COPD
Asthma
Chest Tubes
Pneumothorax
thorocentisis
100
how long must someone have symptoms for it to be considered chronic for COPD?
symptoms lasting greater than 3 months for 2 consecutive years
100
what should patients do after inhalation of the inhaler? why?
rinse mouth ; lesions
100
A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system?
- A. Intermittent bubbling may be noted in the water seal chamber.
- B. 200 cc of drainage per hour is expected during recovery of a pneumothorax.
- C. The chest tube is positioned at the patient's chest level to facilitate drainage.
- D. All of these options are appropriate findings.
The answer is A. It is normal to find intermittent (NOT CONTINUOUS) bubbling in the water seal chamber if the patient is recovery from a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall....therefore air will escape into the water seal chamber causing intermittent bubbles.
100
what is plueral effusion and list the three types of pneumothorax
- Hemothorax: blood enters in the pleural space and causes lung to collapse (trauma to the chest, disease TB, blood clotting issue)
- simple - air enters through rupture/breach of plural space
- tension - trapped air with inspiration, With a tension pneumothorax, you will quickly see hypotension, tachycardia, and dyspnea as the mediastinum shifts from the extra pressure in the intrapleural space on the affected side. A late sign of a tension pneumothorax is that the trachea will eventually shift to the unaffected side ; Hypotension, JVD, tracheal deviation, and tachypnea can all be present in a tension pneumothorax.
- empyema - infection in plueral space
- chylothorax - lymphatic fluid in plueral space
- An open pneumothorax happens when there is an opening in the chest wall ( from a gun shot, stabbing etc.) that creates a passage between the outside air and intrapleural space. This allow air to pass back and forth during inspiration and expiration. The body will shunt air through the opening in the chest well instead of the trachea (if the opening on the chest is large enough) which will create a "sucking" sound.
100
what positions are appropriate for a thorocentisis?
upright and
Sitting on the edge of the bed with the feet supported and arms on a padded over-the-bed table.
Straddling a chair with arms and head resting on the back of the chair.
Lying on the unaffected side with the head of the bed elevated 30° to 45° if unable to assume a sitting position.
The upright position facilitates the removal of fluid that usu?ally localizes at the base of the thorax. It expands the ribs and widens the intercostal space to aid needle insertion. A position of comfort helps the patient to relax and prevents patient movement that could contribute to potential complications.
200
what is the most commonly associated risk for COPD? what are some other risks?
Smoking, environmental causes, occupational, genetic, 2nd hand smoke, age
200
patho and clinical manifestations of asthma attack
- During an asthma attack, the mucosa becomes very inflamed (this narrows the airway…decreasing air flow and air becomes trapped in the alveoli). The goblet cells (due to the inflammatory response) produce excessive amounts of mucous. Hence, leading to further decrease in air flow: coughing, wheezing (as air tries to flow through the narrow airway and around the mucous it makes a musical whistling sound).
- Chest Tightness
- Wheezing (auscultate…expiratory wheezing and can program to inspiration in severe cases)
- Coughing
- Difficulty Breathing (***especially exhaling)
- Increased respiratory rate
200
keep the drainage system _________ patient's chest
below
200
signs and symptoms of pneumothorax :
Remember the mnemonic: COLLAPSED
Chest pain (sharp and sudden and worst on inspiration), Cyanosis
Overt tachycardia and tachypnea
Low blood pressure
Low SpO2
Absent lung sounds on affected side
Pushing of trachea to unaffected side (tension pneumo.)
Subcutaneous emphysema (escaping carbon dioxide collecting in the skin…crunchy bulges on the skin), Sucking sound with open pneumothorax
Expansion of chest rise and fall unequal
Dyspnea
200
what are three important points to tell the patient after describing the nature of the procedure?
1. remain immobile
2. pressure sensations may be experienced.
3. minimal discomfort is anticipated
300
what are some nursing interventions for COPD?
Smoking cessation, 02 therapy, medication management(02, bronchodialotors, vasodialtors, mucolytic antiussive), management of exacerbation, maintaining airway clearance, postural drainage, chest physiotherpay
300
what is an emergency sign of asthma attack?
absent breath sounds and wheezing followed by stop of wheezing indicated completely closed airway
300
what does the water seal chamber do? what if it doesn't fluctuate? excessive bubbling?
Water in the water seal chamber fluctuates as the patient breathes in and out. If the patient is breathing on their own the water will increase during inspiration and decrease during expiration There may be intermittent bubbling, which is expected as air is drained from the pleural space, especially for treatment of a pneumothorax. Remember that a pneumothorax is an AIR leak between the lung and chest wall….therefore air can escape into the water seal chamber causing intermittent bubbles.
- What if it doesn’t fluctuate at all? The lung could have re-expanded or there is a kink somewhere.
- Excessive bubbling? There is an air leak somewhere.
300
is the trachea midline in a pneumothorax?
no, the trachea will be "running away" from the affected side, shifting the heart as well.
300
what conditions is this procedure performed under?
aspetic
400
list the patho and clinical manifestations of copd :
chronic bronchitis and emphysema - In chronic bronchitis, the bronchioles become damaged that leads them to be thick and swollen and deformed. This is accompanied by more sputum production. This limits the ability of the person being able to completely exhale the air taken in. So, when they take another breath in, it will increase the air volume even more (because they have retained air from the previous breath), and this leads to hyperinflation.
