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nursing 212 2.3.1

oxygen uptake A

chest trauma is often sudden and is it traumatic yes
it occurs in __% of traumatic incidents 20%
what are serious pathological consequences hypoxia, hypovolemia, heart failure
mechanism of injury: blunt trauma- when does this occur; what are the types of forces involved; when body is struck by blunt object; deceleration, acceleration, shearing, compression;
contrecoup trauma- def; injury occurs in what 2 places; type of blunt traumacaused by impact ofbody parts against another object; on sideof impact and also on opposite side
Blunt trauma: what is the most common related injury; fractures to what 3 areas suggect massive force of injury rib fx; fx to sternum, first rib, scapula
penetrating injuries: cause; what are secondary injuries to this gunshot or stab wound; hemothorax, pneumothorax, cardiac tamponade, esophageal injury, tracheal tear, great vessel tear
penetrating injuries: resp s/s dyspnea, cough w/ or w/o hemotysis, cyanosis of mouth, mucous membranes, nail beds, decreased Bowel sounds on side injury;
penetrating injuries: CV s/s rapid thready pulse; decreased BP, narrowed pulse pressure, distended neck veins, chest pain, arrythmias
penetrating injuries: visable s/s bruising, abrasions, open chest wound, asymmetrical chest movement, subq emphysema
what is subq emphysema it is the crepitus one hears when palpating the chest
nursing tx for chest trauma: there should be a patent __; what should be administered; what should be accessed; what position in bed; why are there 2 large bore iv sites; airway; high flow O2; IV site; semi fowlers; pt may need lots of fluids;
pneumothorax: what are the 2 types; how does it occur; where does air accumulates; what is tx open or closed; from blunt or penetrating injury that disrupts the parietal or visceral pleura; in the pleural cavity; chest drain
pneumothorax: what are unilateral signs that this has occurred on one side of bod but not other; what will it sound like with percussion; WHAT does resonant mean; decreased movement and breath sounds on affected side, it will have resonant tone; strong and deep tone
lungs: what is the name of the lining of the lungs; what is the portion between the pleara termed; anything that gets in the potential space causes what; visceral and parietal pleura; potential space; irritation;
pneumothorax: things that cause air to get in from the outside; thins that cause air to get in from the inside; how is one confirmed; stabbing from knife, stick; rib fx; with chest xray
closed pneumothorax: is there an external wound; what is in the pleural space; what is the most common cause; other causes; no; air; rupture of small blebs on the visceral pleura; mechanical ventilation, insertion of CVC, perforation of esophagus, broken;
closed pneumothorax: the pain is worse with inspiration of expiration; are there breath sounds over the affected area; why is there pain inspiration; no; due to irritation of the parietal pleura
open pneumothorax: this is a sucking ___ wound; air enters the pleural space through what opening; what can we hear; what is the tx; chest; in the chest wall; air moving in and out of the wound; prevent more air from getting in;
open pneumothorax: dressing- how many sides are taped; when you inhale dressing prevents what; but when breathing out the dressing allows for what; allowing air to escape decreases possibility of what complication 3 sides; air cannot get in; air to get out; tension pneumothorax;
open pneumothorax: should we remove object in chest if it is still there; no;
closed pneumothorax: air leaks into the pleural space from an opening where; with in the lungs;
pneumothorax: degree of lung collapse- if the pneumothorax is less then __% the patient may need only what tx; if it is >___% what tx is needed; 20%, bed rest or limited physical activity; air may need to be evacuated from the plueral space by needle aspiration or insertion of chest tube to an underwater seal
needle aspiration is aka thoracentesis
what is the goal of chest tube therapy to remove the air in the pleural space in order to reestablish subatmospheric intrapleural pressure which will reexpand the affected lung
hemothorax: what is the cause; is it usually with open or closed pneumothorax; def; requires rapid what; why are there resp problems blunt or penetrating trauma; open; accumulation of blood in pleural space; decompression AND FLUID resuscitation; blood makes it difficult for pt to breath
hemothorax: s/s; why is there dullness to percussion; is person hypovolemic or hypervolemic; dyspnea, decreased LS, dullness to percussion; b/c not air but blood in pleural space; hypovolemic;
hemothorax: tx; chest tube, administer PRBC, may require surgical intervention;
tension pneumothorax: is it a complication of open or closed; it is rapid accumulation of air in ___; air can get in but it can't ___; there is increased pressure where; there is a decrease of ____ return; both; air in pleural space causes this; get out and lungs cont to collapse; on the heart and great vessels; venous return;
