Podcast
Questions and Answers
What is the primary difference between an open pneumothorax and a closed pneumothorax?
What is the primary difference between an open pneumothorax and a closed pneumothorax?
- A closed pneumothorax is always a tension pneumothorax, while an open pneumothorax is not.
- An open pneumothorax involves air entering through a chest wall defect, while a closed pneumothorax involves air entering through a defect in the lung tissue. (correct)
- An open pneumothorax only causes partial lung collapse, while a closed pneumothorax always causes total collapse.
- An open pneumothorax requires a chest tube for treatment, while a closed pneumothorax resolves spontaneously.
A patient with a suspected tension pneumothorax is exhibiting anxiety, restlessness, and decreased oxygen saturation. Which additional assessment finding would most strongly support this diagnosis?
A patient with a suspected tension pneumothorax is exhibiting anxiety, restlessness, and decreased oxygen saturation. Which additional assessment finding would most strongly support this diagnosis?
- Increased tactile vocal fremitus on the affected side.
- Presence of a sucking chest wound.
- Hyperresonance to percussion on the affected side. (correct)
- Normal blood pressure and heart rate.
Why is a three-sided occlusive dressing used for an open chest wound in the context of a pneumothorax?
Why is a three-sided occlusive dressing used for an open chest wound in the context of a pneumothorax?
- To promote blood clotting and prevent hemothorax.
- To administer medication directly into the pleural space.
- To completely seal the wound and prevent any air from entering or exiting the pleural space.
- To allow air to escape from the pleural space during exhalation while preventing air entry during inhalation. (correct)
Which of the following nursing interventions is most important when caring for a patient with a chest tube connected to a water seal drainage system?
Which of the following nursing interventions is most important when caring for a patient with a chest tube connected to a water seal drainage system?
What does tidaling (fluid movement in the water seal chamber with respiration) in a chest tube drainage system typically indicate?
What does tidaling (fluid movement in the water seal chamber with respiration) in a chest tube drainage system typically indicate?
When should the healthcare provider be notified regarding chest tube drainage?
When should the healthcare provider be notified regarding chest tube drainage?
What is the immediate priority if a chest tube is accidentally dislodged from a patient?
What is the immediate priority if a chest tube is accidentally dislodged from a patient?
In the water seal chamber of a chest tube drainage system, continuous bubbling is observed. What does this indicate?
In the water seal chamber of a chest tube drainage system, continuous bubbling is observed. What does this indicate?
Which assessment finding in a patient with a chest tube would indicate that the lung is re-expanding as expected?
Which assessment finding in a patient with a chest tube would indicate that the lung is re-expanding as expected?
In the context of chest tube management, what is the purpose of the water seal?
In the context of chest tube management, what is the purpose of the water seal?
Flashcards
Pneumothorax
Pneumothorax
Air enters pleural space, causing lung collapse
Open Pneumothorax
Open Pneumothorax
Air enters pleural space through chest wall hole
Closed Pneumothorax
Closed Pneumothorax
Air enters pleural space through lung tissue hole.
Tension Pneumothorax
Tension Pneumothorax
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Tracheal Deviation
Tracheal Deviation
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Three-Sided Occlusive Dressing
Three-Sided Occlusive Dressing
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Chest Tube System
Chest Tube System
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Tidaling
Tidaling
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Petroleum Gauze
Petroleum Gauze
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Study Notes
Pneumothorax
- Air enters the pleural space, leading to partial or total lung collapse.
- Open pneumothorax occurs when air enters the pleural space through a chest wall hole, like a gunshot wound.
- Closed pneumothorax happens when air enters the pleural space through a lung tissue hole, such as after lung surgery or central line placement.
- Hemothorax is when blood accumulates in the pleural space between the lung and chest wall.
Tension Pneumothorax
- Tension pneumothorax is a closed pneumothorax where air enters the intrapleural space but cannot escape.
- It can cause collapse of both the affected and possibly unaffected lungs.
- This leads to tracheal deviation away from the affected side and compression of heart and vasculature, causing hypotension.
Clinical Features
- Hypoxia is a key feature.
- Collapsed lung manifests as progressive dyspnea, restlessness, anxiety, cyanosis, chest pain (with hypotension and tachycardia), and low O2 saturation.
- A chest X-ray can confirm the diagnosis in stable clients.
Assessment Findings
- Hyperresonance to percussion is present.
- Breath sounds are diminished on the affected side.
- Tactile vocal fremitus is decreased.
- Hypotension also occurs.
Nursing Interventions
- Apply a three-sided occlusive dressing over the chest wound to create a one way valve.
- Position the patient in Fowler's position.
- Prepare a chest tube connected to a water seal drainage system to allow air to escape while preventing re-entry, to reestablish negative pleural air pressure.
Drainage Collection System
- The collection chamber measures and collects fluid.
- The water seal chamber exits through a one-way valve.
- Tidaling (fluid movement with breathing) is expected, but bubbling indicates an air leak.
Suction Chamber
- Negative pressure is applied to the system.
- Continuous bubbling occurs with a wet seal chamber, whereas no bubbling indicates a dry seal chamber.
Other Interventions
- Administer pain medications.
- Ensure the chest tube has no kinks, leaks, or dependent loops.
- Monitor drainage volume and characteristics; notify the healthcare provider (HCP) if drainage exceeds 100 mL/hr or sudden bright red drainage occurs.
- Keep the collection device below the insertion site.
- Reinforce the occlusive dressing if drainage is visible.
- Ensure appropriate X-rays are taken after changes in chest tube status or after removal.
Chest Tube Removal
- In an unplanned chest-tube removal, stay calm.
- Immediately cover the open insertion site with a gloved hand and call for help while staying with the patient.
- Apply petroleum gauze, dry gauze, and tape to complete the dressing.
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