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ati module
gas exchange and oxygenation
| Question | Answer |
|---|---|
| The respiratory system is composed of | the upper and lower airways. |
| The upper airway is divided into two areas: | the pharynx and the larynx. |
| the pharynx is | the cavity posterior to the nose and throat |
| the larynx is located | at the top of the trachea and is where the vocal cords are found |
| The lower airway includes | the trachea, bronchi, bronchioles, and alveoli of the lungs. |
| The lungs are primarily responsible for | gas exchange in the body |
| right and left lobes of the lungs are connected by | the bronchial tubes |
| the bronchial tubes give rise first to ____ then the ____ | bronchioles and then to the alveoli |
| the alveoli are | where the actual gas exchange takes place |
| the right lung has how many lobes | three |
| the left lung has how many lobes | two |
| the lungs are linked to the | nervous system |
| To enable the lungs to expand and contract smoothly.. | pleural fluid is produced in the space known as the pleural cavity. |
| The pleural cavity is located within a membrane known | as the pleura |
| the pleura | surrounds the lungs and is divided into the visceral and parietal pleural layers. |
| The processes of inhalation and exhalation are aided by | both the diaphragm and the intercostal muscles. |
| the muscle that separates the chest cavity from the abdominal cavity is the | The diaphragm |
| The diaphragm is controlled by | the autonomic nervous system |
| keeps the alveoli from collapsing during exhalation. | Surfactant |
| Surfactant | a lubricant made in the lungs |
| When there is a lack of surfactant in the lungs, the lung tissue collapses so that there is a loss of volume during expansion, this condition is called | atelactasis |
| Atelectasis is often due to the use of | general anesthesia or opioids * can lead to slow unproductive breathing that prevents the exchange of gases |
| The lungs enable gas exchange between the | cardiopulmonary system and the outside environment. |
| The large airways and bronchioles deliver gas to | the alveoli and the pulmonary capillaries thru diffusion |
| is the flow of air inside or outside of the alveoli. | Ventilation |
| is the flow of blood, driven by the cardiopulmonary system, into the alveolar capillaries where deoxygenated blood is exchanged for oxygenated blood in the heart and delivered to the rest of the body. | Perfusion |
| oxygenated blood is directed into | the capillaries |
| deoxygenated blood is returned to | the lungs. |
| monitors the body’s oxygen demand and carbon dioxide levels and signals the respiratory system to respond to excesses or under-supply. | The brainstem |
| is vital to every bodily function carried out in the cells and organs. | Oxygen |
| transport oxygen in their hemoglobin. | Red blood cells (erythrocytes) |
| is the point to which a lung can expand in response to increased pressure within the alveoli (interalveolar pressure) | Lung compliance |
| what diseases can either increase or decrease lung compliance? | Diseases such as emphysema, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and atelectasis |
| is the pressure or opposition of the tissues in the airway to the flow of air. | Airway resistance |
| The amount of air breathed in after a typical inspiration is the | inspiratory reserve volume |
| The amount of air expelled after a typical breath is the | expiratory reserve volume. |
| the amount of air inspired and expired with each breath is | the tidal volume |
| is the amount of air remaining in the alveoli after expiration | residual volume |
| is the amount of air that can be expelled from the lungs in 1 second during forced expiration. | forced vital capacity |
| The amount of air remaining in the lung after maximal inspiration is the | total lung capacity |
| The maximum amount of air that is expelled after maximal inspiration is the | vital capacity |
| The movement of deoxygenated blood from the heart to the lungs, where it is oxygenated once again through gas exchange and then disseminated back into the systemic circulation, is known as | pulmonary circulation. |
| Blood leaving the right ventricle of the heart | deoxygenated |
| the mitral and tricuspid valves permit blood to flow from the atria into the relaxed ventricles during what? | diastole |
| the mitral and tricuspid valves close and the aortic and pulmonic valves open during what | systole |
| the S1 heart sound can be heard during what | the systolic phase when the mitral and tricuspid close |
| Pressure in the ventricles decreases as they empty, the aortic and pulmonic valves close, and the second heart sound.. | S2 is heard |
| is a blowing or whooshing sound produced when backflow of blood through the valve occurs and can be noted in clients who have incompetent valves | A murmur |
| cardiac output is | the volume of blood pumped by the left ventricle in 1 minute * It is regulated by the heart rate (HR) and stroke volume |
