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Lindsey Jones 3A5

Lindsey Jones 3A5 Therapeutics: Humidity&Aerosol Therapy B)Chest tubes&Drainage

QuestionAnswer
What are 2 types of therapeutic aids to ventilation? 1. Humidity and Aerosol therapy and 2. Chest tubes and drainage systems.
What is Humidity therapy? Non particle-size water that is distriuted uniformly in the air.
What happens to normal humidity when environment differs? Enviornments differ in their normal humidity (20%, 50%, 70% etc.) but the body always needs 100% humidity.
What is Humidity deficit? It is the amount of water (humidity) the body needs to makeup from ambient air in order to achieve 100%. It is expressed as mmgH20/L of gas. The body needs 44 mg H20/L of gas.
When does devices intended to help humidity deficit work better? 1. Temperature is increased. 2. Surface area of the water is increased. 3. Pressure in the system is decreased.
What is the problem with humidity devices? It can be a source of contamination.
What is areosol therapy/ the aerosol particles? aerosol particles are larger particles, can often been seen visually. May be made of water, liquid medication, or dry powder-type medication.
What does an aerosol therapy cause to the patient? Aerosols are not natural to the airways and may cause irritation, bronchospasm.
What are the optimal particle sizes in aerosol therapy? Large airways -particles >5 microns.Middle&small airways is 3-5 microns. Alveoli-particle s >0.5 microns & < 3 microns.
What happens when there is a particle deposition in an aerosol therpay? The higher the flow rate, the higher up the resp. tract the deposition will occur.The Inspiratory hold will increase particle deposition
What are the general goals of aerosol therpay? goals: delivered medications- Bronchodilators, Mucolytics (secretions thining agents), Provides mucosa hydration & delivered antibiotic medications.
What are the complications and hazards of Aerosol therapy? 1. Fluid overload (monitor input/output) 2. Bronchospasm 3. Contamination 4. Ultrasonic Nebulizers should not be used to for medications 5. Dizziness may result if a pt. over-ventilates -Have pt. slow down &Use normal breathing pattern
How do we monitor an aerosol output? 1.If no output - check medications, fluid level, device for proper function - Commonly need to increase the flow 2. If aerosol doesn't disappear during an inhalation, instruct pt. to breath thru mouth - Not thru Nose
What are the indiccations for a chest-tube insertion? Pneumothorax -Air &Hemothorax -Fluid &Air in pleural space causing lung collapse.If > 20% of lung need a chest tube(CT) based on X-ray &BS.Pleural Effusion -Excess Fluid causes Lung Spaceloss treat by inserting needle in space to relievepressure;insert CT
What is a chest tube insertion procedure? 1.Pneumothorax -Tube placed in upper chest, 2nd interspace, midclavicular line. 2.Hemothorax/Pleural effusion tube placed b/w 4th &5th interspace, midaxillary line.
What conditions must exists when removing/discontinuing a chest tube? Tube must be clamped for 24hrs. In that 24hrs they must not be :1. Any sign of Resp. distress 2. Any evidence of Pnuemothorax/Hemothorax as indicated by X-ray. 3. If these exists, unclamped the chest tube &Resume chest drainage.
Whati s a chest tube removal procedure? 1. Pull the Tube during a Valsalva Manuever after complete exhalation 2. The side should be covered with petroleum based Jelly &Sterile gauze. 3. Pulse X-ray should be taken
What are the type of chest drainage system? They consist of a single/Series of glass bottles/ Jugs. It is helpful for Visualization purpose, to consider the older type of system in order to increase/understanding on how these systems functions.
What are the functions of a chest drainage system? 1. Collection of fluids. 2. Control suction 3. Allow 1-way movement of gases &Fluids(out of lung, not back in). This is called a Water seal.
What are the types of chest drainage systems? The 3 bottle systems (1-bottle, 2-bottle, 3-bottle).
What is the 3 bottle system? From pt. a tube E enters a collection bottle. Fluid drops to bottom &gas is pulled in other tube. TubeD enters water seal bottle gases are drawn thru a tube. i.e Submerged under H2O(Gentle bubbling is seen). TubeC enters suction control bottle no bubbling
What is the disposable system ? Used in 3 bottle system. 1.Suction Control 2.Water Seal 3.Collection bottle. When Collection chamber is full replace whole unit. 1-2cm H2O should be placed in Water seal bottle. 15-20cm H2O should be placed in suction control bottle
What are the potential problems while there is a low return volume in a mech. Vent found during monitioring a chest drainage system? low return volume in a mech. Vent - It means lost volume thru the lung & the Chest Tube. 1. Adjust VT to maintain desired ABG values. 2.Hole in the Lung may need surgical repair.
What are the potential problems when there is no bubbling in the suction control bottle found during monitioring a chest drainage system? Increase vaccum pressure @ the Wall source until bubbling occurs.
What are the potential problems when excessive bubbling in the suction control bottle found during monitioring a chest drainage system? Decrease until only gentle bubbling is present.
What are the potential problems when excessive/continous bubbling found during monitioring a chest drainage system? 1. Indicates a leak b/w pt.&water-seal bottle. 2. If all connections are secure-begin unclamping tube E where the tube exists the pt. If bubbling stops then leak is inside the pt.& surgery is needed.
If bubbling continues what is to be done? If bubbling continues move clamp b/w pt & collection tube. If bubbling stops-replace tube.If bubbling continues move clamp to tubing b/w collection & water-seal bottle. If bubbling stops-replace tubing. Bubbling should stop if not, replace external system
What are the potential problems when nothing developing in the collection bottle - lung is not re-inflating found during monitioring a chest drainage system? 1. Ensure there is suction coming from the wall. 2. Ensure bottle system is below insertion site of chest tube. *sometimes systems use gravity alone. There is no vaccum. These systems work fine. Vaccum only assist evacuation.
What are the potential problems No bubbling in the water-seal bottle found during monitioring a chest drainage system? Suction is not enough -not enough water in the suction control bottle.
What are the potential problemscollection bottle is developing fluid quickly @ >100 ml/hr found during monitioring a chest drainage system? 1. Pt. may be hemorrhaging. 2. Evaluate: Hb, Bp, vitals and all data associated w/blood loss.
What should be done if a glass bottle breaks during monitioring a chest drainage system? If glass bottle breaks then submerge chest tube into water from any container.
Created by: johnfaar