Nurse Think Exam Notes – Chest Trauma/Chest Tube
Define and list subjective and objective assessment data for
... [Show More] each
1. pneumothorax
a. Spontaneous- typically occurs due to rupture of small blebs located on the apex of the lung, smoking increases this risk for bleb formation
b. Iatrogenic- can occur due to laceration or puncture of the lung during medical procedures.
c. Traumatic- can occur from either penetrating or non-penetrating chest trauma. Penetrating trauma allows air to enter pleural space through an opening in the chest wall. Emergency treatment consists of covering the wound with an occlusive dressing that is secured on three sides
d. Tension-occurs when air enters the pleural space but cannot escape. The continuous accumulation of air in the plureal space causes increased elevated intraplureal pressures. This is a medical emergency with both the respiratory and cardiovascular systems affected.
e. Hemothorax- an accumulation of blood in the pleural space resulting from injury to the chest wall, diaphragm, lung, blood vessels or mediastinum.
f. Cyclothorax- presence of lymphatic fluid in the pleural space
2. Trauma
a. Fractured ribs- The most common type of chest injury resulting from blunt trauma. Main goal in treatment is to decrease pain so that the patient can breathe adequately and clear secretions. Patient teaching should emphasize deep breathing and coughing, Incentive Spriometry and appropriate use of pain meds.
b. Flail chest-results from fracture of several consecutive ribs, in two or more separate places. Fail chest is visual on examination. Patient has rapid, shallow respirations and tachycardia, evaluation of crepitus near the rib fractures, chest x-ray and ABGs assist in the diagnosis.
3. Pleural effusion- a buildup of fluid between the tissues that line the lungs and the chest
4. Empyema- the collection of Pus in a cavity in the body especially in the pleural cavity
Chest tubes
Describe the 3 chambers- Fluid chamber: 6ft tube, drain will collect fluid and nurse will monitor Water seal: one way valve allows air to exit chest but not return Suction control: the use of suction helps overcome an air leak improving the rate of air and fluid flow out of the patient.
When can the chest tube be clamped?
Clamping of the chest tube during transport or when the tube is accidentally disconnected is no longer advocated. They can also be clamped momentarily to change the drainage apparatus or to check for air leaks.
What are your nursing responsibilities?
Closely monitor the patient for complications associated with chest tube placement and drainage. Encourage coughing, deep breathing, incentive spirometer use, and range-of-motion exercise.
Nursing care and patient teaching can minimize the risk of atelectasis and shoulder stiffness.
Discuss how you would handle a leak in the system?
Know what type of leak there is, assess the leak, check pts vitals, assure leak is controlled and follow your hospital’s protocol
Discuss how you would handle it if the drainage system came unhooked from the chest tube?
If chest tube becomes disconnected, immediately reestablish the water-seal system and attach a new drainage system as soon as possible.
Discuss how you would handle it if the chest tube came out of the body? Instruct patient to remain calm, prepare patient for the procedure
Know the protocol for your certain hospital in what to do in an emergency [Show Less]