| in a healthy resting adult, expected cardiac output ranges from | 4-6 L/min |
| stroke volume is | is the amount of blood that is ejected from the ventricles during a contraction, which occurs during systole. |
| Factors that affect stroke volume include | preload, afterload, and contractility |
| Preload ( end-diastolic volume) is | the amount of blood in the left ventricle at the end of diastole prior to the next contraction |
| The more the ventricle stretches with the end-diastolic volume.. | the stronger the contraction and the greater the stroke volume are. |
| Afterload is | the amount of resistance or force that the left ventricle must work against to eject blood |
| Afterload is proportional to the | the systemic blood pressure and has an inverse relationship to the stroke volume |
| Blood flow to the myocardium provides | oxygen and other nutrients to the heart. |
| if the myocardium has decreased contractility... | the preload and cardiac output will decrease. |
| Decreased contractility can occur as a result of | myocardial infarction. |
| Electrical conduction of the heart originates from the | sinoatrial (SA) node |
| sinoatrial (SA) node is also known as | the heart’s pacemaker |
| Optimal cardiopulmonary function is necessary to | sustain good health. |
| risk factors associated with developing impaired cardiopulmonary function are | modifiable which is why clients should be educated on healthy cardiopulmonary functioning and identify the risks such as diet, exercise, smoking and stress. |
| To help identify the client’s risk of developing impaired cardiopulmonary function, the nurse should | collect information about the client’s dietary intake. |
| what type of diets should be encouraged? | Diets rich in vegetables, fruits, fiber, whole grains, fish, and omega-3 fatty acids |
| what is DASH | a diet; Dietary Approaches to Stop Hypertension |
| what types of diets are encouraged to lower blood pressure | DASH and the Mediterranean diet |
| why is maintaining a healthy diet recommended? | to control associated risk factors that may increase the cardiopulmonary workload |
| what are the benefits of exercise | improving blood circulation throughout the body and strengthening the heart muscle. |
| exercising at least 30 mins to an hour a day can do what? | can lower the risk of cardiopulmonary disease directly by lowering blood pressure and cholesterol levels, and indirectly by achieving and maintaining a healthy weight. |
| nicotine causes what? | a decrease in blood flow by promoting vasoconstriction of blood vessels, which results in increases in both blood pressure and heart rate. |
| The vasoconstrictive effects of smoking does what to your body? | reduce the amount of oxygen in the blood, causing the heart to work harder to provide oxygen to the body |
| Individuals who smoke have a greater risk of developing .. | cancer ( in lungs, mouth, or the kidneys) |
| Smokers who quit decrease their risk of heart disease by | half for each year of not smoking compared to a person who smokes |
| stress does what to your body? | can raise blood pressure by triggering the fight-or-flight response (sympathetic nervous system), which causes cortisol to be released from the hypothalamus of the brain. |
| during stress, the increasing heart rate causes | the heart to pump oxygenated blood to appropriate reactionary bodily functions. |
| when dealing with clients who are stressed, the nurse should | assess the clients coping mechanisms and assist the client to identify healthy coping mechanisms such as meditation, exercise, and listening to music |
| what is an example of second hand smoke? | pollution generated by factories and vehicles which can increase clients risk of developing impaired cardiopulmonary function by damaging the lung tissue |
| what is an important part of the cardiopulmonary assessment. | The client’s history |
| what information should be collected as a part of a clients history for a cardiopulmonary assessment? | clients medical history, family history of cardiac or pulmonary disease, med history ( prescribed, over the counter, herbal) , social history ( alcohol and drug use, employment history, home history and any recent travel history) |
| A nurse’s assessment should begin with a general survey of the client, this includes? | client’s overall appearance, including level of consciousness, signs of distress, weight, breathing, and hygiene. The nurse should then obtain the client’s vital signs, including the oxygen saturation |
| Trends in the client’s weight should be evaluated, as these measurements can be indicative of | fluid gain or loss |
| Any excessive weight gain over a short span of time could indicate | heart failure |
| During the inspection portion of the physical exam, the nurse should note | the client’s breathing pattern |
| Normal breathing should be | regular and quiet, and no signs of discomfort should be evident. |
| During the inspection portion of the physical exam, the nurse should note | -any signs of difficulty breathing such as use of accessory muscles, restlessness, or cyanosis -look for signs of chronic pulmonary disease such as clubbing and edema. |
