Chest tube video/powerpoint COMPLETE – Flashcards
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thorax
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Where is a chest tube inserted?
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to remove fluid or air from the pleural space
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What is the purpose of a chest tube?
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when air or gas is present within the pleural space
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What is a pneumothorax?
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in an emergency (trauma) or after/during a surgical procedure
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When is a chest tube needed?
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surgical
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What type of procedure is the insertion of a chest tube?
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yes
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Do you need a signed consent for a chest tube?
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respiratory status
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What must be observed carefully after the insertion of a chest tube?
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sterility
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What must the nurse maintain to prevent secondary infection from a chest tube?
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safe environment
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What type of environment should be provided when caring for a client with chest tubes?
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notify physician immediately
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What should the nurse do if a patient complains of chest pain or shows signs of cyanosis?
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a thin film of liquid lying between the outer layer of the lung and inner layer of chest cavity
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What is the pleural space?
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pleural space
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What permits smooth gliding movement of lungs along the chest wall?
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semi fowler's or high fowler's
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What position should the patient with a pneumothorax be placed in to promote optimal drainage?
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high fowler's
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What position should the patient with a hemothorax be placed in to facilitate fluid drainage?
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respiratory rate, rhythm, effort of respirations, breath sounds, palpation for air
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What five aspects of respiratory status must be continually observed after chest tube insertion?
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system patency, system sterility, client safety
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What are 3 management goals for the client with chest tubes?
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loops, kinks, or clots
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What must the nurse inspect for to maintain patency of the chest tube system?
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a straight line
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How should the tubing hang from the top of the mattress to the drainage chamber?
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inspiration
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When would the chest tube system show a rise in the water seal level?
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expiration
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When would the chest tube system show a decrease in the fluid level?
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milking
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How do you advance a clot in the tubing of the chest tube system?
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If the chest tube becomes disconnected from the drainage system, hemostats are used to clamp the tube until a sterile connection can be re-established
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What is shodded hemostats?
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the pressure gradient
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When air and fluid enter the pleural space, what is disturbed?
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the lung may collapse or fail to fully expand
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What happens when the pressure gradient in the pleural space is disturbed?
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1,2,3
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How are chest drainage systems classified?
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self-contained
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What is the more commonly used disposable chest drainage system?
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in the 2nd or 3rd intercostal space at the mid-clavicular line
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Where is the chest tube inserted to treat a pneumothorax?
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in the 8th or 9th intercostal at the mid axillary
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Where is the chest tube inserted to treat a hemothorax?
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rise in temperature
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What is indicative of infection?
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microorganisms
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What can enter through a chest tube and cause infection?
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upright and below the level of the chest tube
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What is the proper placement of the chest drainage system at all times?
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air leak in the system
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What is indicated with the presence of continued bubbling in the water seal?
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drainage color and fluctuation, drainage amount, vital signs, skin color
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What are 4 notations that a nurse must make when assessing the client with a chest tube?
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submerge the chest tube end in sterile saline to reestablish a water seal
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If the drainage collection device breaks, what should you do?
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increased respiratory distress and increased drainage amounts, complaint of chest pain, decrease in breath sounds, cyanosis, asymmetric chest movement, subcutaneous emphysema, hypotension, tachycardia, mediastinal shift
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What are nine S & S that the physician must be notified immediately for in a patient with a chest tube?
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to maintain lung function and prevent lung infection
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Why does the body need sufficient calories (pertaining to the respiratory system)?
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produces high carbon dioxide levels and the lungs are stressed, causing them to work harder to expel
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What does over feeding cause (respiratory system)?
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contributes to respiratory failure, forceful respiratory movements are difficult with reduced lung mass, weak muscles fail to push blood through veins, causes poor circulation and makes pulmonary infections likely, the body needs protein to sustain body cell mass
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What does malnutrition contribute to (respiratory system)?
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pulmonary disease
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What is strongly related to malnutrition?
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malnutrition
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What frequently causes impaired pulmonary function?
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malnutrition
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What can pulmonary disease result in?
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pulmonary diseases
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What causes an increase in energy expenditure because of increased work of breathing and chronic infection?
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fluid restriction, SOB, anorexia, GI distress, and vomiting
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What results in a reduced dietary intake?
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70%
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What percent of patients with COPD exhibit weight loss?
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high caloric and high fat foods, small frequent meals, and resting before meals
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What are strategies for increasing intake and weight gain?
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Bronchodilators
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What relaxes smooth muscle in bronchial airways and blood vessels?
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bronchodilators
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What is used to treat airway obstruction from respiratory disorders, such as asthma and COPD?
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Inderal (beta adrenergic blocker)
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What causes bronchoconstriction?
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tendency to cause cardiac and CNS stimulation
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What are adverse effects of bronchodilators?
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some act to prevent bronchial constriction and others relieve it
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How do bronchodilators work?
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albuterol, epinephrine, Alupent, Terbutaline (brethine), Serevent
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What are the names of sympathomimetic agents?
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aminophylline, theophylline
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What are 2 names of xanthines used to treat asthma and bronchospasm?
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anticholinergics-example=atropine
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What are drugs that are used to block the effects of acetylcholine (parasympatholytic)?
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corticosteroids
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What is an anti-inflammatory and causes decreased edema in the respiratory tract?
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PO, parenteral, and inhalation (nasally and orally). Oral has more side effects
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What are the routes for corticosteroids?
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asthma (less common in COPD)
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What is corticosteroids usually given for?
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fluid and electrolyte imbalance, hypertension, osteoporosis, and muscle wasting
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What are systemic side effects of corticosteroids?
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do not abruptly stop taking, can cause acute adrenal crisis. must be tapered off
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What is important patient teaching about corticosteroids?
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Azmacort, Beclovent
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What are 2 examples of corticosteroids?
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Mucolytics-mucomyst
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What reduces the thickness and stickiness of pulmonary secretions in COPD, emphysema, cystic fibrosis, and sometimes pneumonia?
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prevents replication, halts growth of normal and abnormal cells
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What do cytotoxic antibiotics do?
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alkylating drugs
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When spindle fibers in cells are getting ready to divide, what drug can be given to break these fibers up, interfering with rapidly reproducing cancer cells?
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BP and pulse return to normal, body temperature of hands and feet increase to normal
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What happens 20 mins after quitting smoking?
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nicotine and carbon monoxide levels in the blood are reduced by half, oxygen levels return to normal, blood platelets are less prone to block arteries
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What happens 8 hours after quitting smoking?
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carbon monoxide is eliminated from the body, the chance of a heart attack decreases, lungs start to clear mucus and other smoking debris
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What happens 24 hours after quitting smoking?
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there is no nicotine left in the body, ability to taste and smell is greatly improved, nerve endings start regrowing
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What happens 48 hours after quitting smoking?
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breathing becomes easier, bronchial tubes begin to relax and energy levels increase
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What happens 72 hours after quitting smoking?
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circulation improves, walking becomes easier
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What happens 2-12 weeks after quitting smoking?
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coughs, wheezes, and breathing problems decrease as lung function increases, cilia regrow in lungs, increasing ability to handle mucus, bad lipids in blood return to normal, risk of gum disease decreases
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What happens 3-9 months after quitting smoking?
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ability of lungs to fight infection increases, risk of peptic ulcers equals that of a non smoker
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What happens 1 year after quitting smoking?
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risk of heart attack falls to about half that of a smoker
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What happens 5 years after quitting smoking?
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risk of lung cancer falls to that of a non smoker, risk of heart attack falls to the same as someone who has never smoked
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What happens 10 years after quitting smoking?
