Pneumothorax and Hemothorax

4. A nurse is preparing to administer morphine 2.5 mg IV bolus to a client who has a pneumothorax. Available is morphine injection 10 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth.)

0.3 mL solve for X. desired*quality/have have/quaity=desired

1. A nurse is assessing a client who has experienced a gunshot wound. Findings include blood pressure 108/55 mm Hg, heart rate 124/min, respiratory rate 36/min, temperature 38.6° C (101.4° F), and SaO2 95% on oxygen 15 L/min via nonrebreather mask. The client reports dyspnea and pain. The nurse reassesses the client 30 min later. Which of the following should the nurse report to the provider? (Select all that apply.) A. Distended neck veins B. Tracheal deviation C. Headache D. Nausea E. Heart rate 154/min

1. A. CORRECT: Distended neck veins indicate that the client's condition is worsening and should be reported to the provider. Distended neck veins are due to impaired gas exchange, which compresses the blood vessels and limits blood return. B. CORRECT: Tracheal deviation indicates that the client's condition is worsening and should be reported to the provider. Tracheal deviation is due to altered intrathoracic pressure, which moves the trachea toward the unaffected side. C. INCORRECT: Headache is not indicated with this client's condition and does not need to be reported to the provider. D. INCORRECT: Nausea is not indicated with this client's condition and does not need to be reported to the provider. E. CORRECT: A heart rate of 154/min indicates that the client's condition is worsening and should be reported to the provider. An increased heart rate is due to impaired cardiac output as a result of trauma.

5. A nurse in the emergency department is assessing a client with a suspected flail chest. Which of the following clinical findings confirm this diagnosis? (Select all that apply.) A. Bradycardia B. Cyanosis C. Hypotension D. Dyspnea E. Paradoxic chest movement

5. A. INCORRECT: Tachycardia is a clinical manifestation indicative of flail chest due to inadequate oxygenation. B. CORRECT: Cyanosis is a clinical manifestation indicative of flail chest due to inadequate oxygenation. C. CORRECT: Hypotension is a clinical manifestation indicative of flail chest. D. CORRECT: Dyspnea is a clinical manifestation indicative of flail chest. This is due to injury and the client's inability to effectively inhale and exhale. E. CORRECT: Paradoxic chest movement is a clinical manifestation indicative of flail chest. This is due to injury to the chest and the inability to inhale and exhale.

A flail chest occurs when several ribs, usually on one side of the chest, sustain multiple fractures. Ribs and the fractured segments have minimal attachments, and there is instability of the chest wall. This results in significant limitation in chest wall expansion.

A flail chest occurs when several ribs, usually on one side of the chest, sustain multiple fractures. Ribs and the fractured segments have minimal attachments, and there is instability of the chest wall. This results in significant limitation in chest wall expansion.

2. A nurse is reviewing the prescriptions for a client who has a 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 decompression. C. Administer lorazepam (Ativan). D. Prepare for chest tube insertion.

A. INCORRECT: Assessing the client's pain is important, but this is not the priority action at this time. B. CORRECT: According to the airway, breathing, circulation (ABC) priority-setting framework, establishing and maintaining the client's respiratory function is the priority. Therefore, obtaining a large-bore IV needle for decompression is the priority action by the nurse. C. INCORRECT: The client will likely be anxious, and a benzodiazepine medication can be administered, but this is not the priority action at this time. D. INCORRECT: The nurse should gather supplies to prepare for chest tube insertion, but this is not the priority action at this time.

3. A nurse is reviewing discharge instructions for a client who experienced a pneumothorax. Which of the following should be included in the teaching? 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 cough."

A. INCORRECT: The client does not need to report weakness. This is an expected finding following recovery from a pneumothorax. B. INCORRECT: The client should not expect to return to work in 1 week. The client should expect a lengthy recovery following a pneumothorax. C. INCORRECT: The client does not need to wear a mask following a pneumothorax. A mask is required for clients who are immunosuppressed. D. CORRECT: The client should notify the provider of a cough. This may indicate that the client has a respiratory infection and should be treated.

Opioid agonists (pain medications) Activation of these receptors produces analgesia (pain relief), respiratory depression, euphoria, sedation, and a decrease in gastrointestinal motility.

Activation of these receptors produces analgesia (pain relief), respiratory depression, euphoria, sedation, and a decrease in gastrointestinal motility.

Assessment ● Risk Factors ◯ Blunt chest trauma. ◯ Penetrating chest wounds.

Assessment ● Risk Factors ◯ Blunt chest trauma. ◯ Penetrating chest wounds.

Assist with client positioning and specimen transport. Monitor the client's status (vital signs, SaO2, injection site). Assist the client to the the edge of the bed and to lean over a bedside table.