tension pneumothorax: decreased venous return leads to decreased ___; WHY there decreased CO; is this life threatening; why should pt be monitored in hosp after thoracic surgery CO; b/c vena cava is being smooshed; yes; b/c this could occur causing resp andsig cardiac issues
tension pneumothorax: as right side becomes more compromised trachea will deviate where; the deviation of the trachea is termed what; to the left; medial stinal shift;
tension pneumothorax: s/s; cyanosis, air hunger- panicky, violent agitation, tracheal deviation, subcutaneous emphysema; neck vein distension, hyperresonace to percussion;
subq emphysema is aka crepitus- when chest wall is palpated there is a crackly feeling
tension pneumothorax: why is there neck vein distension b/c vena cava is smooshed and blood cannot get to it;
tension pneumothorax: is this a surgical emergency; the area needs to be de____; what size needle; where should needle be inserted; what should be inserted after emergency yes; decompressed; 14 g; 2nd ICS mid clavicular line; chest tube
chest tubes: these remove the air and fluid from where; these do not remove fluid from where; they restore normal what; restoring intrapleural pressure allowslung to do what the pleural space; the lung; intrapleural pressure; expand
chest tubes: what are the 2 reasons to insert them; to remove air or fluid from pleural cavity;
chest tubes: removing air- should it be inserted anteriorly or posteriorly; what ICS; larger or small tube; why is it inserted higher; anteriorly; 2-3 ICS; smaller tube; bc air rises;
chest tubes: removal of fluid- what ICS is it inserted in; why is it inserted to low; 8-9 ICS: b/c fluid sits lower and settles
chest tubes: interventions- why is chest tube drainage system kept below the insertion site; why should pt not be clamped; we do not want it to go back into the lungs; clamping pt sets them up for pneumothorax;
chest tubes: what to do if chest tube is dislodged from drainage system; why is tube placed in sterile water place tube in sterile water until the system can be reeastablished; this creates and air seal
chest tubes: interventions- what should be measured I
chest tubes: complications- how often is the chest tube not positioned properly; what happens if there is reexpansion pulmonary edema; what are other complications; not often; there is too much fluid taken off too fast; vasovagal response, hypotension, infection, PNA, decreased shoulder mobility
chest tubes: removal- when is it removed; what is usually d/c for a period of time prior to removal; why is suction d/ced before removal; after removal what type of dressing should be used; once lungs reexpands and fluid no longer is draining; suction; to make sure pt can tolerate it; an airtight one-we do not want any air in or out now;
chest tubes: chest tubes to drain air are placed high or low; chest tubes to drain fluid are placed high or low; high; low;
chest tubes: drainage units- what are the 3 chambers; what are the 2 types; what is the one we usually use collection, water seal, suction control; water and dry suction; dry suction
chest tubes: water suction drainage- aka; what doesit use to control wall suction pressure pleurovac; water;
chest tubes: dry suction control- what controls wall suction; it adjusts to what; the automatic control valve; changes in air leaks and fluctuations in sx source;
chest tubes: hemlich valve- def; what does it let out but not in; opens when ___ pressure is > ____ pressure; closes when ___ pressure is > ___ pressure rubber one way valve, hooks to end of chest tube; air; internal pressure is > atmospheric pressure; when atmospheric pressure is > internal pressure
chest tubes: hemlich valve: whenare they used; emergency transport, with pneumothoraxkit, with small bore chest drain, in home care or LTC
chest wall injuries: give examples; rib fx, flail chest open pneumothorax;
Rib Fx: most common __ injury; what ribs most commonly fx; why are ribs 5-10 most commonly fx; what is the risk forsuperior fx; thoracic; 5-10; least protected by chest muscle; there could be vascular injury b/c there are big vessels located there;
Rib Fx: with fx of rib 7-12 what 2ndary injuries could occur; s/s of rib fx liver and spleen injuries; shallow resp, lots of localized pain, cretitus;
Rib Fx: tx- what to use to manage pain; why should narcs be used cautiously; why should taping not be done ; why should chest xray be done; analgesis, intercostal nerve block; they cancan resp depression and that would be compromise resp. even more; it becomes harder for good lung expansion; to rule out other injuries
flail chest: there are multiple what; the multiple fx produce a mobile fragment, this fragment moves how; how is there a fragment; rib fx; paradoxically with respiration; 2 or more adjacent ribs and all are blorken in many places so middle piece does opposite of what rest of ribs do.
