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chest trauma

QuestionAnswer
Describe what happens in blunt trauma to chest? when the chest strike or is struck by an object the impact can cause deceleration, acceleration, shearing and compression of thoracic structures. The external injury may appear minor but but internally the organs may have severe injuries
Describe a penetrating trauma to the chest It is an open injury in which a foreign body impales or passes through the body tissues, creating an open wound. Severity depends on location and if an organ is struck
What is a pneumothorax? Air entering the pleural cavity positive pressure in lung cavity causes the lung to collapse it can be open or closed
Describe an open pneumothorax Air enters through an opening in the chest wall/ parietal outer lining.
Describe a closed pneumothorax The visceral inner lining of the pleural cavity is disrupted . Air enters the pleural space from the lung. There is NO external wound
What diagnostic test is used to diagnose a pneumothorax and what are the results if there is one? A chest Xray is used and the results show air/fluid in the pleural space and reduction in the lung volume
Clinical manifestations of a pneumothorax mild tachypnea dyspnea severe respiratory depression chest pain cough hemoptysis tachycardia Absent breath sounds over affected area.
What is a spontaneous pneumothorax? It occurs due to the rupture of small blebs ( air filled blisters) located on the apex of the lung.
what is PRIMARY spontaneous pneumothorax When blebs occur in healthy young individuals
What is SECONDARY spontaneous pneumothorax Bleb occur as a result of lung disease like COPD, asthma, cystic fibrosis and pneumonia
What habit increases the risk for bleb formation? smoking
Other risk factors for bleb formation being tall thin being male family hx previous spontaneous pneumothorax
What is a iatrogenic pneumothorax? Laceration or puncture of the lung during medical procedure
What type of pneumothorax is a spontaneous pneumothorax? A closed pneumothorax
What is traumatic penetrating chest wound referred to as ? It is refereed to as a sucking chest wound since air enters the pleural space through the chest wall during inspiration.
What kind of dressing is used on a sucking chest wound? A vent dressing( an occlusive dressing that is secured on 3 sides)
What do you do for a if a person has an impaled object in them DO NOT REMOVE THE OBJECT stabalize with a bulky dressing
what can happen to the lung after a rib fracture It can lacerate the lung and cause air frm lung to enter the laeural space
What is a tension pneumothorax? It is when air enters the pleural space and cannot escape the mediasternum shifts, there is compression of the good lung and pressure on the heart and great vessels which leads to decrease venous return and decreased CO
Clinical manifestations of a tension pneumothorax are? Dyspnea, increased HR, trachea deviation, absent breath sounds on affected side, JVD, cyanosis, diaphoresis, anxiety
Treatment for a tension pnuemothorax needle decompression, chest tube insertion
Is a tension pneumothorax a medical emergency? YES it is they have low CO they can die
What is a hemothorax? It is the accumulation of blood in the pleural space secondary to injury to the chest wall
Treatment for a hemothorax? Chest tube insertion,' reinfusion of collected blood
What is a hemopneumothorax? blood and air in the pleural space
Collaborative care for pnuemothorax depends on severity may resolve spontaneously thoracentesis ( sucking liquid out with syringe) chest tube pleurodesis/ plurectomy (surgeries) needle compression ( for tension pneumothorax followed by a chest tube) Medical emergency
What is the most definitive and common treatment for a pneumothorax and a hemothorax? A chest tube connected to water seal drainage
What is the purpose of chest tubes? Remove air and fluid reestablishes negative pressure they are usually 20 inches long and between 12-40 french the size of french determined by patient condition
What are the steps and material needed for a chest tube insertion? Head of bed 30-60 degrees Patient is positioned with arm raised above head on affected side Aseptic technique sutured occlusive dressing confirm placement with chest xray pain control
What are the parts of the water suction plural drainage system? 1. Collection chamber 2. water seal chamber 3. suction control chamber
What is the purpose of the collection chamber? the collection chamber receives fluid and air from the pleural or mediastinal space
What is the purpose of the water seal chamber it contains 2cm of water that acts as a one way valve Air from pleural space and collection chamber can escape but it prevented from back flowing to patient
what is normal fluctuation of water within the water seal called? tidaling
Increased bubbling in the water seal chamber could indicate what? that there is an air leak
What is the purpose of the water suction control chamber? the water suction control chamber uses a column of water with the top end vented to the atmosphere to control the amount of suction from the wall regulator. The chamber is typically filled with 20cm of water. Gentle bubbling okay in this area
Is gentle bubbling okay in the water suction control chamber? YES
How does the dry suciton control chamber work? There is no water A dial is used to chose the desired negative pressure
What are the steps in chest tube nursing management Prepare drainage unit, maintain patency, observe for tidaling in water seal chamber, Assess patient clinical status, ( check VS, BS), check drainage site for infection or subQ emphysema
Should we milk or strip the tubing on the pleural drainage system? NO also don't kink or clamp tubing becseu that creates positive pressure.