Assist with client positioning and specimen transport. Monitor the client's status (vital signs, SaO2, injection site). Assist the client to the the edge of the bed and to lean over a bedside table.

Care After Discharge ◯ Set up referral services (home health, respiratory services) to provide portable oxygen if needed. ◯ Client Education ■ Encourage the client to take rest periods as needed. ■ Remind the client to use proper hand hygiene to prevent infection.

Care After Discharge ◯ Set up referral services (home health, respiratory services) to provide portable oxygen if needed. ◯ Client Education ■ Encourage the client to take rest periods as needed. ■ Remind the client to use proper hand hygiene to prevent infection.

Check ABGs, SaO2, CBC, and chest x-ray results. ◯ Position the client to maximize ventilation (high-Fowler's = 90%)

Check ABGs, SaO2, CBC, and chest x-ray results. ◯ Position the client to maximize ventilation (high-Fowler's = 90%)

Client Education ☐ Remind the client that medications will have amnesic effect and cause drowsiness.

Client Education ☐ Remind the client that medications will have amnesic effect and cause drowsiness.

Assessment ● Risk Factor Closed/occluded chest tube. ◯ Older adult clients have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli. ◯ Older adult clients are more susceptible to infections. ◯ Chronic obstructive pulmonary disease (COPD).

Closed/occluded chest tube. ◯ Older adult clients have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli. ◯ Older adult clients are more susceptible to infections. ◯ Chronic obstructive pulmonary disease (COPD).

Complications ● Decreased cardiac output ◯ The amount of blood pumped by the heart decreases as intrathoracic pressure rises. ◯ Hypotension develops.

Complications ● Decreased cardiac output ◯ The amount of blood pumped by the heart decreases as intrathoracic pressure rises. ◯ Hypotension develops.

Dull percussion (hemothorax) ■ Subcutaneous emphysema (air accumulating in subcutaneous tissue)

Dull percussion (hemothorax) ■ Subcutaneous emphysema (air accumulating in subcutaneous tissue)

Flail chest is the inability of the injured side of the chest to expand adequately upon inhalation and contract upon exhalation. ● One side of the chest is typically affected due to multiple rib fractures.

Flail chest is the inability of the injured side of the chest to expand adequately upon inhalation and contract upon exhalation. ● One side of the chest is typically affected due to multiple rib fractures.

If the client is receiving ventilation, the above nursing considerations and client education may vary

If the client is receiving ventilation, the above nursing considerations and client education may vary

Laboratory Tests ■ ABGs ☐ Hypoxemia (PaO2 less than 80 mm Hg)

Laboratory Tests ■ ABGs ☐ Hypoxemia (PaO2 less than 80 mm Hg)

Maintain mechanical ventilation in the event of severe injury to establish adequate gas exchange and stabilize the injury. ■ Suction trachea and endotracheal tube as needed. ■ Administer pain medication as prescribed. Patient-controlled analgesia or an epidural block commonly is used.

Maintain mechanical ventilation in the event of severe injury to establish adequate gas exchange and stabilize the injury. ■ Suction trachea and endotracheal tube as needed. ■ Administer pain medication as prescribed. Patient-controlled analgesia or an epidural block commonly is used.

Monitor clients, especially older adults, for manifestations of respiratory depression. If respirations are 12/min or less, stop the medication and notify provider immediately

Monitor clients, especially older adults, for manifestations of respiratory depression. If respirations are 12/min or less, stop the medication and notify provider immediately

Monitor for constipation. ☐ Encourage fluid intake and activity related to a decrease in gastric motility. ☐ Monitor intake and output and fluid retention (common in clients who have an enlarged prostate).

Monitor for constipation. ☐ Encourage fluid intake and activity related to a decrease in gastric motility. ☐ Monitor intake and output and fluid retention (common in clients who have an enlarged prostate).

Nursing Actions ☐ Obtain informed consent, gather supplies, monitor the client's status (vital signs, SaO2, chest tube drainage), report abnormalities to the health care provider, and administer pain medications.

Nursing Actions ☐ Obtain informed consent, gather supplies, monitor the client's status (vital signs, SaO2, chest tube drainage), report abnormalities to the health care provider, and administer pain medications.

Nursing Care ◯ Administer oxygen therapy. ◯ Auscultate heart and lung sounds and monitor vital signs every 4 hr. ◯ Document ventilator settings hourly if the client is receiving ventilation

Nursing Care ◯ Administer oxygen therapy. ◯ Auscultate heart and lung sounds and monitor vital signs every 4 hr. ◯ Document ventilator settings hourly if the client is receiving ventilation

Objective Data ◯ Unequal chest expansion (the unaffected side of the chest will expand, while the affected side may appears to diminish in size or remain stationary)

Objective Data ◯ Unequal chest expansion (the unaffected side of the chest will expand, while the affected side may appears to diminish in size or remain stationary)

Opioid agonists (pain medications) ■ Morphine sulfate and fentanyl (Duragesic) are opioid agents used to treat moderate to severe pain. These medication acts on the mu and kappa receptors that help alleviate pain.