| Clubbing is | an enlargement of the fingertips that is often seen in clients with chronic pulmonary diseases such as COPD, cystic fibrosis, or lung cancer |
| The client’s jugular veins should be assessed for | distention |
| Assessment of the jugular veins can give the nurse information about the | pressure and blood volume in the right side of the heart. |
| A measurement of greater than 1.5 inches indicates abnormal distention and indicates | increased central venous pressure, which could be indicative of a cardiopulmonary condition |
| during the cardiopulmonary assessment, palpation should be used to assess which pulses | carotid and apical pulses simultaneously *Palpating these pulses simultaneously allows the nurse to assess and compare their regularity and timing, ensuring they have the correct rate. |
| after palpating the carotid and apical pulses , the nurse should then palpate .. | the thorax for tenderness, respiratory excursion, and tactile fremitus. |
| if there is tenderness upon palpation, it may be an indication of | an inflamed or dislocated costochondral joint (the area between the rib cage and the costal cartilage), pleural inflammation, or a rib fracture. |
| how should Respiratory excursion be assessed? | while standing behind the client and placing both hands to the side of the client’s back, with the thumbs approximately 2 inches apart at the 10th rib * should assess for expansion and symmetry while the client breathes |
| Tactile fremitus is | is a vibration felt in the chest wall during palpation while the client is speaking. |
| the vibration while palpating the tactile fremitus may.. | It may be decreased in clients with a condition that is causing an accumulation of fluid or air in the lungs, such as a pleural effusion or pneumothorax. |
| pleural effusion is | A buildup of fluid in the pleural space. |
| pneumothorax | Air in the pleural space causing the lung to completely or partially collapse. |
| The bilateral upper and lower extremities should be palpated for | for skin turgor, temperature, capillary refill, edema, and pulses. |
| Edema of the upper and lower extremities should be assessed on | a four-point scale. * When palpated, if the examiner’s finger leaves a slight imprint, a score of 1+ is given. A score of 4+ is given for a deep imprint left that slowly returns to usual. |
| capillary refill time (CRT) should be assessed in the | nailbeds of the fingers and toes. *no longer than 3 secs ( if it does that means impaired circulation or oxygenation.) |
| Pulses of the bilateral upper and lower extremities should be assessed for | rate and quality |
| during the cardiopulmonary assessment, Percussion is used to assess the | cardiac border and identify any abnormal accumulation of fluid in the lungs. |
| how do you know that the percussion is over the cardiac border? | the sound will turn from resonance to dullness |
| during the cardiopulmonary assessment, auscultation is used to assess | the heart and lungs |
| Bronchial sounds are heard over the | trachea and bronchi |
| vesicular sounds are heard over | lung tissue. |
| Crackles are caused by | are caused by fluid filling the air sacs; they sound like popping and crackling. *Clients with pneumonia or an infection may have crackles. |
| Wheezing is | is a whistling or a musical noise that is heard on exhalation. It is caused by constricted airways. *clients with asthma and COPD. |
| Rhonchi sound like | sound like rattling and are caused by obstruction of the airway. *clients with asthma and COPD. |
| Stridor sounds much like | like wheezing but is caused constriction in the upper airways and is heard on inhalation * IT IS A MEDICAL EMERGENCY |
| Stridor is caused by | by an inflammation of the epiglottis (epiglottitis) or by croup, a viral infection. |
| S1 heart sound is | lub |
| S2 heart sound is | dub |
| S3 gallop is | is often benign in children but in adults can indicate heart failure * sounds like kentucky |
| S4 gallop can be indicative of | of aortic stenosis, hypertension, or a history of myocardial infarction. * sounds like tennessee |
| murmurs can be described as | as a whooshing or blowing sound and can be low, medium, or high pitched. *If murmurs are present, the nurse should assess and document their location, quality, intensity, and pitch. |
| Hypoxemia occurs | when there is a decreased amount of oxygen in the blood and can lead to hypoxia |
| Manifestations of hypoxemia and hypoxia include | confusion, irritability, and restlessness. |
| intercostal retractions occurs when | the muscles are pulled inward between the intercostal spaces during inhalation. These retractions occur when the pressure inside the chest is reduced and can indicate an airway blockage * medical emergency |
| hypoxia is | Below the expected level of oxygen in body tissue. |
| hypoxemia | Low amount of oxygen in the blood. |
| Factors Affecting Oxygenation and Function of the Respiratory System | hyperventilation, hypoventilation, and hypoxia. |
