Tension Pneumothorax
A tension pneumothorax causes a shift of the __________, leading to compromised cardiopulmonary function.
What is mediastinum?
Rationale: The mediastinum contains critical structures like the heart and great vessels. Shifting compresses them, impairing blood return and cardiac output.
A flail chest occurs when ____ or more ribs are broken in at least two places, causing a segment of the chest wall to move independently from the rest of the thorax.
What is three?
Rationale: A flail chest is defined as three or more ribs broken in two or more places.
A _________ is a thrombus at the bifurcation of the main pulmonary artery and can cause hemodynamic collapse.
What is saddle embolism?
Rationale: Saddle embolism blocks both branches of the pulmonary artery, severely impairing circulation.
Hypoxemic respiratory failure is defined by a PaO₂ of less than __________ mm Hg.
What is 60?
Rationale: A PaO₂ < 60 mm Hg indicates inadequate oxygenation.
A primary spontaneous pneumothorax typically occurs in individuals without underlying lung disease but may involve rupture of ________.
What is blebs?
Rationale:
Blebs are small air blisters on the surface of the lung, and when they rupture, they allow air to leak into the pleural cavity, leading to PSP.
A chest tube size ________ to ________ French is commonly used to drain blood from the pleural space.
What is 28 to 32?
Rationale: Large-bore tubes are required to effectively remove blood.
Mechanical ventilation is primarily used to increase ____ and decrease ____.
What is PaO2; PaCO2?
Rationale: Mechanical ventilation helps improve oxygenation (PaO2) and remove carbon dioxide (PaCO2), especially in clients with respiratory failure.
__________ may be felt on palpation due to air escaping into the soft tissues.
What is subcutaneous emphysema?
Rationale: Air leaks into the tissue beneath the skin from the pleural space, creating a crackling sensation upon palpation.
During inspiration, the flail segment moves ____, while the rest of the chest expands outward. During expiration, the flail segment bulges ____.
What is inward, outward?
Rationale: This paradoxical movement is a hallmark of flail chest and contributes to impaired ventilation.
A PE causes a ___________, where alveolar ventilation is normal, but perfusion is reduced.
Rationale: This leads to inadequate gas exchange and hypoxemia.
Most respiratory failures involve both __________ and __________ abnormalities.
What is hypoxemia and hypercapnia?
Rationale: These forms often coexist due to mixed causes.
The negative pressure in the pleural space is required to maintain _________ of the lung.
What is inflation?
Rationale:
The lungs remain inflated due to the negative intrapleural pressure. When this pressure is lost (e.g., due to air entering the space), the lung collapses.
Chest tubes are used to drain ________ or remove ________ from the intrapleural space, which is located between the lungs and chest wall.
What is fluid, air
Rationale:
Chest tubes help remove fluid or air that accumulates in the pleural space, preventing lung collapse and aiding lung re-expansion, often used in conditions like pneumothorax, infections, or after thoracic surgery.
During ECMO therapy, a nurse should assess the client's neurological status frequently to detect early signs of a ______ event, such as a stroke.
What is thrombolytic?
Rationale: Blood flow changes and clot risks with ECMO increase the likelihood of thrombotic events, including strokes.
A __________ pneumothorax is caused by medical intervention or treatment.
What is iatrogenic?
Rationale: "Iatrogenic" refers to any condition caused inadvertently by a medical procedure or treatment.
While a chest x-ray may be used, the preferred imaging method for diagnosing flail chest is a ____, due to its higher sensitivity.
What is CT scan?
Rationale: CT scans better identify rib fractures and associated injuries like contusions or pneumothorax.
The most common cause of death in PE is ___________ due to pressure overload.
What is right ventricular failure?
Rationale: RV failure reduces cardiac output and causes hemodynamic instability.
ARDS typically develops within ______ days of a triggering event.
What is 7?
Rationale:
According to the Berlin criteria, ARDS begins within 7 days of a known clinical insult or worsening respiratory symptoms.
Secondary spontaneous pneumothorax (SSP) is associated with underlying conditions such as ________, ___________, and ________ .
What is cystic fibrosis, tuberculosis, and COPD.
Rationale:
SSP occurs in clients with existing lung diseases, including cystic fibrosis, which weakens the lungs and predisposes them to rupture.
During chest tube care, the nurse should confirm the closed chest drainage system (CCD) is positioned ________ and ________ the client’s chest to ensure proper drainage.
What is upright; below?
Rationale:
The CCD must be upright and below chest level to allow gravity drainage of fluid or air and prevent backflow into the pleural space.
