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Respiratory System lecture Notes for nurses | Thorax | Lung

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Respiratory System Chest Trauma Mechanics of Respiration ã ã ã Breathing- Neg. pressure- pressure in chest cavity lower than atmosphere Inspiration- Contraction of diaphragm, intercostals musc., chg in thorax (enlarges) & cohesion of pleura Expiration- relaxation (Intrapleural pressure is negative at all times) (756mmHg) Hemothorax ã ã collection of blood in the pleural space o laceration, puncture, surgery, knife, or gun shot wound S&S o Chest pain o Cyanosis o Dec BP, inc. pulse, inc. RR o
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  Respiratory SystemChest TraumaMechanics of Respiration ã Breathing- Neg. pressure- pressure in chest cavity lower than atmosphere ã Inspiration- Contraction of diaphragm, intercostals musc., chg in thorax (enlarges) & cohesion of  pleura ã Expiration- relaxation(Intrapleural pressure is negative at all times) (756mmHg)Hemothorax ã collection of blood in the pleural space o laceration, puncture, surgery, knife, or gun shot wound ã S&S o Chest pain o Cyanosis o Dec BP, inc. pulse, inc. RR  o Dyspnea o Dullness on percussion o Shock  o Acidosis/ alklosis state ã size o Small- less 400,no S&S(clears itself in 10-14 days) o Moderate- 500-2000cc,-Pallor, restless, anxiety, inc. HR, dec. BP, chest tightening, bloody sputum, dec. or absent LS on side. o Massive-SOB, Inc. HR, Dec. BP, hypoxia, shock (fluid in half of lung), absent LSPleural Effusion ã causes: CA, pneumonia, lt side CHF, blocked lymph systemEmphysema ã Pus, fluid PNEUMOTHORAX ã closed- chest wall intact  o Spontaneous- may have Hx of COPD, TB, Cystic Fibrosis, Cancer  o S&S- sudden sharp pain, cough, sudden SOB, dec. BP, rapid pulse, tightness in chest,asymmetric chest movement, hypersonant,(BP inc. or dec., resp, inc., pulse inc.) ã Tension pneumothorax o Untreated closed o S&S- severe SOB, deviation of larynx to unaffected side, distended neck veins, inc. pulseand RR, dec. BP, SQ emphysema, crepatis, change in PMI, muffled heart tones.( if open to outside do not occlude) ã Open- penetration of chest wall o S&S- sucking chest wound, chest pain, inc. HR, inc. RR, dec. breath sounds on side of injury, unequal expansion, shallow breathing (resp. alk) o TX- cover on three sides with a gauze with patient breathing outMediastinal flutter  ã Inspiratory movement- shift to unaffected side ã Expiratory movement- shift to affected sideHemo- pnuemothorax ã  blood & air in the thoracic cavity ã Dx/ Tx is basically the same o May see with chest tubes  High or anterior for air   Low or posteriorlateral for bloodFractured Ribs ã  painful and dec. chest movement which can lead to atelectasis ã shallow resp., guarding, grunting at end of inspiration, asymmetrical resp., crepitus ã Danger: contusion, rib piercing lung ã Tx: anesthetic block, analgesics, splint area  Flail chest ã inspriatory movement- sucking in of ribs ã expiratory movement- puffing out of ribs ã S&S- extreme distress o Desperately tries to breathe in spite of pain o Hypoxia, cyanotic, severe SOB o Grunting resp o Paradoxical movement ã Tx: HOB elevated and patent airway o Mild= C&DB, suction, pain control, lay on affected side or splint o Moderate= fluid restriction, diuretics, steroids, albumin, tx resp o Severe= intubate and ventCHEST TUBES ã type of drain into the pleural space that also prevents leak of air back into that space ã Chest tube placement o Air- 2 nd intercostals space mid cav. Area o Liquid- 5 th intercostals space mid axillary area o Open heart- medialstinalPleurodesis ã sclerosing agents- doxycycline, minocycline, bleomycin o cause inflammation reaction o Post care: watch patient may have low grade temp and pleuritic painTYPES OF CHEST DRAINAGE ã one bottle o expiration- air leaves pleural space o inspiration- water will fluctuate upward toward the chest(2cm of H2O in bottle- underwater seal)(intermittent bubbling during expiration)(movement of fluid during expiration/ inspiration is tidaling)  ã two bottles o  bottle one- tubing to patient, Blood (drainage) in bottle o  bottle two- tubing connecting bottles, tubing to suction, underwater seal ã three bottles o More negative pressure (15cm of water pressure) o Suction control bottle o Inc. suctioning the more neg. usually -20cm o Wall suction with thoracic unit- gentle bubbling o Tidaling   bottle one- tubing to patient   bottle two- tubing connecting bottle 1&2, drainage in bottle   bottle three- tubing connection bottle 2&3, tubing to suction, underwater sealINSERTION ã Equipment o CT tray (suture) & CT o Local anesthetic & betadine o Gloves, protective gear  o Drainage system o Dressing o Hemostats o Fill chamber to 2cm water level  Check placement of CT with x-ray Nursing Care ã Positioning patient and chest tubes (coil on bed to promote drainage) ã Clamping ã Assessing o Patient- VS, LS o Entry site- for crepetis o Tubing- all connections taped o Drainage unit- below chest, check amount, color of drainage ã Chest x-rayInterventions ã Sit in semi fowlers position ã C&D, splint ã Turn q 2hrs ã Do not lie on tubing, keep coiled ã Passive ROM ã Keep below level of heart
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