Chest Tubes, Pneumothorax, and Flail Chest

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Lobes
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The lungs are separated into sections called ____, 2 on the left and 3 on the right.
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Negative
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The visceral and parietal pleurae are head together by ______ pressure.
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If air, fluid, or blood enters the space between the two membranes, a ____ ____ is developed.
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Pleural Space
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Transudate
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A clear fluid that collects in the pleural space when there are fluid shifts in the body from conditions such as CHF, malnutrition, renal and liver failure.
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Exudate
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Cloudy fluid with cells and proteins that collects when the pleurae are affected by malignancy or diseases such as tuberculosis and pneumonia
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Remove fluid and air through a ____ or ___ ____ drainage system
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Thoracentesis; Chest tube
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Pleural Effusion
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Transudate or exudate in the pleural space
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Flail Chest
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Multiple rib fractures results in free-floating segment of rib cage and paradoxical movement of the detached part with breathing
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Treatment of Flail Chest
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1. Supportive care (PAIN, Deep breathing, cheerleader) 2. TREAT PAIN (it can be severe) 3. Possible PCA pump (depending on severity and the client) 4. Intercostal nerve blocks 5. epidural analgesia 6. Intrapleural administration of opioids (directly to the site)
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Nursing Management of Flail Chest
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1. MANAGE THE PAIN**** 2. Monitor pulse ox, Temp, Pulse, Resp 3. Encourage client to sit up and cough every hour (clears lungs and prevent Pneumonia) 4. Promote mobility ASAP (may mobilize arm and shoulder to ease pain) — Prevents blood clots and Pneumonia 5. Assess breath sounds and depth of respirations regularly
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Pneumotthorax
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When there is a breach (opening) on the surface of the lung (parietal or visceral pleura) -Opening allows air to enter the pleural space which results in exposure to positive atmospheric pressure
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Pneumoothorax
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Air between the pleurae
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Traumatic Pneumothorax
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when air escapes from a laceration in the lung itself and allows atmospheric air to enter the pleural space
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Open Pneumothorax
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When a wound in the chest wall is large enough to allow air to pass freely in and out of the thoracic cavity with each attempted respiration
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The opening of an Open Pneumothorax acts as a ____ so pressure from trapped air cannot build up in the chest
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Vent
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Closed or Simple Pneumothorax
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Chest wall is intact -Rupture of the lung and visceral pleura allows air into the pleural space
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Spontaneous Pneumothorax
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Rupture of an air filled bleb or blister on the surface of the lung Client will have symptoms but NOT LIFE-THREATENING
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Tension Pneumothorax
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Air is drawn into pleural space from lacerated lung or small opening or wound in chest wall -Air enters with every inspiration and has no way to leave (TRAPPED) -NO vent to expel air
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Tension Pneumothorax occurs when a ___pneumothorax creates positive pressure in the pleural space that continues to build with air
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CLOSED
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With each breath, tension is increased which causes the lung to collapse and the heart, great vessels and trachea to shift to unaffected side (_______)
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Mediastinal shift
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When the pressure is ____, CPR WILL NOT HELP
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EXTERNAL
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Emergency Tx for Tension Pneumothorax
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large bore needle followed by a chest tube -relieves pressure -like deflating a balloon -usually 14 gauge needle at 2nd intercostal space midclavicular line on affected side
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Mediastinal shift
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Occurs when the pressure gets so high that it pushes the heart and great vessels into the unaffected side of the chest
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Mediastinal shift can quickly lead to ____ collapse
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Cardiovascular
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The Vena Cava on the right side of the heart cant accept venous return so there is NO ____ ____
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CARDIAC OUTPUT
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Hemothorax
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blood in the pleural space -negative pressure is disrupted and lung will collapse to some degree -best seen in an upright chest radiograph
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Pneumonectomy
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WHOLE lung
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Lobectomy
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ONE lobe
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Segmentectomy
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SEGMENT of the lung
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Wedge Resection
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SMALL AREA of the lung
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-Lie on non-operated lung (GOOD lung) -better match of ventilation and perfusion -Can do all three if not specified (back->side and flat->semii upright
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Lobectomy, Segmentectomy, Wed Resection
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Pneumonectomy
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-operative side should be dependent -lie on operative side -fluid stays below level of bronchial stump -other lung can expand -prevents good lung and heart from swifting
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Pre-op care for Lung Surgery
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Airway is cleared of secretions to reduce chance of post-op atelectasis or infection -Humidification, postural draiinage and chest percussion are done befoore BRONCHODILATORS are administered (if preescribed)
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____ are administered for infection
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Antibiotics
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Teach client ___ for effective cough techniques and cough schedule
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position
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Inform pt of possible ____ or ___ ___ depending on surgery, how it went, or how breathing after
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ventilator; chest tube
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Monitor V/S as wells as ___ and ____ status
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respiratory; cardiovascular
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Impove airway clearance by ___ qh (for first 24 hrss at minimum) then q2h
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TCDB (Turn Cough and Deep Breathe)
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___is IMPORTANT. Surgeon should be contacted about ____ after surgery
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Positioning
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Cheest tubes
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remove access air, fluid, and blood from the pleural cavity to allow re-expansion of the lung
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Pleural Cavity
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Includes the right or left pleural space and the mediastinum
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Thoracotomy
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Creates an opening in the chest wall through which a chest tube (thoracic catheter) is placed, which allows air and fluiid to flow out of the chest
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Chest tube
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is attached to an unobstructed drainage device to allow air and fluid to leave the chest into a collective container bellow chest level to allow draining by gravity
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One-Way Valve
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prevents air and fluid returning to the chest
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Straw attached to chest tube from patient is placed under ___ of fluid (water seal)
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2cm
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Wet Suction System
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-Amt set by level of water addeed to suction control chamber (20cm) -gentle bubbling in suction control chambeer when wall suction properly applied
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Dry Suction System
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-Amy set by a dial (20 cm) -Float indicator or bellows will be visible when wall suction is properly applied -if STOPS moving, check for kinks
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Avoid ___ tube as that can causee a tension pneumothorax
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clamping
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ONLY clamp the tube when:
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CHANGING the drainage system
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Always keep ____ level of client’s chest
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BELOW
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If disconnection occurs, reconnect and ask client to ___
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COUGH
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Drainage chamber should be marked for
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I&O
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Check __ and __ frequently
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connections and tubing
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DO NOT ___ chest tube during transport
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CLAMP
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Leave drainage system ___ to atmoshere when disconnected froom suction
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OPEN
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REMOVAL of chest tube
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1. instruct client to perform the Valsalva Maneuver 2. Remove at height of expiration (stand level with pt) 3. Tube is clamped and removed by physician 4. SIMULTANEOUSLY, small airtight bandage is applied
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A post-procedure ___ ____ should be performed to exclude a pneumothorax
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chest x-ray

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