| Hyperventilation is | is an increase in the rate and depth of breathing. |
| During hyperventilation, an increased amount of carbon dioxide is exhaled, leading to | lower than expected levels of carbon dioxide in the blood. * can cause alkalosis to develop |
| Alkalosis may cause | weakness, dizziness, headache, anxiety, increased heart rate, tingling in fingers and difficulty breathing. |
| Causes of hyperventilation include | Anxiety attacks Infections such as pneumonia Lung disease such as COPD and asthma Diabetic ketoacidosis Brain injury |
| Hypoventilation is | is shallow breathing with a lower than expected respiratory rate. It leads to too much CO2 in the blood and not enough oxygen * results in acidosis |
| with hypoventilation, clients may experience | anxiety, dyspnea with exertion, confusion, disturbed sleep patterns, weakness, and an impaired cough. |
| Causes of hypoventilation include: | Neuromuscular disorders such as muscular dystrophy and Guillain-Barré syndrome Medications such as barbiturates, narcotics, and benzodiazepines Neurologic disorders Trauma |
| Causes of hypoxia may include | a low number of red blood cells to carry oxygen; decreased diffusion, which can be caused by COPD and pneumonia; poor tissue perfusion; and decreased ventilation. - smoke inhaling, meds that decrease RR and anemia |
| Clients with hypoxia should be given | supplemental oxygenation, and their oxygen levels should be monitored closely. |
| rhythm disturbances are attributable to factors such as | hypoxia, drugs or toxins (e.g., caffeine or alcohol), hormone imbalances (e.g., hypothyroidism and hyperthyroidism), or electrolyte imbalances (e.g., low potassium or magnesium level). |
| Examples of contractility disorders include | heart failure, valvular diseases, and arrhythmias |
| examples of perfusion disorders include | hypertension, myocardial infarction, and CAD. |
| Bradycardia is | is defined as a heart rate less than 60 beats per minute. Bradycardia may occur in adults, especially those who are athletic, and is considered normal as long as the client is asymptomatic. |
| bradycardia complications | lightheadedness, fatigue, chest pain, confusion, fainting (syncope), shortness of breath, and tiring easily with physical activity |
| during bradycardia, | the heart is unable to pump effectively, so the tissues of the body does not receive oxygen-rich blood. |
| Treatment for bradycardia depends on the | cause of the arrhythmia and whether the client is asymptomatic. |
| Tachycardia is | defined as a heart rate of 100 beats per minute or greater |
| During tachycardia, | the heart beats faster than expected and may not be able to pump enough blood to the organs and tissues of the body. |
| tachycardia complications | lightheadedness, fatigue, chest pain, heart palpitations, syncope, and shortness of breath |
| The goal when treating tachycardia is to | identify the cause of the rapid heart rate and return it to a normal sinus rhythm. |
| Atrial fibrillation | is a rapid, irregular heartbeat that starts in the atria; it is triggered by signals coming from outside of the SA node. |
| what happens to the the atria as a result of the signals from outside of the SA node | the AV node becomes overwhelmed, and the atria do not contract but instead quiver. This causes blood clots to form due to blood pooling in the atria *Clients may be asymptomatic, or they experience vague chest discomfort and palpitations. |
| Ventricular dysrhythmias occur when | electrical impulses begin in the ventricle. |
| Ventricular tachycardia is | an arrhythmia that is caused by electrical signals coming from the ventricles. *The heart chambers are unable to fill with blood, which results in blood not being pumped to the lungs and the body |
| symptoms of Ventricular tachycardia | Clients may have chest pain, dizziness, or shortness of breath. Clients may also have ventricular tachycardia with or without a pulse. |
| what conditions affect the mechanical function of the heart and lead to decreased cardiac output and altered tissue perfusion | heart failure, valvular disease, and myocardial ischemia and infarction. |
| Heart failure is | is the inability of the heart muscle to provide adequate cardiac output, which leaves body tissues deprived of oxygen. * can be on either side of the heart or both |
| Left-sided heart failure alters | alters the heart’s ability to pump blood to the rest of the body, which eventually causes blood to back up in the pulmonary veins instead of being carried away from them |
| Manifestations of left-sided heart failure include | hypoxia, crackles in the lungs, and shortness of breath. |
| what happens with right-sided heart failure | the heart is unable to effectively pump blood to the lungs, so that the blood begins to back up into the systemic veins * results in edema ( in genitals, organs or abdomen |
| Damage to any of the heart valves can cause | the valves to not open fully or to remain closed. Missing leaflets may also develop. *The aortic valve is most commonly affected by disease. |
