Podcast
Questions and Answers
Which condition involves an accumulation of pus in the pleural space?
Which condition involves an accumulation of pus in the pleural space?
A patient with congestive heart failure is likely to develop which type of pleural effusion?
A patient with congestive heart failure is likely to develop which type of pleural effusion?
Which of these best describes the visceral pleura?
Which of these best describes the visceral pleura?
Which of the following is a common cause of exudative pleural effusion?
Which of the following is a common cause of exudative pleural effusion?
Signup and view all the answers
A patient who has undergone thoracic surgery is at risk of developing which condition?
A patient who has undergone thoracic surgery is at risk of developing which condition?
Signup and view all the answers
Which of the following is a primary goal of nursing management when a patient has a chest tube?
Which of the following is a primary goal of nursing management when a patient has a chest tube?
Signup and view all the answers
What is the primary purpose of a chest tube?
What is the primary purpose of a chest tube?
Signup and view all the answers
A patient with a chest tube needs to be transported to radiology. Which of the following actions is most appropriate during transport?
A patient with a chest tube needs to be transported to radiology. Which of the following actions is most appropriate during transport?
Signup and view all the answers
Which of these surgical procedures involves the removal of the entire lung?
Which of these surgical procedures involves the removal of the entire lung?
Signup and view all the answers
What is an advantage of an axillary thoracotomy incision?
What is an advantage of an axillary thoracotomy incision?
Signup and view all the answers
Which of the following is NOT a typical item that should be available at the bedside for a patient with a chest tube?
Which of the following is NOT a typical item that should be available at the bedside for a patient with a chest tube?
Signup and view all the answers
What is the purpose of a water seal in a chest tube system?
What is the purpose of a water seal in a chest tube system?
Signup and view all the answers
Which of the following is NOT a type of thoracotomy?
Which of the following is NOT a type of thoracotomy?
Signup and view all the answers
Which of the following is NOT a typical cause of a spontaneous hemothorax?
Which of the following is NOT a typical cause of a spontaneous hemothorax?
Signup and view all the answers
A patient presents with a sudden onset of pleuritic pain, decreased breath sounds and tracheal deviation. Based on these symptoms, which condition is most likely?
A patient presents with a sudden onset of pleuritic pain, decreased breath sounds and tracheal deviation. Based on these symptoms, which condition is most likely?
Signup and view all the answers
In a tension pneumothorax, what happens to the intrapleural pressure?
In a tension pneumothorax, what happens to the intrapleural pressure?
Signup and view all the answers
Which of the following individuals is at the highest risk for a primary spontaneous pneumothorax (PSP)?
Which of the following individuals is at the highest risk for a primary spontaneous pneumothorax (PSP)?
Signup and view all the answers
What is a key difference between a primary and secondary spontaneous pneumothorax?
What is a key difference between a primary and secondary spontaneous pneumothorax?
Signup and view all the answers
What is the primary goal of pleurodesis?
What is the primary goal of pleurodesis?
Signup and view all the answers
Which procedure involves the surgical removal of fibrous tissue over the lung, chest wall and diaphragm?
Which procedure involves the surgical removal of fibrous tissue over the lung, chest wall and diaphragm?
Signup and view all the answers
A patient with a pneumothorax presents with absent fremitus. What does this finding indicate?
A patient with a pneumothorax presents with absent fremitus. What does this finding indicate?