flail chest: why is there decreased gas exchange; s/s; is there usually a pneumothorax with this b/c significant force is required for respiration; paradoxical movement of chest wall, resp distress, assoc hemothorax, pneumothorax; yes
flail chest: tx- what should be stabilized; why may pt be intubated; when sedated they can have what; the flail segment; b/c it hurts too much for pt to breath effectively themselves; all the pain meds they need;
cardiac tamponade: where does blood rapidly collect; when blood collects in the pericardial sac what is compressed; when heart is compressed what can it not do; does it take a lot or a little bit of blood for this to happen in the pericardial sac; the heart; pump effectively; only a little
cardiac tamponade: what are the 3 common distinguishing s/s; what 3 common s/s are termed ___; why are the distended neck veins; why are there muffled heart sounds; why is there hypotension distended neck veins, muffled heart sounds, hypotension; becks triad; heart cannot except blood; b/c fluid is all around it; b/c not much CO
chest tubes: how often is the chest tube mispositions; if too much fluid is taken off what can happen; what are other complications; not often; reexpansion pulmonary edema; vasovagal response, hypotension, infection, PNA, decreased shoulder mobility;
cardiac tamponade: what are tx options; pericardiocentesis, surgical repair, volume resuscitation
chest trauma: what is primary goal of tx; to provide oxygen to all organs;
reasons for intubation: list them upper airway obstruction, apnea, increased risk of aspiration, ineffective clearance of airway secretions, respiratory distress
intubation: why is oral preffered r/t easier insertion and can use larger tube thus decrease the work of breathing
intubation: nursing interventions- maintain correct __; how do you maintain proper cuff placement; how do you check cuff pressure; tube placement; low pressure cuffs prevent tracheal trauma from high pressure; using MOV-minimal occluding volume or MLT- minimal leak technique
when intubating, if tube is placed too far in- what main bronchi is it most likely to enter the right one
intubation: cuff- it has high or low volume; it was high or low pressure; why is there high volume and low pressure volume; pressure; to prevent tracheal trauma
thoracentesis: def; why is it done; how is the pt positioned; the insertion of a largebore needle through the chest wall into the pleural space; to obtain specimens, remove pleural fluid, instill medications; upright with elbows on a table and feet supported;
partial airway obstruction can be caused by what; s/s of airway obstruction laryngeal edema following extubation, aspiration of food, laryngeal or tracheal stenosis, CNS depression, allergic reactions; stridor, use of accessory muscles, suprasternal and intercostal retractions, wheezing, restlessness, tachycardia, cyanosisl
tracheostomy: def of tracheotomy; def tracheostomy; with this - it is best used for long or short term ventilation; what should always be taped to the wall; why should cuff be inflated with minimal volume of air a surgical incision into the trachea for the purpose of establishing an airway; is the stoma that results from the tracheotomy; long term; obturator; to decrease the pressure on the tracheal mucosa;
tracheostomy: trach pressure should not exceed what; why is it important not to cause too much pressure to the tracheal mucosa; 20 mm Hg; the increased pressure can cause necrosis b/c it blocks of blood supply;
tracheostomy: suctioning should not exceed what; suction time should be limited to how many seconds; 12- 150 mm hg of pressure; 10 sec;
tracheostomy: nursing dx for this; why should 100% humidified air be administered for these pt; ineffective airway clearance, ineffective therapeutic regimen maintainance, impaired verbal communication, risk for infection, impaired swallowing; due to fact that having trach blocks normal humidification from upper airway;
