Respiratory

What are four reasons a chest tube might be inserted into a patient?

-return negative pressure to chest cavity -clear excessive air from the intro pleural space -drain blood/fluid from the intra pleural space -relieve respiratory distress

How many chambers does the Ocean have?

A, B, C, D

How many chambers does the Oasis have?

A, B, C, D, E

What Chamber will you see Titling in?

Chamber B

In what chamber should you never see continuous/vigorous bubbling?

Chamber C

Ocean/Oasis Chamber D

Collection Chamber

What do you label on Chamber D at the end of your shift?

Initials, Date, Time

The nurse connects the closed drainage system to -20 centimeters of suction per physician orders. How does the nurse determine the suction is engaged?

Oasis- the bellow is engaged in Chamber E Ocean- there is gentle/light bubbling in Chamber A

Tension Pneumothorax

Occurs when air is drawn into the pleural space from a lacerated lung or through a small opening or wound in the chest wall. Characterized by increasing positive pressure in the pleural space with each breath; this is an emergency situation, and the positive pressure needs to be decompressed or released immediately

Clinical Manifestation of Pneumothorax

Pain- sudden and may be pleuritic. The patient could present with minimal respiratory distress or discomfort as well as tachypnea with an uncomplicated pneumothorax. If the lung completely collapses the patient will be anxious, dyspnea, air hunger, use of accessory muscles, agitation, increasing hypoxemia, hypotension, tachycardia, diaphoresis. Late sign: cyanosis

What type of solution do you fill a chest tube drainage system with?

Sterile Water

Oasis/Ocean Chamber A

Suction Control Regulator

Oasis Chamber E

Suction Monitor Bellow -if suction is on the bellow will come out, even with the arrow

Hemopneumothorax

The accumulation of blood and air in the pleural space of the chest.

Clinical Manifestations of Tension Pneumothorax

Trachea is shifted away from affected side, chest expansion may be decreased or fixed in hyper-expansion state, breath sounds are diminished or absent

Clinical Manifestations of Simple Pneumothorax

Trachea midline, expansion of the chest is decreased, breath sounds may be diminished or absent

Ocean/Oasis Chamber C

Water Seal Chamber/Air Leak Monitor

How do we know if there is an air leak in the lung?

When the patient takes a deep breath, breaths out, or coughs we will see some bubbling inside of Chamber C. We can't take the chest tube out until this goes away

Open pneumothorax

air enters the chest during inspiration and exits during expiration. A slight shift of the affected lung may occur because of a decrease in pressure as air moves out of the chest

During the first 36 hours after the insertion of chest tubes, when assessing the function of a three-chamber, closed-chest drainage system, the nurse identifies that the water in the underwater seal tube is not fluctuating. What initial action should the nurse take?

checked to make sure the tube is not kinked

Hemothorax

collection of blood in the pleural space resulting from torn intercostal vessels, lacerations of the great vessels, or lacerations of the lungs

Cardiac Tamponade

compression of the heart resulting from fluid or blood within the pericardial sac. It usually is caused by blunt or penetrating trauma to the chest. A penetrating wound of the heart is associated with a high mortality rate. ______________ ______________________ also may follow diagnostic cardiac catheterization, angiographic procedures, and pacemaker insertion, which can produce perforations of the heart and great vessels.

What should you see in Ocean Chamber A to indicate the suction is on?

gentle bubbling

The visceral pleural covers the?

lungs

A nurse is caring for a client with a pneumothorax who has a chest tube attached to a closed chest drainage system. If the chest tube and closed chest drainage system are effective, what type of pressure will be reestablished?

negative pressure in the pleural spaces

Simple or Spontaneous Pneumothorax

occurs when air enters the pleural space through a breach of either the parietal or visceral pleura -this occurs as air enters the pleural space through the rupture of a bleb or a bronchopleural fistula. A _____________________ pneumothorax may occur in an apparently healthy person in the absence of trauma due to rupture of an air-filled bleb, or blister, on the surface of the lung, allowing air from the airways to enter the pleural cavity. It may be associated with diffuse interstitial lung disease and severe emphysema.

Traumatic Pneumothorax

occurs when air escapes from a laceration in the lung itself and enters the pleural space from a wound in the chest wall -It may result from blunt trauma (e.g., rib fractures), penetrating chest or abdominal trauma (e.g., stab wounds or gunshot wounds), or diaphragmatic tears. _______________________ pneumothorax may occur during invasive thoracic procedures (i.e., thoracentesis, transbronchial lung biopsy, and insertion of a subclavian/central line) in which the pleura is inadvertently punctured, or with barotrauma from mechanical ventilation. -Chest surgery can be classified as a _______________ pneumothorax as a result of the entry into the pleural space and the accumulation of air and fluid in the pleural space.

Cardiac Tamponed s/s

pericardial friction rub, muffled or distant heart tones

A client with a pneumothorax has a chest tube inserted and attached to a closed chest drainage system. The client asks, "Why is the tube in my chest hooked up to a contraption with water in it?" How does the nurse explain the function of the water?

prevents reflux of air back into the chest

Pneumothorax s/s

sharp chest pain, respiratory distress, decreased O2 Sat, anxious, dyspnea, air hungry, use of accessory muscles, late sign = cyanosis

Closed Pneumothorax

the patient has a pneumothorax but the chest wall remains intact, so the chest wall isn't open, but the lung is injured

The parietal pleural lines the?

thoracic cavity, lateral wall of the mediastinum diaphragm and inner aspects of the ribs

What is titling?

when the patient takes a deep breath in and out you will see the fluid go up and down, this is normal.