Pleural Disorders - Copy.pptx PDF

LAKELAND COMMUNITY COLLEGE NURS 1250 NURSING CARE OF ADULTS II CONCEPTS OF OXYGENATION: PLEURAL DISORDERS ROWENA A. BAUTISTA, MSN, RN, CMSRN  OVERVIEW Pleura – tissue that covers the outside of the lungs and lines the inside of the chest cavity. —Vi...

LAKELAND COMMUNITY COLLEGE NURS 1250 NURSING CARE OF ADULTS II CONCEPTS OF OXYGENATION: PLEURAL DISORDERS ROWENA A. BAUTISTA, MSN, RN, CMSRN  OVERVIEW Pleura – tissue that covers the outside of the lungs and lines the inside of the chest cavity. —Visceral is the inner layer that covers the lungs. —Parietal is the outer layer that lines the chest wall and diaphragm.  PLEURAL DISORDERS Pleurisy (Definition?) Empyema Pleural Effusion What is in the pleural Hemothorax space? Pneumothorax  COMMON ETIOLOGY Pleural Hemothora Pneumoth Pleurisy Empyema Effusion x orax Bacterial Transudat Spontane PSP Infection Infections ive ous Idiopathic Autoimm Iatrogeni une Exudative Trauma Trauma c Disease Pulmonar y Condition s  EMPYEMA Bacterial Medical Infections Streptococcus Procedures Thoracic surgery pneumoniae Esophageal perforation Staphylococcus aureus  PLEURAL EFFUSION Transudative – caused by systemic factors like fluid imbalance. Ex: CHF, Kidney Failure, Liver Failure Exudative – caused by local inflammation or damage. Ex: TB, Pneumonia, Cancer  HEMOTHORAX Spontaneous Ex: Coagulopathy, Pulmonary infarction, Lung or pleural cancer Trauma Ex: Lung or heart surgery, CVC placement  PNEUMOTHORAX Spontaneo Traumatic Tension us Primary Trauma Life-threatening Spontaneous Iatrogenic Pneumothorax Secondary Spontaneous Pneumothorax  Intra-pleural pressure is PATHOPHYSIOLOGY normally negative Spontaneous Trauma Air accumulates in pleural cavity and built-up positive pressure Lung will compress and collapse Vital capacity of affected lung will decrease and there will be mediastinal shift INTRAPLEURAL PRESSURE  SPONTANEOUS PNEUMOTHORAX Sudden, without an injury PSP – no preexisting lung pathology —Tall, thin male, smoker SSP – compromised pulmonary function —TB, COPD, CF, Asthma  TRAUMATIC PNEUMOTHORAX Injury-related —MVA, GSW, stab wound, contact sport Medical Procedures —Lung biopsy, CVC placement  TENSION PNEUMOTHORA X Air leaks and trapped between the pleura and lung. Tracheal deviation. Mediastinal shift. Common cause: —PSP, trauma, iatrogenic,  Pleuritic pain RECOGNIZE P CUES T Tracheal deviation H Hyperresonance O Onset sudden R A ↓ breath sounds and dyspnea X Absent fremitus X-ray shows collapse SCREENING TESTS Medical History and Physical Exam Laboratory Tests Chest CT, MRI, CXR, Ultrasound Endoscopy Thoracentesis — test for infection, cancer SURGICAL INTERVENTION Pleurodesis – involves adhesion of the lung to the chest wall Talc pleurodesis – injection of talc into the pleural space SURGICAL INTERVENTION Pleurectomy/ Decortication —removal of the fibrous tissue over the lung, chest wall, and diaphragm. —allows lung re-expansion. —chest wall compliance returns.  SURGICAL INTERVENTION Thoracotomy – surgical opening to gain access into the pleural space. Pain management — Patient Controlled Epidural Anesthesia (PCEA) — Patient Controlled Analgesia (PCA)  TYPES OF THORAC OTOMY Wedge resection Segmentectom y Lobectomy Pneumonectom y Extrapleural pneumonectom y TYPES OF THORACOTOMY INCISION  Type of Incision Disadvanta Thoracoto Advantage Location ge my 5th or 6th ICS Anterolater TYPES Quick below the OF access THORACOTOMY Potential pectoralis during cosmetic al major to mid- INCISIONconcerns. emergency. axillary line. Muscle-sparing, 4 or 5 ICS in th th Less suitable decreasing post- Axillary the underarm op pain. Better for other major area. surgeries. cosmetic results. 5th or 6th ICS Larger incision. from the Gold standard for Increased Posterolat scapula to the complex lung postop pain eral PLEURAL DISORDE RS: CHEST TUBES  CHEST TUBE INDICATION To promote lung re- expansion. Restores negative pressure. Prevents air from returning to the pleural space.  NURSING MANAGEMENT Main Goal: pain management. Breathing and oxygenation. Tube placement and patient positioning. Dressing and insertion site care.  NURSING MANAGEMENT Tubes are patent and connected securely. Drainage amount and characteristics. Assess water seal & suction. Keep system below patient’s chest level.  NURSING MANAGEMENT Must be available at bedside: — O2, nasal cannula, suction — Kelly clamps — Bottle of sterile NSS — Occlusive dressings  NURSING MANAGEMENT All patients need to travel by cart for testing. Keep the collection device below chest level and upright all the time. Note/document drainage in the collection device prior to transport.  Feature Dry Wet Suction Suction No water Requires Setup needed water Suction Mechanical Water column Control regulator Bubbling Visual Dial or air shows suction Indicator leak indicator is active Modern Still used in Common Use preference some settings EVALUATE OUTCOMES: INDICATION FOR REMOVAL Clear breath sounds bilaterally. Chest expansion is symmetrical. Absence of bubbling in water seal