MSN 377: Exam 3 Questions And Answers Verified 100% Correct

MSN 377: Exam 3 Questions And Answers Verified 100% Correct What should be done following removal? - ANSWER When the lung is re-expanded or the fluid drainage is minimal/has ceased Prior to removal: -24 hours: chest tube to gravity/without suctioning --Making sure the lung remains inflated -30 - 60 minutes prior to removal: pre-medicate with pain meds -Pt should be instructed to hold breath while tube is pulled out After removal: -Occlusive petroleum bandage applied while tube is removed F/u CXR When might a thoracotomy be performed? What is the most common approach for a thoracotomy? - ANSWER Tumor Infection Trauma Posterolateral approach What surgical approach might be used instead of a thoracotomy due to reduced post-op pain, decreased length of stay, decreased morbidity, and few complications? - ANSWER Video-Assisted Thoracoscopic Surgery (VATS) What should be done (work up/education) prior to a thoracotomy or video-assisted thoracoscopic surgery? - ANSWER PFTs, ABGs: confirm respiratory stability Cardiac work up: determine if any heart involvement that should be addressed during the surgery Educate: -Smoking cessation for at least a month before the surgery to improve oxygenation Post-op expectations: oxygen, intubation, chest tubes What should be included in the post-op respiratory assessment for a patient following thoracic surgery? - ANSWER Respiratory rate, effort Sputum eval Lung sounds Chest tube drainage What is the respiratory condition where fluid accumulates in the pleural space, exerting pressure on the lung and decreasing gas exchange? What is this condition indicative of? - ANSWER Pleural effusion: fluid collection between the parietal and visceral pleura Indicative of disease What is the difference between transudate, exudate, and empyema when it comes to pleural effusion? - ANSWER Transudate: caused by an abnormality in the patient's fluid regulation system Exudate: inflammatory reaction to an external cause, resulting in edema Empyema: infection of transudate or exudate -CA/malgnancies, infxn What can cause fluid accumulation in the pleural space (ie pleural effusion)? - ANSWER Increased pulmonary capillary pressure (such as in HF) Decreased oncotic pressure (decreased albumin production in liver disease) Increased pleural membrane permeability (inflammation) Obstruction of lymphatic flow Dyspnea, cough, sharp chest pain that worsens with inhalation, decreased chest movement, diminished breath sounds, fever, night sweats, weight loss, and possible friction rub are all clinical manifestations of which respiratory complication? - ANSWER Pleural effusion How is pleural effusion corrected? - ANSWER Treat the underlying cause Thoracentesis *Monitor v/s, pulse-x, s/s respiratory distress, CXR What treatment for pleural effusion involves chemical injection into the pleural space via a chest tube that causes an inflammatory process, resulting in fusion of the parietal and visceral pleura? When is this used to treat pleural effusion? - ANSWER Chemical pleurodesis Done for patients who have recurrent pleural effusion What treatment for pleural effusion involves removing part or all of the pleural tissue? - ANSWER Decortication When is pneumonia diagnosed as medical care-associated pneumonia? - ANSWER When the patient has been hospitalized for 48 - 72 hours before s/s of pneumonia develop What organisms are the most common cause of pneumonia? What organisms are the most common cause of pneumonia in immunocompromised individuals? - ANSWER Common causes: bacteria, viruses Immunocompromised: fungus, parasites What are the four main types of pneumonia? - ANSWER 1.) Community acquired pneumonia 2.) Medical care-associated pneumonia 3.) Aspiration pneumonia 4.) Opportunistic pneumonia Abdominal or thoracic surgery, > 65 y/o, air pollution, altered consciousness, bed rest, prolonged immobility, chronic disease, exposure to animal feces, immunosuppressive disease/therapy, inhalation/aspiration of noxious substances, intestinal/gastric feedings, IV drug use, malnutrition, abx therapy, LTC facility resident, smoking, intubation, and URI are all risk factors for developing what respiratory condition? - ANSWER Pneumonia What organism causes necrotizing pneumonia? What complication arises with this specific infection? - ANSWER Staph aureus Immediate respiratory insufficiency/failure, leukopenia, bleeding into airways *Rare