| regurgitation is | Leaking heart valves that do not close (CDC). * |
| Regurgitation leads to | leads to backflow of blood and failure of blood to move forward. Backflow from the ventricles into the atria often can be auscultated as a murmur. |
| Stenosis occurs when | a heart valve becomes narrow and stiff, which prevents blood from moving forward. Prolonged stenosis causes the ventricles to work harder to push blood forward. * ventricle becomes large ( hypertrophy) leading to failure |
| hypoperfusion is | Impaired tissue perfusion * often occurs in the presence of hypotension |
| If impaired tissue perfusion lasts long enough, multiple systems in the body can be damaged due to | the lack of blood flow. |
| Three factors contribute to tissue perfusion: | preload, contractility, and afterload. *Any disruption of one or more of these factors can decrease cardiac output and lead to hypotension and impaired tissue perfusion. |
| Manifestations of impaired tissue perfusion can affect | the heart, brain, and kidneys. |
| Manifestations of impaired tissue perfusion | chest pain, syncope, arrhythmias, changes in level of consciousness, decreased urine output, and lactic acidosis. |
| myocardial ischemia is caused by | this condition is caused by a complete or partial blockage of the coronary arteries |
| with myocardial ischemia, Clients may experience manifestations that include | angina, neck or jaw pain, fatigue, nausea, vomiting, tachycardia, arm or shoulder pain, or sweating. |
| If untreated, myocardial ischemia can lead to a | myocardial infarction. |
| Angina pectoris is caused by | by a reduction in blood flow to the heart, which then creates chest pain and/or discomfort because the supply of oxygen is insufficient to allow the heart to function adequately |
| manifestations for Angina pectoris, experienced by clients | tightness, squeezing, and heaviness in the chest; burning; fullness; or pressure, pain that radiates to the arms, neck area, jaw, shoulder, or back. Sweating (diaphoresis), dizziness, fatigue, shortness of breath, and nausea * up to 5 mins |
| Treatment for angina pectoris includes | rest, nitroglycerin, aspirin, or drugs to prevent the formation of clots. |
| Manifestations for myocardial infarction include | irregular heart rate, diaphoresis, anxiety, lightheadedness, and chest pain with radiation. |
| Acute oxygen toxicity affects | the central nervous system (CNS). lead to nausea, generalized convulsions, dysphoria, and tinnitus (ringing in the ears). Aggravating factors include stress, cold, and increased carbon dioxide in the blood. |
| chronic oxygen toxicity affects | the pulmonary system *atelectasis, coughing, dyspnea, pleuritic chest pain, and heaviness substernally * if o2 is discontinued, symptoms lessen within 4 hrs |
| obstructive sleep apnea | partial or complete closure of the upper airway occurs during sleep. |
| manifestations of obstructive sleep apnea ( osa ) | include a morning headache, extreme daytime drowsiness, loud snoring, and restlessness. |
| therapeutic interventions to prevent cardiopulmonary complications are | Sputum Specimen Collection Chest Physiotherapy Incentive Spirometer Purse-Lipped Breathing Flutter Valve |
| when should a sputum sample be collected | preferably in the morning before eating or drinking, or when the client is able to produce a sample |
| A sputum sample assists in the diagnosis and treatment of | infectious pulmonary disease |
| to collect a sputum sample, the client must | take deep breaths to loosen the secretions and force a deep cough, 1-2 t of mucus should be in the cup * for clients with thick secretions or difficulty producing it, nurses can perform cpt ; if not then suctioning might be an option |
| Chest physiotherapy (CPT) consists of | percussion of the chest, vibration, and postural drainage |
| Chest physiotherapy (CPT) enhances what? and for what type of clients? | enhances the clearance of secretions from the lungs the use of mechanical devices . * benefital for copd, , cystic fibrosis, or pneumonia, and for other clients who are unable to expectorate thick, copious secretions |
| CPT sessions usually last | between 20 and 30 minutes, and are performed up to four times a day. |
| During postural drainage ( cpt) , the client should be positioned | the client should be positioned supine first, then prone with the left side up at 45°, then prone with the right side up at 45°, and finally back to supine. |
| To perform percussion ( cpt ) | the caregiver’s hand should be cupped, with the fingers and thumb together, and the caregiver should use a clapping motion to the back. * a hollow sound should be heard |
| percussion should not be done where ( cpt ) | ver the ribs, the sides of the chest, or the lower back. The breastbone, lower back, and spine should be avoided to prevent damage to the internal organs |
