All About Sputum
A patient comes in with a fever and a productive cough. The sputum is green-yellow in color. What type of disease might the nurse suspect the patient has contracted?
Bacterial Infection
What is a normal pH; Carbon Dioxide, and Bicarbonate levels?
pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26
True or False: It is normal to to see the water level rise in the water seal chamber when the patient inhales and falls as the patient exhales.
True: This is called tidaling.
You are assessing a patient who has a chest tube. You assess around the patient's insertion site and feel rice crispy feeling under the skin. What is this called?
Crepitus
What is the purpose of chest physical therapy (CPT)? How is it performed?
To help drain mucus from the lobes of the lungs, chest physical therapy (CPT) may be ordered.
This involves assisting the patient into different positions to encourage the drainage of mucus out of the lungs. It also involves using percussion to help loosen pooled mucus.
What is the difference between a productive and non-productive cough?
Productive means sputum/ mucus is expelled.
Non-productive means that it is dry and no sputum is expelled.
Increased pH and decreased Carbon dioxide
Respiratory Alkalosis
How would you educate a family member on Y-tubing chest tube drainage chambers?
The upper chest tube is draining air from the chest and lower chest tube drains fluid.
Should a patient with COPD wear supplemental oxygen over 3L without a Healthcare Providers specific order.
No. When >3L is worn it cause respiratory depression and even death.
How is a patient's body going to react if they have excess carbon dioxide?
Breathing Rate increases
A patient complains of difficulty breathing and productive cough with frothy, pink-tinged sputum. What diagnosis are you most concerned for?
Pulmonary edema
Increased pH and increased bicarbonate
Metabolic alkalosis
What is Chamber One used for in a chest tube?
It is used for wet suction.
It is used when drainage is needed to be gently pulled out of the pleural space. When suction is attached bubbling will be present.
A patient has Asthma and takes nebulizer treatments at home. They request they be added to their medication list while staying in the hospital. What will the nurse be expected to do?
Contact the HCP. Remember we cannot start a medication without a doctors order?
You enter your patient's room and they are in tripod (orthopneic) position what are you concerned for? What is going to be your first action to take?
Impaired oxygenation; Auscultate the patient's lungs.
A patient is experiencing a productive cough and thick, rust-colored sputum. What diagnosis does the patient likely have?
Pneumonia or tuberculosis
Decreased pH and increased Carbon Dioxide
Respiratory acidosis
What is Chamber two used for in a three-chamber system?
This is considered the water seal.
It establishes negative pressure in the pleural space and prevent air from entering the cavity through the chest tube. At the first sign of bubbles in the water-seal chamber of a patient with a resolved pneumothorax, check all tubing connections and the dressings at the insertion site for possible air leaks.
Patient's are prone for pneumonia after surgery. What is something the nurse can suggest the patient do to help prevent pneumonia?
Cough regularly and take deep breaths, turn bed-bound patients q2h, raise the bed at least 30 degrees
How would you document a patient who becomes short of breath when ambulating (walking) to the door of her room and back?
Nurse noted dyspnea with exertion after patient walked 20 feet.
Increase fluids to help thin out secretions. Thick sputum is difficult to cough out and can cause a breeding ground for bacteria to grow.
Decreased pH and decreased bicarbonate
Metabolic acidosis
What is chamber three in a three-chamber system?
This is the collection drainage chamber.
You should expect the amount of drainage to gradually decrease each day until the pleural space has been drained and the physician removes the chest tube. It is important for you to assess the color and amount of chest tube drainage several times during your shift. If a sudden increase in total output or a sudden increase in bright red output occurs in the chest tube drainage unit, notify the physician immediately because this could indicate hemorrhage.
Why is crepitus a medical emergency? If you notice crepitus what should be your priority action?
Air in the subcutaneous tissues, also called subcutaneous emphysema, indicates that air that should be in the lungs is in the tissues.
Notify the physician immediately.
If you are the nurse changing a tracheostomy ties individually, should you remove the old ties first or should you attach the new ties first before removing the old ties? Why
If you are by yourself, Put the new ties on prior to removing the old ties because if you don't the patient could cough the tube out of the trachea.