Opioid agonists (pain medications) ■ Morphine sulfate and fentanyl (Duragesic) are opioid agents used to treat moderate to severe pain. These medication acts on the mu and kappa receptors that help alleviate pain.

Patient-Centered Care ◯ Nursing Care ■ Administer humidified oxygen. ■ Monitor vital signs and SaO2. ■ Review findings of pulmonary function tests, periodic chest x-rays, and ABGs. ■ Assess lung sounds, color, and capillary refill. ■ Promote lung expansion by encouraging deep breathing and proper positioning

Patient-Centered Care ◯ Nursing Care ■ Administer humidified oxygen. ■ Monitor vital signs and SaO2. ■ Review findings of pulmonary function tests, periodic chest x-rays, and ABGs. ■ Assess lung sounds, color, and capillary refill. ■ Promote lung expansion by encouraging deep breathing and proper positioning

Physical Assessment Findings ■ Signs of respiratory distress (tachypnea, tachycardia, hypoxia, cyanosis, dyspnea, and use of accessory muscles) ■ Tracheal deviation to the unaffected side (tension pneumothorax)

Physical Assessment Findings ■ Signs of respiratory distress (tachypnea, tachycardia, hypoxia, cyanosis, dyspnea, and use of accessory muscles) ■ Tracheal deviation to the unaffected side (tension pneumothorax)

Provide emotional support to the client and family. ◯ Monitor chest tube drainage. ◯ Administer medications as prescribed. ◯ Encourage prompt medical attention when evidence of infection occurs.

Provide emotional support to the client and family. ◯ Monitor chest tube drainage. ◯ Administer medications as prescribed. ◯ Encourage prompt medical attention when evidence of infection occurs.

Reduced or absent breath sounds on the affected side ■ Asymmetrical chest wall movement ■ Hyperresonance on percussion due to trapped air (pneumothorax)

Reduced or absent breath sounds on the affected side ■ Asymmetrical chest wall movement ■ Hyperresonance on percussion due to trapped air (pneumothorax)

Remind clients who are receiving a fentanyl patch that the initial patch takes several hours to take effect. A short-acting pain medication will be administered for breakthrough pain.

Remind clients who are receiving a fentanyl patch that the initial patch takes several hours to take effect. A short-acting pain medication will be administered for breakthrough pain.

Respiratory failure ◯ Inadequate gas exchange due to lung collapse ◯ Nursing Actions ■ Prepare for mechanical ventilation. ■ Continue respiratory assessment.

Respiratory failure ◯ Inadequate gas exchange due to lung collapse ◯ Nursing Actions ■ Prepare for mechanical ventilation. ■ Continue respiratory assessment.

risks Tachycardia ◯ Hypotension ◯ Dyspnea ◯ Cyanosis

Tachycardia ◯ Hypotension ◯ Dyspnea ◯ Cyanosis

Teach the client how to use a patient-controlled analgesia (PCA) pump if applicable. The client is the only person who should push the medication administration button. Reassure the client that the safety lockout mechanism on the PCA prevents overdosing of medication.

Teach the client how to use a patient-controlled analgesia (PCA) pump if applicable. The client is the only person who should push the medication administration button. Reassure the client that the safety lockout mechanism on the PCA prevents overdosing of medication.

Teamwork and Collaboration ◯ Respiratory services should be consulted for ABGs, breathing treatments, and suctioning for airway management. ◯ Pulmonary services may be consulted for chest tube management and pulmonary care.

Teamwork and Collaboration ◯ Respiratory services should be consulted for ABGs, breathing treatments, and suctioning for airway management. ◯ Pulmonary services may be consulted for chest tube management and pulmonary care.

Thoracentesis may be used to confirm hemothorax. ☐ Thoracentesis is the surgical perforation of the chest wall and pleural space with a large-bore needle.

Thoracentesis may be used to confirm hemothorax. ☐ Thoracentesis is the surgical perforation of the chest wall and pleural space with a large-bore needle.

X Inform the client he will feel discomfort when the local anesthetic solution is injected. When the needle is inserted into the lung, some pressure may be felt, but no pain.

X Inform the client he will feel discomfort when the local anesthetic solution is injected. When the needle is inserted into the lung, some pressure may be felt, but no pain.

his chapter will review pneumothorax, hemothorax, and flail chest. ● A pneumothorax is the presence of air or gas in the pleural space that causes lung collapse

his chapter will review pneumothorax, hemothorax, and flail chest. ● A pneumothorax is the presence of air or gas in the pleural space that causes lung collapse

■ Encourage immunizations for influenza and pneumonia. ■ Remind the client that recovery from a pneumothorax/hemothorax may be lengthy. ■ Educate the client and family about the illness, and encourage them to express their feelings.