Signup and view all the answers
Study Notes
Pleural Disorders: Overview
- Pleura is tissue covering the outside of the lungs and lining the inside of the chest cavity
- Visceral pleura is the inner layer covering the lungs
- Parietal pleura is the outer layer lining the chest wall and diaphragm
Pleural Disorders
- Pleurisy (Definition?): Inflammation of the pleura
- Empyema: Pus in the pleural space
- Pleural Effusion: Fluid in the pleural space
- Hemothorax: Blood in the pleural space
- Pneumothorax: Air in the pleural space
Common Etiology of Pleural Disorders
- Pleurisy: Infection (e.g., autoimmune, pneumonia), other pulmonary conditions
- Empyema: Bacterial Infections, Medical procedures (e.g., esophageal perforation)
- Pleural Effusion: Transudative (fluid imbalance - e.g., CHF, kidney failure, liver failure), Exudative (local inflammation/damage - e.g., TB, pneumonia, cancer)
- Hemothorax: Spontaneous (e.g., coagulopathy, pulmonary infarction, lung/pleural cancer), Trauma (e.g., lung/heart surgery, CVC placement)
- Pneumothorax: Spontaneous (e.g., primary, secondary), Traumatic (e.g., MVA, GSW, stab wound, contact sports), Tension (life-threatening, air leaks, tracheal deviation, mediastinal shift, common causes: PSP, trauma, iatrogenic, mechanical)
Empyema
- Caused by bacterial infections (e.g., pneumonia), medical procedures (e.g., surgery)
- Involves accumulation of pus in the pleural space
Pleural Effusion
- Transudative
- Caused by systemic factors like fluid imbalance (e.g., CHF, kidney failure, liver failure)
- Exudative
- Caused by local inflammation or damage (e.g., TB, pneumonia, cancer)
Hemothorax
- Spontaneous
- Caused by coagulopathy, pulmonary infarction, or lung/pleural cancer
- Trauma
- Caused by lung or heart surgery, or CVC placement
Pneumothorax
-
Spontaneous:
- Primary: no prior lung pathology
- Secondary: compromised pulmonary function (e.g., TB, COPD, CF, Asthma)
- Traumatic: Injury-related (e.g., MVA, GSW, stab wound, contact sport)
- Tension: Life-threatening, air trapped between the pleura and lung; tracheal deviation, mediastinal shift
Pathophysiology
- Intrapleural pressure is normally negative
- Air in the pleural cavity causes positive pressure
- Lung compression & collapse
- Vital capacity decrease, mediastinal shift
Intrapulmonary Pressure
- Intrapulmonary pressure decreases during inspiration and increases during expiration
Spontaneous Pneumothorax
- Sudden onset without an injury
- PSP: no underlying lung pathology - tall, thin male smokers
- SSP: compromised pulmonary function (TB, COPD, CF, Asthma)
Traumatic Pneumothorax
- Injury related (MVA, GSW, stab wound, contact sports)
- Medical procedures (lung biopsy, CVC placement)
Tension Pneumothorax
- Air leaks and is trapped between the pleura and lung
- Tracheal deviation and mediastinal shift (common causes: PSP, trauma/iatrogenic, mechanical)
Recognize Cues
- Pleuritic pain
- Tracheal deviation
- Hyperresonance
- Sudden onset of dyspnea with decreased breath sounds and absent fremitus
Risk factors for collapsed lung
- Chest injury
- Lung diseases (e.g.TB, COPD, CF)
- Spontaneous Pneumothorax
- Smoking
- Genetics (male, 20-40 year olds)
Screening Tests
- Medical history, physical exam
- Laboratory tests, Imaging tests (e.g. CT, MRI, CXR, Ultrasound)
- Endoscopy
- Thoracentesis
Surgical Intervention
- Pleurodesis: Adhesion of the lung to the chest wall
- Talc pleurodesis: Injecting talc into the pleural space
- Pleurectomy/decortication: Removing fibrous tissue over the lung, chest wall, and diaphragm, to re-expand the lung and restore chest wall compliance.
- Thoracotomy (surgical opening to gain access into the pleural space)
Types of Thoracotomy
-
Wedge resection
-
Segmentectomy
-
Lobectomy
-
Pneumonectomy
-
Types of Thoracotomy incisions:
- Anterolateral
- Axillary
- Posterolateral
Chest Tube Indication
- Promote lung re-expansion
- Restore negative pressure
- Prevent returning air to the pleural space
Nursing Management
- Main Goal Pain management, breathing/oxygenation, tube placement/positioning
- Dressing/insertion site care, monitor tubes (patent and securely connected; drainage amount and character; water seal & suction; keep system below patient's chest level)
- Bedside equipment (O2, nasal cannula, suction, Kelly clamps, sterile NSS bottle, occlusive dressings)
- Transport of patient, collection device position (below chest level)
Evaluation Indicators for Chest Tube Removal
- Clear breath sounds bilaterally
- Symmetric expansion of the chest
- Absence of bubbling in the water seal
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz focuses on critical aspects of nursing management related to thoracic conditions, particularly involving chest tubes and pleural effusions. Test your knowledge on the indications, procedures, and nursing interventions essential for effective thoracic care. Ideal for nursing students or professionals seeking to enhance their understanding of thoracic patient management.
