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Air Leak Disorders
Pneumothorax, Volutrauma, Barotrauma
46
Nursing
Undergraduate 4
02/02/2010

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Cards

Term
What is an air leak disorder?
Definition
It is a condition that results in extraalveolar air in the pleural space?
Term
What is a Pneumothorax?
Definition
An accumulation of air in the pleural space
Term
What are the causes of an air leak disorder?
Definition
Disruption of parietal or visceral pleura casued by blunt trauma and rupture of alveoli caused by pulmonary diseases.
Term
What causes a spontaneous pneumothorax?
Definition
Caused by rupture of subpleural blebs. It may be a cyst of the lungs, it can rupture at any time.
Term
What is the most common cause of barotrauma/volutrauma?
Definition
Mechanical Ventilations
Term
What is Barotrauma?
Definition
Overdistension and rupture of alveoli due to increased pressure in alveoli
Term
What is volutrauma?
Definition
Overdistention and rupture of alveoli due to increased volume in alveoli.
Term
How do you treat a sucking chest wound?
Definition
Cover wound with occlusive dressing, taping only 3 sides to allow air to escape.
Term
What causes a pneumothorax?
Definition
Air enters the pleura space, affected lung becomes compressed and collapses causing V/Q mismatching and intrapleural shunting. This results in hypoxemia and resp. failure. the increased pressure in the chest can lead to shifting of the mediastinum and decreased CO.
Term
What causes barotrauma/volutrauma?
Definition
Air enters the interstitial space and travels to the mediastinum, pleural space, subq tissues, pericardium, peritoneum.
Term
___ can lead to cardiac tamponade.
Definition
Pneumopericardium
Term
__ in the mediastinum can lead to decreased venous return and upper airway obstruction.
Definition
Air
Term
A large pneumothorax leads to __ lung excursion on affected side, __ intercostal muscles, decreased or __ breath sounds over affected area.
Definition
Decreased, bulging, absent
Term
What does an ABG show on a patient with an pneumothorax?
Definition
Hypoxemia (Low O2) and Hypercapnia (High CO2)
Term
What does a chest x-ray show for pneumothorax?
Definition
increased translucency on affected side
Term
What can you assess to monitor for barotrauma/volutrauma?
Definition
Subq emphysema, evident by crepitus in the neck, upper chest and face. Substernal chest pain with position changes seen in pneumomediastinum. May hear friction rub over left side of chest with pneumopericardium.
Term
If pneuomthorax is greater than _% treatment to remove air from pleural space and reexpansion of the lung is required.
Definition
15%
Term
There are 4 ways that air is removed in the case of a pneumothorax, what are they?
Definition
Aspiration with a needle, percutaneous catheter with Heimlich valves, insertion of a thoracic vent, or insertion of a chest tube with underwater-seal suction drainage.
Term
Chest tubes are inserted and connected to underwater chest drainage systed with _cm water suction.
Definition
20cm
Term
Reexpansion of lung is confirmed with a __?
Definition
Chest X-ray
Term
What are the emergencies for pneumothorax?
Definition
Tension pneumothorax and Tension pneumopericardium
Term
What does a tension pneumthorax cause?
Definition
It causes shifting of mediastinum to the unaffected side and decreased venous return (Decreased CO).
Term
What are the s/s of a tension pneumothorax?
Definition
Diminished breath sounds, tachycardia, hyperresonance to percussion, and hypotension
Term
How is tension pneumothorax treated?
Definition
Give O2, insert large bore needle in the 2nd intercostal space at the midclavicular line on the affected side.
Term
What does tension pneumopericardium cause?
Definition
Pressure inside the pericardium causes compression of the heart and development of cardiac tamponade.
Term
What is the treatment for tension pneumopericardium, and who performs it?
Definition
pericardiocentesis, performed by the doctor
Term
What does the nursing assessment include for pneumothorax?
Definition
Inspection and palpation of the trachea for deviation, chest excursion, and skin for crepitus. Percussion: hyperresonance over affected area. Ausculation: absent/diminished breath sounds on affected side, friction rubs may be hear.
Term
What are 2 main nursing diagnoses for pneumothorax?
Definition
Impaired gas exchange r/t V/Q mismatching or intrapulmonary shunting and Ineffective breathing pattern r/t decreased lung expansion
Term
What nursing interventions or implemented for patients with pneumothorax?
Definition
Optimize oxygenation and ventilation, maintain chest tube system, provide comfort and emotional support, and monitor for complications.
Term
You are administering PRBC in the ICU, 15 minutes after the infusion has began the patient c/o of SOB and pain. What do you do?
Definition
Stop the infusion and give O2. You would do the same thing when administering IV fluids.
Term
What is the purpose of a chest tube?
Definition
To remove air/fluid from the pleural space and reinstate the negative intrapleural pressure and reexpand a collapsed lung.
Term
How is a chest tube inserted?
Definition
It is inserted by a physician under sterile technique in the ER, OR, or at the bedside in the ICU. Chest tube is inserted into the 4th or 5th ICS, midaxillary line on affected side and connected to a water seal drainage system
Term
How many chambers does a water-seal drainage system have and what are they?
Definition
3. Suction control Chamber, Water seal chamber, and the collection chamber.
Term
What does the suction control chamber do?
Definition
It is filled with sterile water to desired level and connected to suction. Steady, gentle bubbling occurs in this chamber.
Term
How much water do you add to the water seal chamber?
Definition
It is filled with 2cm of water, and acts as a one way valve
Term
What does the collection chamber do?
Definition
It collects fluid from the patient
Term
Which chamber is the only one that bubbles?
Definition
The suction control Chamber
Term
How does the water seal chamber work?
Definition
It fluctuates with respirations until the lung is fully reexpanded.
Term
What does bubbling in the water seal chamber indicate?
Definition
It indicates that there is an air leak in the system and needs to be located. All connections must be taped securely, an occlusive dressing is applied to the insertion site.
Term
Why is it important to always have sterile petroleum gauze, bottle of sterile water, and rubber-tipped clams at the beside.
Definition
If the tube becomes disconnected, the end of the tube needs to be placed in the sterile water. If tube comes out of patient the dressing must be applied to site.
Term
Where should the drainage system be kept at all times?
Definition
below the level of the patient's chest
Term
How often should you observe the dressing on a patient with a chest tube?
Definition
At least every 4 hours.
Term
How often should you encourage deep breathing for a patient with a chest tube?
Definition
every 2 hours, can use incentive spirometry
Term
What are some important nursing responsibilites for the patient with a chest tube?
Definition
Keep all tubing straight, no kinks; ensrue all connections are tight/taped, milk tubing as needed, adminster pain meds for discomfort, assess VS, O2 sat, resp and CV status, ausculate breath sounds q2h, monitor for crepitus, and monitor patency and integrity of drainage system
Term
What is done when transporting a patient with a chest tube?
Definition
Disconnect suction, keep system below chest level and upright. Keep rubber-tipped clamps with patient. If pt becomse dyspneic may have to clamp tubing.
Term
What is doen before and after removal of a chest tube?
Definition
Premedicate patient before procedure, explain procedure to client, doctor removes chest tube and occlusive dressing is applied to site. Monitor respiratory status.
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