Pulmonary Embolism
This classic triad increases a patient's risk for PE and includes venous stasis, hypercoagulability, and endothelial damage.
What is Virchow's triad?
Flail chest occurs when this minimum number of consecutive ribs are fractured in at least this many places.
What is 3 ribs in 2 or more places?
These is the classic assessment findings you'd expect with a pneumothorax
What is absent breath sounds on the affected side?
After chest tube insertion for pneumothorax, you note continuous bubbling in the water seal chamber. This indicates this problem.
What is an air leak (either from the patient or the system)?
What is call the HCP?
This is the gold standard diagnostic test for confirming pulmonary embolism.
What is CT pulmonary angiography (CTPA)?
This breathing pattern in flail chest that is a high-risk concern, where the flail segment moves opposite to the rest of the chest wall.
What is paradoxical chest movement?
This life-threatening type of pneumothorax can present with hypotension, JVD, tachypnea, and causes tracheal deviation AWAY from the affected side.
What is tension pneumothorax?
When caring for a patient with a chest tube, you should never do this action that could cause a tension pneumothorax (except for brief assessments, when changing a drainage system, or specifically ordered by the physician)
What is clamp the chest tube
A patient with severe respiratory distress is using accessory muscles and has nasal flaring. This indicates this level of respiratory compromise.
What is impending respiratory failure?
These are classic signs of a PE (list at least 3).
What is sudden onset: hypoxemia, dyspnea, tachypnea, pleural friction rub, petechiae, tachycardia, pleuritic chest pain, hemoptysis?
The primary cause of hypoxemia in flail chest is not the flail segment itself, but this underlying injury.
What is pulmonary contusion?
For a tension pneumothorax, this emergency intervention should be performed immediately, even before chest tube insertion.
What is needle decompression (14-16 gauge needle in 2nd intercostal space, midclavicular line)?
Rise and fall of the water in the water seal chamber that occurs with respiration indicates this normal finding.
What is tidaling (or respiratory variation).
This respiratory rate in an adult patient should trigger immediate concern and assessment for respiratory failure.
What is less than 8 or greater than 30 breaths per minute?
This lab value, when elevated, indicates right ventricular strain and helps risk-stratify PE patients.
What is troponin? (Accept: What is BNP/NT-proBNP?)
The intervention the nurse should prepare for in a patient with flail chest and increasing respiratory distress.
What is preparing for intubation and mechanical ventilation? (positive pressure ventilation can help to stabilize the flail chest segments)
In an open pneumothorax (sucking chest wound), you should apply a three-sided occlusive dressing for this reason.
What is to allow air to escape on exhalation while preventing air entry on inhalation? (Accept: To prevent tension pneumothorax development) 4th side acts like an air vent, flutter valve.
If a chest tube becomes dislodged, your immediate action is to do this.
What is cover the site with sterile occlusive dressing (petroleum gauze) and tape on three sides?
This is the correct patient position for a thoracentesis procedure to drain a pleural effusion.
What is sitting upright, leaning forward over a bedside table with arms supported? (Allows fluid to collect at base of lungs and separates ribs for easier needle insertion)
The main treatments for PE are these 2 interventions and include medications such as: Factor Xa inhibitors (rivoroxaban, apixaban), LMWH, Fibrolytic agents (Alteplase)
What is anticoagulation and thrombolytic therapy (tPA)? (Accept: What is embolectomy- if life-threatening PE?)
The emergency complication that patients with a flail chest are at most risk of developing
What is pneumothorax?
When a trauma patient presents with subcutaneous emphysema, you should immediately assess for this underlying injury.
What is pneumothorax or tracheobronchial injury?
The chest tube drainage system should always be kept in this position relative to the patient's chest to maintain proper function.
What is below the level of the chest (dependent position)?
After a thoracentesis, the nurse should immediately assess for this serious complication characterized by sudden chest pain, dyspnea, and decreased breath sounds on the affected side.
What is pneumothorax? (Can occur from needle puncturing the lung during the procedure)