Oxygenation: Pleural Disorders (SP Fall 2024) PDF

OXYGENATION: Nursing Care of the Patient with Alterations in Oxygenation PLEURAL DISORDERS NURS 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN  TYPES Pleural Effusion...

OXYGENATION: Nursing Care of the Patient with Alterations in Oxygenation PLEURAL DISORDERS NURS 1250/1610 Victoria Leonetti, MSN, RN Emily Raddell, MSN, RN  TYPES Pleural Effusion (what is in pleural OF space?) PLEURAL Hemothorax (what is in pleural space?) DISORDE Pneumothorax (what is in pleural RS (DISCUSSED IN THIS space?) COURSE) OVERVIEW: The goal is to do what with pleural disorders? ? THE PLEURA – WHAT IS IT? WHAT DOES IT DO? Consists of a two- layered membrane that covers each lung (visceral & parietal pleura) The layer is separated by a small amount of lubricant known as pleural fluid in the pleural cavity Helps cushion the lungs and reduce any friction PATHOPHYSIOLOGY Fluid build-up between the lung and chest (between the visceral/parietal pleural layers) Fluid, air, particles move into the pleural space due to: Its low pressure Ability to hold large amounts of liquid or air “potential space” Small amount of serous fluid “lubricant” normally here (roughly 20-50mL) Allows visceral/parietal pleurae to glide over each other without friction Allows pleural surfaces to adhere to each other  Heart Failure Pneumonia (40% involve an effusion) Malignancies Malnutrition Low protein  fluid leaves vascular system) Blunt or penetrating trauma Chest surgeries Emphysema PLEURAL EFFUSIONS: Infection ETIOLOGY & RISK FACTORS PREVENTION Many causes Frequently results from disease centered elsewhere in the body No universal way to prevent pleural disease Reduce risk of contracting tuberculosis Avoid asbestos exposure CLINICAL MANIFESTATIONS 1. 2. 3. 4. 5. 6. 7.  CXR confirmatio n Patient history and exam Thoracente sis Diagnostic DIAGNOSTICS versus therapeutic PLEURAL EFFUSION – XRAY PATHOPHYSIOLO GY: PNEUMOTHORAX Air entry into the pleural space Causes a loss of negative pressure needed to produce lung expansion Pressure between pleural space and outside the body is equalized Loss of vacuum effect = lung collapse PNEUMOTHORAX TYPES Spontaneous: no known causes Traumatic Injury Primary & Secondary (with or without lung disease)  1. PNEUMOT HORAX 2. ETIOLOGY 3. AND RISK 4. FACTORS 5. SIGNS & SYMPTOMS- PNEUMOTHORAX Pain: often sharp during inhalation Note: pain is located on the side that is affected SOB Absent breath sounds over the affected area PNEUMOTHORAX TREATMENT What is the size of the pneumothorax? SURGICAL INTERVENTIONS: PLEURODESIS Injection of an irritating agent into the pleural space Talc pleurodesis 60-80% effective SURGICAL INTERVENTIONS: DECORTICATION Surgical procedure that removes a restrictive layer of fibrous tissue over the lung, chest wall, and diaphragm Performed when a thick, inelastic pleural peel is present SURGICAL INTERVENTION THORACOTOMY Access to the thoracic cavity Emergency access Massive hemothorax Non-emergent Lung resection Cardiac surgery Esophageal surgery Remove tumors or lung abscesses Biopsies SURGICAL INTERVENTION THORACOTOMY: TYPES Posterolateral Muscle sparing (latissimus dorsi) Anterior approach THORACOTOMY – NURSING CARE Pain management is key! Pain after thoracotomy may be severe Impairs ability to cough and deep breathe Thoracic epidural catheters Anesthetic and opioid analgesia can be used Patient Controlled Epidural Analgesia (PCEA) Patient Controlled Analgesia (PCA) CHEST TUBE: NURSING CARE Place collection chamber below chest Be sure tubing is free of dependent loops and kinks Bubbling? Constant bubbling=leak! Document drainage Encourage Deep Breathing/Incentives Spirometer Encourage ambulation (keep collection upright) Control Pain Check for subcutaneous emphysema THORACOTOMY AND CHEST TUBE COMPLICATION Subcutaneous emphysema (crepitus) Escaped air from pleural space to SQ tissue SNAP, CRACKLE, POP! WHAT IS THE OVERALL GOAL OF CHEST TUBE THERAPY?? 1. 2. 3. 4. CHEST TUBE