■ Encourage immunizations for influenza and pneumonia. ■ Remind the client that recovery from a pneumothorax/hemothorax may be lengthy. ■ Educate the client and family about the illness, and encourage them to express their feelings.

■ Nursing Considerations ☐ Monitor vital signs. (Benzodiazepines may cause hypotension and respiratory distress.) ☐ The medications have amnesiac effect. ☐ Monitor for paradoxical effects (euphoria, rage)

■ Nursing Considerations ☐ Monitor vital signs. (Benzodiazepines may cause hypotension and respiratory distress.) ☐ The medications have amnesiac effect. ☐ Monitor for paradoxical effects (euphoria, rage)

■ Nursing Considerations ☐ Use cautiously with clients who have asthma or emphysema, due to the risk of respiratory depression. ☐ Assess pain every 4 hr.

■ Nursing Considerations ☐ Use cautiously with clients who have asthma or emphysema, due to the risk of respiratory depression. ☐ Assess pain every 4 hr.

● A tension pneumothorax occurs when air enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration. The trapped air causes pressure on the heart and the lung. As a result, the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output. Death can result if not treated immediately

● A tension pneumothorax occurs when air enters the pleural space during inspiration through a one-way valve and is not able to exit upon expiration. The trapped air causes pressure on the heart and the lung. As a result, the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output. Death can result if not treated immediately

● Medications ◯ Benzodiazepines (sedatives) ■ Lorazepam (Ativan) or midazolam may be used to decrease anxiety

● Medications ◯ Benzodiazepines (sedatives) ■ Lorazepam (Ativan) or midazolam may be used to decrease anxiety

● Risk Factors ◯ Multiple rib fractures (often caused by motor-vehicle crash or as a result of cardiopulmonary resuscitation on older adults)

● Risk Factors ◯ Multiple rib fractures (often caused by motor-vehicle crash or as a result of cardiopulmonary resuscitation on older adults)

● Subjective Data ◯ Anxiety ◯ Chest pain

● Subjective Data ◯ Anxiety ◯ Chest pain

● Subjective Data ◯ Anxiety ◯ Pleuritic pain

● Subjective Data ◯ Anxiety ◯ Pleuritic pain

● Surgical Interventions ◯ Chest tube insertion ■ Chest tubes are inserted in the pleural space to drain fluid, blood, or air; re-establish a negative pressure; facilitate lung expansion; and restore normal intrapleural pressure.

● Surgical Interventions ◯ Chest tube insertion ■ Chest tubes are inserted in the pleural space to drain fluid, blood, or air; re-establish a negative pressure; facilitate lung expansion; and restore normal intrapleural pressure.

◯ As a result of a tension pneumothorax, air and pressure continue to rise in the pleural cavity, which causes a mediastinal shift.

◯ As a result of a tension pneumothorax, air and pressure continue to rise in the pleural cavity, which causes a mediastinal shift.

◯ Diagnostic Procedures ■ Chest x-ray ☐ Used to confirm pneumothorax or hemothorax

◯ Diagnostic Procedures ■ Chest x-ray ☐ Used to confirm pneumothorax or hemothorax

◯ Nursing Actions ■ Administer IV fluids and blood products as prescribed. ■ Monitor heart rate and rhythm. ■ Monitor intake and output (chest tube drainage)

◯ Nursing Actions ■ Administer IV fluids and blood products as prescribed. ■ Monitor heart rate and rhythm. ■ Monitor intake and output (chest tube drainage)

◯ Pain management services may be consulted if pain persists and/or is uncontrolled. ◯ Rehabilitation care may be consulted if the client has prolonged weakness and needs assistance with an increasing level of activity

◯ Pain management services may be consulted if pain persists and/or is uncontrolled. ◯ Rehabilitation care may be consulted if the client has prolonged weakness and needs assistance with an increasing level of activity

☐ Continually monitor vital signs and the client's response to the procedure. ☐ Monitor chest tube placement and function.

☐ Continually monitor vital signs and the client's response to the procedure. ☐ Monitor chest tube placement and function.

☐ Monitor vital signs for hypotension and bradypnea. ☐ Assess for nausea and vomiting. ☐ Assess level of sedation (drowsiness, level of consciousness)

☐ Monitor vital signs for hypotension and bradypnea. ☐ Assess for nausea and vomiting. ☐ Assess level of sedation (drowsiness, level of consciousness)

☐ Nursing Actions X Ensure that informed consent has been obtained. X Make sure the client understands the importance of remaining still during the procedure.

☐ Nursing Actions X Ensure that informed consent has been obtained. X Make sure the client understands the importance of remaining still during the procedure.