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Respiratory -lower

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mattisensept's version from 2017-09-25 05:59

chest trauma

Question Answer
Blunt traumashearing and compression injuries of thoracic structures, may appear minor externally, can be life threatening
penetrating open wound through pleural space
pneumothorax definitioncaused by air entering pleural cavity
what is a pneumothorax?positive pressure in cavity causes lung to partially or fully collapse, should be suspect after any trauma to chest wall
open pneumothoraxair enters an opening in the chest wall and outer lining of the pleura
closed pneumothoraxinner lining of the pleura disrupted, allowing air to enter the pleural space from the lung. no external wound
clinical manifestations of pneumothoraxmild tachy & dyspnea --> severe respiratory distress, absent breath sounds over area, evident on x-rays
spontaneous pneumothoraxrupture of blebs, RF: smoking, tall think male, family hx, previous one
latrogenic caused by medical procedures, barotrauma from excessive ventilatory pressure during manual or mechanical ventilation can rupture alveoli or bronchioles
tension pneumothoraxaccumulation of air in pleural space that does not escape, continued pressure puts pressure on heart and great vessels
as tension pneumothorax continues compresses good lung, further compromises O2, venous return decreased, cardiac output fails
manis for tension pneumothoraxdyspnea, tachycardia, tracheal deviation, decreased or absent breath sounds, neck vein distention, cyanosis, profuse diaphoresis
if tension pneumothorax is not treated... patient will likely die form inadequate CO or severe hypoxemia
tx. for tenstion pneumothoraxurgent needle decompression, followed by chest tube insertion to water-seal drainage
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pneumothorax

Question Answer
hemothoraxblood in pleural space
hemothorax tx w/chest tube
chylothoraxlymphatic fluid in pleural space, tx. conservatively w/meds, sx, pleurodesis
hemopneumothoraxhemothorax occuring with pnuemonthorax
interprofessional care pneumothoraxdepends on severity, may resolve spontaneously
emergency treatment vent/occlusive dressing
vent/occlusive dressing on expirationpressure rises, dressing is pushed out and air escapes through wound and from under the dressing
vent/occlusive dressing on inspirationdressing pulls against wound, preventing air from entering
if object in open wound cheststabilize implanted object until HCP is present, do not remove
pneumothorax & hemothorax txinsert chest tube and connect it to water-seal drainage
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Section 3

Question Answer
rib fractures can damage pleura, lungs, internal organs
clinical manifestationspain, splinting, shallow respirations, atelectasis & pneumonia may develop
treatmentno stabbing or binding chest, goal is to treat the pain so that the patient can breath and clear secretions
medication treatmentNSAIDS, opioids, nerve block
patient teachingdeep breathing, incentive spirometry, use of anaglesics
flail chestresults from the fracture of several consecutive ribs, causing paradoxical movement during breathing
flail chest moves in the opposite direction with respect to the intact portion of the chest
flair chest inspiration/expirationaffected portion is sucked in/ it bulges out
flair chest preventsadequate ventilation and increases the work of breathing
underlying lung may have pulmonary contusion aggravating hypoxemia
flail chest manifestationsrapid, shallow respirations and tachycardia, moves air poorly, thorax is asymmetric and uncoordinated
initial therapy ensuring adequate ventilation and supplemental O2 therapy
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chest tubes

Question Answer
cardiac tamponade definition blood rapidly collects in pericardial sac, compressing myocardium because pericardium does not stretch, prevents ventricles from filling
manifestationsmuffles, distant heart sounds, hypotension, neck vein distention, increased central venous pressure
medical emergencypericardiocentesis w/surgical repair as appropriate
signs of respiratory distressdyspnea, cough, cyanosis, tracheal deviation, decreased breath sounds and 02 saturation, frothy secretions
cardiovascular compramiserapid, thready pulse, decreased BP w/narrowed pulse pressure and or/asymmetric readings, distended neck veins, muffled heart sounds, chest pain, dysrhythmias
initial interventionsairway, breathing, circulation, administer 02, start IV and begin fluid, remove clothing
ongoing monitoringVS, LOC, 02 sat, cardiac rhythm, respiratory status, urinary output, potential intubation
position for insertion of chest tubeleft side w/arm raised above the head, head of bed is elevated to allow diaphragm to fall downward
reason for chest tube and pleural drainageremove air and/or fluid, reestablishes negative pressure, lung reexpands
indicates an air leakbubbling in water-seal chmaber
tidlingchanges in pressure, disappears as lung reexpands
adjust suction untul gentle bubbling in third chamber
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TB