Extracorporeal membrane oxygenation (ECMO) temporarily takes over the function of the _______ and/or _______ to support gas exchange and perfusion in critically ill clients.
What is lungs and heart?
Rationale:
ECMO is a form of advanced life support used in critical care when a client’s heart and/or lungs are unable to function adequately. The ECMO circuit removes blood from the body, oxygenates it using an artificial lung (oxygenator), removes carbon dioxide, and then returns the blood to the body—thus performing the job of the lungs. In some forms (e.g., venoarterial ECMO), it also supports circulation, acting as a temporary mechanical heart. This allows the client’s heart and lungs to rest and recover while maintaining tissue oxygenation and perfusion.
In mechanical ventilation, excessive __________ can lead to a tension pneumothorax.
What is positive pressure?
Rationale: High positive pressure can rupture alveoli, allowing air to leak into the pleural space.
The most common cause of flail chest is ____ trauma, most often from ____.
What is blunt, motor vehicle collisions?
Rationale: Blunt trauma from MVCs accounts for 75% of flail chest cases.
The __________ is the amount of air that enters the lungs divided by the amount of blood flow in the lung capillaries.
What is V/Q ratio?
Rationale: Normal V/Q ratio is 0.8 (4L air / 5L blood)
A hallmark of ARDS is the presence of bilateral lung ______ on imaging.
What is infiltrates?
Rationale:
Bilateral infiltrates are one of the diagnostic criteria for ARDS and reflect widespread alveolar damage and fluid accumulation.
Common symptoms of a pneumothorax include ___________, ____________, and _________ on auscultation.
What is chest pain, SOB, and decreased sounds on auscultation?
Rationale:
As the lung collapses, air movement is reduced or absent in the affected area, leading to decreased breath sounds.
Chest pain occurs due to inflammation or irritation of the pleura, and is common in pneumothorax. It is typically sharp and worsens with breathing, coughing, or movement.
Shortness of breath (dyspnea) occurs in pneumothorax because the affected lung partially or completely collapses, reducing its ability to exchange oxygen effectively.
If there is continuous bubbling in the water seal chamber of the chest tube drainage system, it may indicate an ________ .
What is air leak?
Rationale:
Continuous bubbling suggests air escaping into the drainage system, which indicates a possible air leak that may compromise lung re-expansion.
The ventilator setting that refers to the amount of air delivered with each breath is called ______.
What is tidal volume?
Rationale: Tidal volume is the volume of air exchanged in a single breath.
Clients with chronic conditions such as __________ or AIDS have a higher risk of recurrence.
What is COPD?
Rationale: These clients have weakened lung structures, predisposing them to spontaneous or recurrent pneumothoraces.
In severe flail chest, clients may require mechanical ventilation to stabilize ventilation. A key complication of this intervention is ____, an infection linked to prolonged intubation.
What is pneumonia (or VAP)?
Rationale: Mechanical ventilation supports breathing but increases the risk for ventilator-associated pneumonia (VAP).
The initial treatment for a hemodynamically unstable PE includes supportive care such as ________ and possibly ___________.
What is supplemental oxygen and mechanical ventilation?
Rationale: Stabilizing oxygenation is the first priority
Mechanical ventilation in ARDS should follow a ______ tidal volume strategy to avoid lung injury.
What is low?
Rationale:
Lung-protective ventilation uses low tidal volumes (4–8 mL/kg of body weight) to minimize volutrauma and barotrauma
A hemothorax is the accumulation of ________ in the pleural space, which lies between the visceral and parietal pleura.
What is blood?
Rationale: Hemothorax is specifically the collection of blood between these two pleural layers.
The nurse must check the chest tube and drainage tubing to ensure there are no ________, dependent loops, or ________ that could impede drainage.
What is kinks; occlusions?
Rationale:
Kinks or occlusions can block drainage and increase pressure in the chest cavity, potentially causing complications.
A backup ______ should always be kept at the bedside of an intubated client in case of ventilator failure.
What is bag valve mask?
Rationale: A BVM allows manual ventilation if the ventilator malfunctions or during transport.
The nurse should monitor for absent breath sounds and asymmetrical __________ on the affected side.
What is chest expansion?
Rationale: Air trapped in the pleural space collapses the lung, limiting expansion and reducing or eliminating breath sounds.
Clients with flail chest often have increased ____ space, reduced intrathoracic pressure, and a higher ____ demand due to tissue injury.
What is dead, oxygen?
Rationale: The ineffective ventilation increases areas where gas exchange doesn’t occur, and injured tissues consume more oxygen.
Anticoagulation therapy typically continues for a minimum of ________ after initial treatment for PE
What is 3 months?
