MD4 Exam 2 study guide

Pneumothorax Tension Pneumothorax Hemothorax  Air in pleural space causing loss of neg pressure in chest cavity  Sx: Reduced breath sounds, Hyperresonance on percussion, poor movement of affected side, deviation of trachea  Interventions: -Stable/ Mild: No treatment needed -Severe- chest tube therapy is essential  Life threatening  Air continues to enter pleural space on inspiration, but not exit on expiration  Sx: extreme resp distress, cyanosis, distended neck veins, hemodynamic instability  Intervention -Immediate thoracostomy with a large bore needle -chest tube with water seal drainage  Bleeding in chest cavity  Sx: percussion on involved side produces a dull sound  Intervention -Chest tube therapy -Removal of blood from pleural space -Normalize breathing and prevent infection Rib Fracture Flail Chest  Increases risk of pneumothorax/ hemothorax and pulmonary contusion  Sx: pain in side of ribs post trauma  Interventions -Decreased pain so adequate gas exchange is maintained -no casting, molding or braces -Relieve pain and let ribs heal  Results from fractures of at least 2 close ribs resulting in inward movement of thorax  Sx: Paradoxical chest movement, dyspnea, cyanosis, tachycardia and hypotension, anxiety, SOB, pain  Interventions -humidified O2, pain management, deep breathing, positioning, secretion clearance by coughing and tracheal suctioning. Labs  ABG’s (respiratory alkalosis)  metabolic panel  Troponin  BNP  D-dimer Imaging  Pulmonary angiographygold standard Early Prevention  Passive/Active ROM- All extremities  Anti-embolism stockings  Avoid tight clothing  Eval for clotting risk  Instruct not to cross or massage legs  Instruct to avoid activities that result in Valsalva maneuver o Holding breath, baring down. Symptoms  Classic: dyspnea (sudden), sharp/ stabbing chest pain, restlessness, apprehension, feeling of impending doom, cough, hemoptysis  Tachypnea, pleural friction rub, tachycardia, S3/S4 hear sound, diaphoresis, fever, petechiae over chest, decreased oxygen saturation. Nursing interventions  Refrain from massaging/ compressing leg (DVT)  Assess for bleeding every 2 hrs  Measure abdominal girth every 8 hours  Surgery o Embolectomy Drug therapy o Inferior vena cava filtrations  Anticoagulants- prevent embolus enlargement and more clotting  Low-molecular Heparin (Lovenox) o Monitor Pt  Fibrinolytic drugs o APT Pulmonary Embolism ABG’s  Values Acidic pH: 7.35-7.45 Alkaline PaO2: 80-100 Alkaline PaCO2: 35-45 Acidic Acidic HCO3: 21-28 Alkaline  Respiratory Acidosis o Cause: hypoventilation, Obstruction o Sx: ineffective, shallow, rapid breathing o Care: oxygen, airway, ventilatory support, bronchodilators  Respiratory Alkalosis o Cause: Hyperventilation, salicylate toxicity o Sc: Rapid, deep respirations o Care: anxiety reduction, breathing into bag (rebreather technique)  Metabolic Acidosis o Cause: excess production of H ions (DKA, Aspirin, Kidney Failure, Diarrhea, Decreased HCO3) o Sx: dysrhythmias, bradycardia, weak periph pulses, hypotension, rapid deep respirations (Kussmaul), warm dry skin, hyperkalemia o Care: Admin insulin, admin antidiarrhea  Metabolic Alkalosis o Cause: Oral ingestion of excess amounts of antacids, vomiting, NG suction, increased HCO3 o Care: antiemetics, fluid and electrolyte replacement