client experiences a lateral crushing chest injury. Assessment findings include obvious right-sided paradoxical motion of the chest and multiple rib fractures, resulting in a flail chest. The nurse would monitor the client for which complication? A. Mediastinal shift B. Tracheal laceration C. Open pneumothorax D. Pericardial tamponade

A Mediastinal shift moved toward the uninjured lung, reducing oxygenation and venous return. Tracheal laceration is unlikely with a crushing injury to the chest. Flail chest is a closed chest injury; open pneumothorax results from a penetrating injury to the chest wall. Pericardial tamponade is associated with a cardiac contusion and usually occurs from sternal, not lateral, compression injury

After insertion of a central venous catheter through the left subclavian vein, a client reports chest pain and dyspnea and has decreased breath sounds on the left side. Which action would the nurse take first? A. Administer oxygen as prescribed B. Activate the rapid response team C. Give the prescribed as needed morphine sulfate D. Assist the client to cough and deep breathe

A The client's history of a subclavian vein central line insertion and sudden onset of pain, dyspnea, and decreased breath sounds suggest tension pneumothorax. The nurse will initially administer oxygen. The next action would be to activate the rapid response team, because chest tube placement is likely to be needed to allow lung reexpansion. Morphine may be needed for pain control, but would not be initial action. Coughing and deep breathing will not help with dyspnea caused by by tension pnuemothorax, although the client would be encouraged to cough and deep breathe once the chest tube is in place

Which information would the nurse educator include in a presentation on how to care for clients with a chest tube drainage system? SATA A. Ensure the chest tube dressing is tight and intact B. Palpate the skin to detect subcutaneous emphysema C. Place the chest tube drainage system below the chest D. Quickly attempt to reinsert the chest tube if it falls out E. Strip the chest tube with long strokes to promote drainage

ABC Care of clients with chest tubes includes ensuring the chest tube dressing is tight and intact to prevent tube dislodgment and air leak. The nurse will palpate the skin to detect subcutaneous emphysema. The chest tube drainage system is placed below the chest. If a chest tube falls out, the nurse will cover the site with sterile gauze and immediately notify the HCP. The chest tube should not be stripped because this causes negative pressure that can cause trauma to the pleura

a patient w/trach dev., absent L breath sounds, hypotension and chest tube w/ 1800mL blood. What surgery is expected? A. Cardiac tamponade B. Thoracotomy C. Splenectomy D. Pneumothorax

B

Which is the function of the water-seal chamber on a closed chest drainage system for a client with hemothorax? A. Collects drainage from the pleural space B. Prevents reflux of air back into the pleural space C. Promotes drainage of blood from the pleural space D. Controls level of suction applied to intrapleural space

B Water acts as a seal, preventing air from reentering the pleural space collects in the collection chamber of the chest drainage system. Blood from the hemothorax will drain into the collection chamber mainly under the effect of gravity. The level of suction applied to the intrapleural place is controlled by the fluid level in the suction control chamber

When the chest x-ray for a client who has arrived at the emergency department with chest trauma shows multiple fractured ribs, which action will the nurse take next? A. Administer the prescribed morphine sulfate B. Assist the client to take deep breaths and cough C. Check for paradoxical movement of the chest D. Teach the client about ways to manage rib pain

C Flail chest can occur when multiple ribs are fractured and can compromise breathing efforts because of paradoxical movements during inspiration and expiration. Flail chest may require intubation and mechanical ventilation. Analgesic medication administration will be needed, because rib fractures make breathing painful, but further assessment of the client's ventilatory effort is needed prior to giving narcotic pain medications. The client with fractured ribs will need to deep breathe and cough to prevent atelectasis and pneumonia, but assessing for possible flail chest would be done first. Education about management of pain is needed, but this would be done after assessing for possible respiratory distress caused by flail chest

A client has a wedge resection of a lobe of the lung and now has a chest tube with three-chamber underwater drainage system has which main purpose? A. Acts as a drainage container B. Provides an airtight water seal C. Controls the amount of suction D. Allows for escape of air bubbles

C The first chamber collects drainage; the second chamber provides for the underwater seal; the third chamber controls the amount of suction.

Mr. Jackle has a right chest tube inserted for a large pneumothorax. Immediately following insertion, the nurse notes that there is no fluctuation or bubbling in the underwater seal. Which one of the following interventions is the priority? A. Increase the level of suction B. Increase the volume in the water seal C. Strip the chest tube D. Obtain a STAT chest xray

D A chest tube that is successfully placed to resolve a pneumothorax should fluctuate (indicated it is patent and in the pleural space) and bubble (indicating it is evacuating the pneumothorax). The lack of fluctuation and bubbling from the onset of insertion indicates the tube is not in the proper position. The physician should be notified and a chest xray done to confirm correct placement. The patient should also be watched for signs of tension pneumothorax development/deterioration.

Which finding best indicates that the chest tube for a client with a pneumothorax may be discontinued? A. Clear breath sounds heard in both lungs B. Oxygen saturation reading is higher than 90% C. Absence of bubbling in the water seal chamber D. Full reexpansion of the lung seen on the x-ray

D Chest x-ray films reveal the degree to which the lungs fills the Pleural cavity and also the presence or absence of pneumothorax. Clear breath sounds heard bilaterally do help indicate that the lung has re expanded, but a chest x-ray is needed to confirm lung reexpansion. Oxygen saturation's improve with resolution of pneumothorax, but a chest x-ray is needed for confirmation. Because intrapleural air is expelled into the water seal chamber, lack of bubbling in the water seal chamber indicates possible resolution of the pneumothorax , but a chest x-ray is needed for confirmation

Mr. Sing is admitted to the critical care unit with a closed head injury following a fall from a ladder. He develops respiratory distress and has HR 144, RR 38, BP 60/40 and SpO2 74%. His peak airway pressures increase and his trachea deviates to the right side. Which one of the following interventions is the priority? A. Mannitol B. Norepinephrine (Levophed) C. Right sided chest tube D. Left sided chest tube

D These findings (hypoxemia, respiratory distress and hypotension), combined with the tracheal shift toward the right side, suggest a left sided tension hemothorax or pneumothorax

A client with a spontaneous pneumothorax asks, "Why did they put this tube into my chest?" Which information would the nurse provide about the purpose of the chest tube? A. It checks for bleeding in the lung B. It monitors the function of the lung C. It drains fluid from the pleural space D. It removes air from the pleural space

D With a pneumothorax, a chest tube attached to a closed chest drainage system removes trapped air and helps reestablish negative pressure within the pleural space; this results in lung reinflation. A closed chest drainage system may be inserted to remove blood related to a hemothorax, not to assess for bleeding. Monitoring the function of the lung is not the purpose of inserting chest tubes; the function of the lungs is monitored through the assessment of vital signs, breath sounds, arterial blood gases, and chest x-ray. Draining fluid from the pleural space is the reason for use of a closed chest drainage system the there is fluid in the pleural space