Rationale: Treatment duration may be extended depending on recurrence risk.
The most common cause of ARDS is ______.
What is sepsis?
Rationale:
Sepsis, particularly in clients with alcohol use disorder, is the leading cause of ARDS. It triggers a massive inflammatory response damaging lung tissue.
All origins of a hemothorax involve major arteries such as the ________ arteries and the ________.
What is intercostal and aorta?
Rationale:
Hemothorax results from bleeding into the pleural space, often caused by injury to major blood vessels. The intercostal arteries, which run along the ribs, and the aorta, the largest artery in the body, are common sources of bleeding in hemothorax cases. Damage to these vessels can lead to significant blood loss and accumulation in the thoracic cavity.
When the chest tube drainage system is connected to suction, the nurse should verify that the suction tubing is connected and the wall suction is ________.
What is on?
Rationale:
Proper suction ensures effective drainage and reduces the risk of pneumothorax.
The nurse should suction secretions every ______ hours, or as needed, to prevent pulmonary complications.
What is 4 to 6?
Rationale: Regular suctioning helps prevent pneumonia and promotes airway clearance.
Following chest tube insertion, __________ bubbling in the water seal chamber may indicate an air leak.
What is continuous?
Rationale: While intermittent bubbling is normal, continuous bubbling may indicate a persistent leak in the system or pleural space.
Older adults are at increased risk for flail chest due to age-related thoracic stiffness and higher rates of ____.
What is osteoporosis?
Rationale: Age-related changes increase fracture risk and reduce compensatory respiratory capacity.
The three major risk factors for PE, known as Virchow’s triad, are __________, ____________, and____________.
What is hypercoagulability, venous stasis, and endothelial injury?
Rationale: These conditions promote thrombosis.
Acute respiratory failure develops over a period of __________ to __________.
What is minutes and hours?
Rationale: Acute respiratory failure has a rapid onset and can become life-threatening quickly.
Chronic respiratory failure develops over several days.
To promote comfort and lung expansion in a hemothorax patient, the nurse should place the client in a ________ position.
What is semi-Fowler’s (or high-Fowler’s)?
Rationale: Elevation facilitates lung expansion and ease of breathing.
________ is used to fill the water seal chamber of a chest drainage system, and ________ is applied to the chest tube insertion site to create an airtight seal and prevent air leaks.
What is sterile water; Vaseline gauze?
Rationale:
Sterile water maintains the water seal in the drainage system, allowing air to escape but preventing its return into the pleural space. Vaseline gauze provides an occlusive, airtight dressing over the chest tube site to prevent air leaks and infection.
Before suctioning a client with a tracheostomy, the nurse should perform ______ to prevent deoxygenation.
What is preoxygenation?
Rationale: Preoxygenating minimizes the risk of hypoxia during suctioning.
What 3 cardiac symptoms may be seen with tension pneumothorax?
What is decreased blood pressure, increased heart rate, and jugular vein distention?
Rationale:
Increased heart rate: Tachycardia is a compensatory response to reduced oxygenation and cardiac output.
Decreased blood pressure: Hypotension results from reduced venous return due to increased intrathoracic pressure.
Jugular vein distention: Indicates impaired venous return and possible cardiac tamponade or right-sided heart strain.
Pain from rib fractures may cause clients to limit their respiratory effort, also known as ____, which increases the risk of ____, a partial or complete collapse of the lung.
What is splinting, atelectasis?
Rationale: Splinting reduces inspiratory effort, leading to alveolar collapse and poor oxygenation.
Most emboli arise from the proximal veins of the lower extremities, including the ________, _________, and _________ veins.
What is iliac, femoral, and popliteal?
Rationale: These are common DVT locations.
__________ is a flapping tremor of the hands seen in hypercapnic respiratory failure.
What is asterixis?
Rationale: Indicates advanced CO₂ buildup
The nurse assists the client with pain control by encouraging ________ during coughing and deep breathing.
What is splinting?
Rationale: Splinting supports the chest and reduces pain during respiratory exercises.
In cases of unstable pneumothorax or hemothorax, ________ is performed as an emergency procedure to relieve pressure before definitive chest tube placement.
What is needle decompression?
Rationale:
Needle decompression is a rapid, life-saving procedure that temporarily relieves pressure from air or blood trapped in the pleural space, improving respiratory and circulatory function until a chest tube can be inserted for ongoing drainage.
Clients on ECMO are at risk of developing ______ due to the use of room-temperature extracorporeal circuits.
What is hypothermia?
Rationale: Blood is cooled during circulation outside the body, so active warming may be necessary.