Where should the chest tube drainage system be placed in relation to the chest? It should be placed below the chest. NEVER elevate above chest
what amount of drainage per hour needs to be reported to the doctor? 100ml/hour
When the collection chamber is is full what should we do? Change the whole unit. DO NOT TRY TO EMPTY IT
What can happen to a patient that has 1-1.5 Liters of pleural fluid removed rapidly? Reexpanion pulmonary edema or a vasovagal response with symptomatic hypotension
What is subcutaneous emphysema? Air leaking into tissue around chest tube insertion site . A crackling sensation is felt when palpating skin (crack snapple pop)
When subcutaneous emphysema occurs in a large amount what can occur drastic swelling of neck /head which leads to an airway compromise
Infection is a complication of chest tubes how can this be prevented? sterile technique with dressing changes, follow protocol , and use of an occlusive dressing with date and time
Chest tube emergent care What do you do if the chest tube drainage is overturned and the water seal is disrupted? return it to an upright position, have patient take a few deep breaths followed by a forced exhale and cough
What do you do if the chest tube is disconnected? Immerse in 2cm of sterile water until the system is established. Keep a cup taped to the wall.
When is a chest tube removed? when the lungs are reexpanded and there is no drainage or minimal drainage
steps to take before a chest tube is removed the suction is discontinues and chest drain is on water seal for 24hours, Premedicate the patient with pain meds, Valsalva maneuver during removal, apply occlusive dressing, A chest x ray and monitor for resp. distress
why is an xray done after the chest tube removal to observe for a pneumothorax or reaccumulation of fluid.
The ribs that get broken the most are ribs 5-9
What can be damaged by fractures ribs? the lungs and pleura
Clinical manifestations of a rib fracture? pain, splinting, shallow respirations, ,Atelectasis, pneumonia
Treatment for a rib fracture DO NOT Strap or bind the chest, NSAIDS, opiods, nerveblockers, deep breaths, cough, Incentive spirometer
why don't you strap and bind broken ribs? because it limits chest expansion
What is a flail chest? it results from the fracture of several consecutive ribs, in two or more separate places, causing an unstable segment
what are the clinical manifestations of a flail chest paradoxic movement during breathing,Inspiration the affected portion is sucked in,Expiration: the affected portion bulges out, Inadequate ventilation on affected side,increased WOB,Apparent in visual exam,rapid shallow breathing, increased HR, crepitus
Diagnostic tests for flail chest YOU SEE IT, palpation of abnormal respiratory movements, evaluation of crepitus near the rib fractures, chest X-ray, ABGs
Treatment for flail chest Airway management, adequate ventilation, supplemental O2, careful administration of IV fluids, pain control, surgical intervention
symptoms of respiratory distress in chest trauma dyspnea, cough, cyanosis, tracheal deviation, decreased BS, decreased O2 sat, bloody sputum/secretions
Symptoms of cardiovascular compromise in chest trauma rapid thready pulse, decreased BP, JVD, muffled heart sounds, chest pain, dysrhythmias,
Emergency nursing interventions for chest trauma Patent airway, SpO2 more thatn 90, IV access, remove clothing to access injury, stabilize impaled objects, semi fowlers, needle decompression,Assess: VS, cardiac rhythm, Urine output,
Abdominal trauma What happens when a solid organ is damaged? profuse bleeding
Abdominal trauma: what happens when a hollow organ is damaged? contents spill into the peritoneal cavity ( peritonitis)
clinical manifestations of abdonail trauma? pain, guarding, splinting, decreased bowel sounds, bowel sound in chest, rigid hard abdomen, hematemesis, ( decreased RR and decreased CO indicate abdomen compartment syndrome), grey turners sign, cullens sign
What is Grey Turner's sign bruising on the flanks
What is Cullen's sign Blue bruising around belly button
Diagnostic tests for abdominal trauma cat scan, x-ray, peritoneal lavage ( less than 10ml negative more than 10 ml positive), prepare for emergency surgery
nursing management for abdominal trauma? patent airway, NG tube, fluids, foley, NO PAIN MEDS until diagnosis confirmed, prepare for emergency surgery, prevent shock and sepsis, DO NO REMOVE IMPALED OBJECT
Charateristics of pelvic trauma easily missed, associated with high mortality rate
Clinical manifestation of pelvic trauma swelling, tenderness, ecchymosis, deformity, unusual movement.
treatment for Pelvic trauma Assesss, neurovascular assessment, special mattress, minimize complications ( DVT, PE, sepsis), urinary and bowel function
Interventions for limb trauma Assess neurovascular _ 6Ps, Immobilize, treat compartment syndrome with fasciotomy.
Created by: Rbailey16