def blunt trauma; in blunt trauma what is more severe the external injury or the internal injury; def penetrating trauma; countercoup trauma def; when the body is struck by a blunt object; the internal; when a foreign body impales or passes through the body tissue; type of blunt trauma impact of body parts against another object- body parts moved back and forth against bony structures of body;
pneumothorax: closed- are there any external wounds; what is the most common cause; other causes; what happens on the visceral pleural space no; pt may have one spontaneously with out real cause; injury from vent, perforation of esophagus, injury to lungs from broken ribs, ruptured blebs from COPD; blebs rupture
pneumothorax: def; the air in the pleural space causes what to happen to the lung; with what injury should we expect this; air in the pleural space; partial or complete collapse of it; any blunt trauma to the chest wall;
pneumothorax: open- when does this happen; examples of this injury; penetrating chest wound is often aka; what type of dressing should cover this; should we remove the object when air enters the pleural space through an opening in the chest wall; gun shot wound, stab; sucking chest wound; a vented dressing; no
vented dressing: def; why is 4th side untapped; dressing the is secured on 3 sides with fourth side left untapped; this allows for air to escape from the vent and decreases the likelihood of tension pneumothorax developing;
pneumothorax: tension- def; this rapidly accumulating air causes what to increase; this increased pressure creates tension where; can an open or closed pneumothorax cause this this is one with rapid accumulation of air in the pleural space; intrapleural pressure; on the heart and great vessels; both;
pneumothorax: tension- where does the mediastinum shift; the shift of the mediastinum compresses the heart causing what; why is there decreased CO; why is this a medical emergency; to the unaffected side; decreased CO; due to the decreased venous return and compression of the vena cava or the aorta; bc both resp and circulatory systems are effected;
pneumothorax: tension- why does this pt die; what is tx inadequate CO or severe hypoxemia; insertion of a large bore needle into the chest wall to release trapped air;
hemothorax: def; commonly found with what type of pneumothorax; causes; accumulation of blood in the intrapleural space; an open one; chest trauma, lung maglinencies, complications of anticoagulant therapy, pulmonary embolism, tearing of pleural adhesions;
chylothorax: def; accumulation of lymphatic fluid in pleural space
what pneumothorax is associated with air hunger; tension pneumothorax;
tension pneumothorax: there is a continued increase in air shifting what; intrathoracic organs and increases intrathoracic pressure;
cardiac tamponade: what will heart sounds be; this prevents the heart from doing what; does BP increase or decrease; muffled distant heart sounds; pumping effectively; decrease
with flail chest pt could also have what else hemothorax, pneuomothorax
WHAT RIBS are most commonly fx; why are ribs 5-10 most commonly fx; ribs 5-10;b/c they are least protected by the chest muscle;
fx ribs: when is pain most common- inspiration or expiration'; why does atelectasis happen; why are opioids avoided; inspiration; pt is reluctant to take a deep breath; they can decrease resp
flail chest: during inspiration the flail segment moves in or out; it is apparent on what assessment; in; visual examination;
def empyema purulent pleural fluid associated with lung abscesses or pna
if disconnection accidently occurs what is main nursing priority to reconnect, establish immerse in sterile water
what is the most common complication of chest tubes malposition
chest tubes: what is tidaling/fluctuation; what happens if bubbling increases; air rise with inspiration and falling with expiration; may be an air leak;
Created by: jmkettel