| documentation for cpt clients includes | Vital signs; characteristics, color, and amount of sputum; and any complications should be recorded and monitored 02 and suction may be required before and after, meds prescribed for the procedure needs to be administered and documented. |
| The client and family of cpt clients should be educated on | the purpose and steps of the procedure, medications to be administered, humidification, hydration, and manifestations of infection |
| An incentive spirometer (IS) is | used by clients to promote deep breathing. |
| The IS serves as a method of | bronchial hygiene therapy, which increases lung function by improving inspiratory volume and transpulmonary pressure. |
| The use of an IS decreases the risk of | of atelectasis by mobilizing secretions from the lungs and promoting lung expansion |
| When using the IS, clients should understand that the device is to be used | 10 repetitions per hour with each breath held for 3 to 5 seconds |
| Purse-lipped breathing is a | a technique to help with breathlessness. by relaxing the neck and shoulders. The client takes a deep breath, inhaling through the nostrils slowly, and then exhaling slowly through the mouth with pursed lips |
| Purse-lipped breathing can release | release air trapped in the lungs by keeping the airway open for easier breathing. It can also slow the rate of breathing through prolonged expiration and move air out of the lungs so that air can enter, thereby improving the breathing pattern. |
| A flutter valve is | a device that is used as breathing therapy. It makes breathing more comfortable and makes it easier to clear mucus in the lungs |
| The steps to use the flutter valve are as follows: | - client in clair w elbows resting on table; head is held upwards slightly; tight seal made around mouthpiece and inhale air w deep breath; exhales for at least 3-4 secs ( repeated 10 x) ; cough up to 3 times to remove secretions |
| Suctioning helps | clear the airway and can prevent respiratory infections and other respiratory complications. |
| Suctioning can be performed through | the mouth (oropharyngeal), nose (nasopharyngeal), tracheostomy, or endotracheal tube (ETT) |
| mouth (oropharyngeal) suctioning | entails clearing secretions or foreign substances from the mouth and pharynx by intermittent suctioning. This clears the upper airway and keeps it patent. |
| mouth (oropharyngeal) suctioning is performed | for clients who have a nonproductive cough (i.e., are unable to clear oral secretions) and for clients who have an artificial airway |
| how is mouth (oropharyngeal) suctioning performed? | The catheter is simultaneously pulled back and rotated throughout the oropharyngeal area for 10 to 15 seconds. |
| Nasopharyngeal suctioning is performed for clients | is performed for clients who are unable to cough or blow their nose to clear secretions |
| A tracheostomy tube is | is a long-term airway management device that is inserted into the trachea through a surgical opening in the front of the neck below the vocal cords. |
| what technique is used for open system suctioning | sterile technique |
| what technique is used for closed system suctioning | aspectic technique |
| before the catheter is placed inside the tracheostomy tube, the client is | hyperoxygenated * they should be hyperoxygenated again afterwards and be able to rest before starting again |
| care of the tracheostomy is important to | prevent the buildup of secretions in the cannula that could obstruct the client’s airway, to avoid skin breakdown at the site of the stoma, and to avert the accumulation of bacteria on the inner surface of the cannula. |
| how often is tracheostomy care | every 4 to 8 hours or as needed |
| A chest tube is | a tube that is inserted into the pleural or mediastinal space of the thorax of a client to allow for drainage of blood, fluid, or air. |
| The goal of chest tube insertion is to | facilitate lung expansion and to restore normal intrapleural pressure |
| following the insertion, the chest tube is connected to three chambers which are ... | 1- collection chamber( where drainage is collected) 2- water seal chamber * sterile water * ( allows air to leave during exhalation and prevents it from entering during inhalation 3- suction chamber ( can be wet or dry ) |
| An absence of tidaling in the chamber indicates that | normal intrapleural pressure has been reached and that the chest tube may be ready for removal. |
| If the water in the chamber begins continuously bubbling then | an air leak may be present |
| When caring for clients with a chest drainage system, the nurses needs to.. | assess vitals, breath sounds, O2, respiratory effort |
| Nurses should ensure that the drainage system is always positioned where | below the client’s chest and that the drainage tubing is not kinked or occluded. |
| When caring for clients with a chest drainage system, the nurses needs to assess and document what? | amount, color and consistency of drainage frequently insertion site should be assessed for redness, swelling, pain and signs of subcutaneous emphysema |
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saharmahmoud