Question Answer
resistance to 2 potent firs-ling anti- TB drugsrifampin & isoniazid
extensively drug-resistant TB resistant to any fluoroquinalone plus injfectablethis bug is most resistant to treatment
resistance occurs becauseincorrect prescribing, lack of case management, nonadherence
spread viaairborne particles, gram positive, acid-fast bacillus
can be suspended in air forminutes to hours, TB bug remains for a while
transmission requiresclose, frequent, or prolonged exposure, not by touching or sharing utensils, kissing or other physical contact
once isoniasidaled...particles lodge in bronchioles and alveoli
infection can spread via lyphatics and grow in other organs as wellcerebral cortex, spine, epiphyses of bone, adrenal glands
skin testingimmune response seen by hypersensitivity, once acquired--> remains for life, positive reaction indicates infection does not indicate if dormant or active causing illness
early stagesdry cough that becomes productive, fatigue, malaise, anorexia, weight loss, low-grade fevers, night sweats
later on cough more frequent, mucoid sputum, dyspnea is unusual, chest pain may be present, hemoptysis common
acute episodeshigh fever, chills, generalized flu symptoms, pleuritic pain, productive cough, crackles/adventitious breath sounds
miliary TB always serious and if untreated--> fatal, wide dissemination of tiny lesions, progresses slowly, vary depending on organs, necrotic Ghon complexes (eat thru vessels, invade the blood stream and invade all organs)
complicationsfever, dyspnea & cyanosis
systemic S/S includepleural effusion and empyema, TB pneumonia, other organs involvement
diagnostic studies chest x-ray, 2-3 consecutive sputum samples are collected on different days and sent for culture
culturetakes 6-8 weeks, most accurate, from: sputum, gastric washing, CSF, pus from an abscess
drug therapy for TBIsoniazid, rifampin, pyrazinamide, ethambutol
best time for sputumearly morning, get it when productive cough
afternoon temperature elevationobserved in about 2/3 , especially those under 60 years
nursing diagnosisineffective breathing patter, ineffective clearance, imbalances nutrition, noncompliance, ineffective health maintenance, activity intolerance
goalscomply w/theraputic regimen, no recurrence, normal pulmonary function, appropriate measures to prevent spread of disease,
primary management place in airborne isolation, neg pressure room, begin drug therapy as ordered
rifampindiscolors body secretions (sweat, tears, urine), non-infections hepatitis is a toxic side effect
patient teachingcomply w/medications, minimize close contacts, open windows, get outdoors, avoid public transportation, sleep alone until sputum is negative,
what can you do to ensure that he continues meds after dischargeteaching and counseling (building relationship), set up reminder systems, incentives for compliance, health department should be involved
ambulatory caremust notify health care department, can go home even if culture is positive, monthly sputum cultures, teach symptoms of reoccurence, instruct about factors that could reactivate TB, smoking cessation
evaluationcomplete resolution of disease, normal pulmonary function, absence of any complications, no transmission of TB
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pneumonia

Question Answer
pneumonia description acute infection of lung parenchyma, assoc. w/ signifigant morbidity and mortality rates
etiologylikely to result when defense mechanisms become incompetent or overwhelmed, decreased cough and epiglottal reflexes may allow aspiration
causes that can contributepollution, cigarette smoking, upper respiratory infections, tracheal intubation, aging, chronic disease suppress immune system
three ways organisms reach the lungs1) aspiration from naspharynx or oropharynx, 2) inhalation of microbes present in air, 3) hematogenous spread from primary infection elsewhere in body
community-acquired pneumonia not hospitalized or in long-term care 14 days of the onset of symptoms, can be tx @ home or in hopsital
hospital acquired pneumonia 48 hr or longer after hospitalization and not present @ time of admission. associated w/longer hospital stays, increased costs, sicker patients, increased risk of morbidity and mortality
multi drug resistant organisms RF: aging, immunosuppression, lots of antibiotic use, long-term mechanical ventilation
aspiration pneumoniaRF: decreased LOC, dysphagia, NG tube, inflammatory response to other aspirations
necrotizing pneumonia rate, usually CAP, immediate respiratory insufficient or failure
opportunisticat risk, immunocompramised, chemo, radiation, caused by bugs that do not normally cause disease
manifestationscough, weakness, confusion, other--> shaking chills, dyspnea, tachypnea, pleuritic chest pain
soundsrhonchi and rales, bronchial breath sounds, egophony, dullness to percussion if pleural effusion present
diagnostic testschest x-ray, sputum for gram stain and culture and sensitivity, CBC w/dif, electrolytes, BNP
potential problemsatelectasis, pleurisy (pain w/breathing), pleural effusion (sterile, reabsorbed couple weeks, bactermia, penumothorax, meningitis (most risky w/strep), acute respiratory failure, sepsis, lung abcess, empyema
look for history oflung cancer, COPD, DM, malnutrition, AIDS, use of antibiotics, corticosteroids, chemotherapy, immunosuppressive drugs, recent abdominal or thoracid sx, smoking, alcoholism, respiratory infections
pneumonia collaborative care/preventionpenumococcal vaccine
promote treatment w/antibioticsdecrease temp, improved breathing, decrease chest discomfort, repeat x-ray in 6-8 weeks
supportive careO2 for hypoxemia, analgesics for chest pain, antipyretics, individualize rest
drug therapystart on IV then switch to oral once stable, should see improvement in 3-5 days
nutritional therapyadequate hydration, thin and lose secretions, high calorie, small frequent meals
what we wantclear breath sounds, normal breathing patterns, no signs of hypoxia, normal chest x-ray, normal WBC count, absence of complications r/t pneumonia
discharge teachingtake all medications, adequate rest and hydration, avoid alcohol & smoking, cool mist humidifier, chest x-ray
evaluationeffective respiratory rate, rhythm and depth of respirations, lungs clear to auscultation, reports good pain control, SP02 >95. free of adventitious breath sounds, clear sputum from airway
pleural effusion developinglocalized decreased breath sounds, dyspnea and chest that increase w/inspiration
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