In emphysema, the alveoli sacs lose their ability to inflate and deflate due to an inflammatory response in the body. So, the sac is unable to properly deflate and inflate. Inhaled air starts to get trapped in the sacs and this causes major hyperinflation of the lungs because the patient is retaining so much volume.
LUNG DAMAGE - lack of energy, unable to tolerate activity (SOB), nutrition is poor, gases are abnormal, dry or productive cough constant, accessory muscles/abnormal lung sounds (diminished, coarse crackles, or wheezing), modification of skin color, anteroposterior diameter (barrel chest), gets in tripod position, extreme dyspnea
400
list nursing interventions for asthma
- Baseline vital signs
- Keep patient calm and comfort the patient
- Position in high Fowler’s to help with ease of breathing
- Administer bronchodilators as ordered by MD
- Administer oxygen (oxygen saturation 95-99%)
- Assess peak flow meter reading (watch for numbers less than 50% of the patient’s personal best reading)
- Auscultate lung sounds throughout: (decrease in wheezing?….patient breathing easier? respiratory rate normal?)
- Monitor skin color and for any retractions of the chest, can they talk to you with ease now or is it still difficult for them to talk?)
- Current peak flow meter reading numbers (if the patient uses this device…ask patient (if they know) their personal best reading and current readings, and medications they’ve taken
400
The patient in room 2569 calls on the call light to tell you something is wrong with his chest tube. When you arrive to the room you note that the drainage system has fallen on its side and is leaking drainage onto the floor from a crack in the system. What is your next PRIORITY?
- A. Place the patient in supine position and clamp the tubing.
- B. Notify the physician immediately.
- C. Disconnect the drainage system and get a new one.
- D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
- D. Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.
400
your patient just had a thorocentisis and you're monitoring for complications. what manifestations would suggest pneumothorax, subcutaneous empyseme or pyogenic infection?
Monitor the patient at intervals for increasing respiratory rate; asymmetry in respiratory movement; dyspnea; diminished breath sounds; anxiety or restlessness; tightness in chest; uncontrollable cough; blood-tinged, frothy mucus; a rapid pulse; pain; and signs of hypoxemia.
400
what type of diagnostic procedure is obtained before and after a thoracentesis?
x-ray before - Chest x-ray films are used to localize fluid and air in the pleural cavity and to aid in determining the puncture site. When fluid is loculated (isolated in a pocket of pleural fluid), ultrasound scans are performed to help select the best site for needle aspiration
xray after - chest x-ray verifies that there is no pneumothorax.
500
list patient education points for COPD
- Nutrition needs: eating high calorie, protein rich meals that are small but frequent and staying hydrated if not contraindicated….avoid large heavy meals due to compression on the lungs from the stomach
- Avoiding sick people, irritants, hot humid (smothering) or very cold weather
- Stop smoking or being around people who smoke
- Vaccination up-to-date: annual flu shot and Pneumovax every 5 years because it is very hard for people with COPD to recover from illnesses
- Pursed lip and diaphragmatic breathing techniques
- Administering medications: be familiar with groups, side effects, and patient teaching
medicinal management - Chronic Pulmoary Meds Save Lungs
Coriticosteroids, phosphodiesterase 4- inhibitors, methxanthines, short acting beta 2 agonist, long acting beta 2 agonist
500
You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient:
- A. Easily fatigued with physical activity
- B. Reduced peak flow meter reading
- C. Chest retractions
- D. Cyanosis
- E. Wheezing with activity
- F. Nighttime coughing
- G. No relief with short-acting bronchodilator inhaler
- A. Easily fatigued with physical activity
- B. Reduced peak flow meter reading
- C. Chest retractions
- D. Cyanosis
- E. Wheezing with activity
- F. Nighttime coughing
- G. No relief with short-acting bronchodilator inhaler
500
what do you do for the following Chest Tube mishaps : dislodgment, system breaks, clamped tubing
- What to do if chest tube becomes dislodged? Cover the site with a sterile dressing, and tape on three sides (this allows air to escape and prevent tension pneumothorax) and notify physician immediately.
- System breaks? Insert the tube 1 inch into a bottle of sterile water or sterile normal saline and obtain a new system.
- Clamping tubing? Increase risk of patient developing a tension pneumothorax. Never do it without an order and follow hospital policies.
500
3. A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?
- A. It can be caused by the rupture of a pulmonary bleb.
- B. It can occur in patients who are young, tall and thin without a history of lung disease.
- C. Smoking increases the chances of a patient developing a spontaneous pneumothorax.
- D. It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.
The answer is D. All options are correct about primary spontaneous pneumothorax EXCEPT D. This describes SECONDARY spontaneous pneumothorax not primary.
500
describe a timeout
Verify patient’s identity using at least two identifiers, not including the patient’s room number.
Verify purpose of procedure and procedure site;
assess patient for allergies to latex, antiseptic, or local anesthetic;
and review coagulation status (prothrombin time/INR [international normalized ratio] and platelet count).