NURS 403 Exam 1Questions with 100% Correct Answers

What's the leading cause of chest trauma? - Correct Answer Motor vehicle accidents What are the 6 P's? - Correct Answer Pain Pallor Pulselessness Paresthesia Paralysis Poikilothermia What are the two classifications of chest trauma? - Correct Answer *Penetrating* & *Blunt* Chest Trauma What is a blunt chest trauma? - Correct Answer Sudden, blunt object compresses the chest. The object that strikes the patient compresses the thoracic structures (heart, diaphragm, lungs) & can cause major ABC issues It can look fine externally, but may have major internal problems What is a penetrating chest trauma? - Correct Answer Foreign body causes an open wound, passes through body tissue & pierces major vessels organs etc. The severity of the trauma depends on the location of wound (i.e someone who was stabbed in the LV is worse off than someone who was stabbed superficially by a pencil) What is a pneumothorax? - Correct Answer It's an accumulation of air in the pleural space (area in which the lungs lie) This changes the normal negative pressure cavity into a positive pressure area (causing the lung to collapse) Why are pneumothoraxes concerning? - Correct Answer The pressure changes can result in lung collapse -- as the amount of air increases in the pleural space, the less volume (inflation/deflation) the lung has to expand, which causes *decreased oxygenation* What does iatrogenic mean? What would an iatrogenic pneumothorax be caused by? - Correct Answer Illness caused by a healthcare worker May be the result of a thoracentesis, central line insertion, Barotrauma (d/t positive pressure mechanical ventilation altering alveolar/interstitial pressure -- potential alveolar rupture) What clinical manifestations are present with a pneumothorax? - Correct Answer Asymmetrical chest expansion (pressure on the affected side decreases lung expansion) Absent lung sounds on affected side (d/t pressure on the lung) Lower oxygen saturation (one lung has potentially collapsed buddy) Cyanosis & Pain (it's gonna hurt, & you'll have a decrease in oxygenated blood -- cyanosis) Diaphoretic (it's harder to breath, body is working harder) Tachycardia (compensatory mechanism) Retractions & accessory muscle use Subcutaneous emphysema (crackles under the skin from air being there) Anxious, agitated, LOC changes What's one of the first symptoms you see w an oxygenation issue? - Correct Answer Agitation, anxiety & altered LOC d/t decreased oxygenation What is a tension pneumothorax? - Correct Answer Air enters the pleural space, but it cannot exit -- with each breath the pt. takes, the more air that compresses organs in the thoracic cavity. Results in a mediastinum shift as everything moves across the midline *Life-threatening* What clinical manifestations are present with a tension pneumothorax? - Correct Answer *Tracheal deviation* (d/t pressure & mediastinum shift) Absent breath sounds on affected side & asymmetrical chest movement O2 Sats super low JVD (d/t high intrapleural pressure) Hypotension & decreased CO d/t pressure on the heart/aorta In the hospital setting, what causes tension pneumothoraxes? - Correct Answer Mechanical ventilation Clamped or blocked chest tubes What can occur if tension pneumothorax isn't treated? - Correct Answer They'll die of hypoxemia What is a pleural effusion? - Correct Answer Excess pleural fluid inside the pleural space What does pleural fluid assist with? - Correct Answer It helps with friction that occurs d/t expansion of the lungs in the pleural space What is a hemothorax? - Correct Answer Blood in the pleural space associated w some type of injury What is a chylothorax? - Correct Answer Lymphatic fluid in the pleural space Often occurs w *cancer* What is a pyothorax? - Correct Answer Yucky purulent fluid in the pleural space Often caused by a lung abscess, bacterial pneumonia, or tuberculosis. What's the most definitive treatment of a pneumothorax? - Correct Answer Chest tube Whats the treatment for a tension pneumothorax? (emergent) - Correct Answer Needle decompression and then putting in a chest tube If an individual is stabbed (penetrating chest trauma), what steps are taken to secure the knife? What should be done if the knife is removed (on accident)? - Correct Answer Don't remove it (atmospheric air will flow into pleural space) Foreign body stabilization / dressing is done -- stabilization with tape & gauze If removed; Cover wound with an occlusive dressing and tape on *3 sides* (this allows air within the pleural cavity to be expelled into the atmosphere while preventing atmospheric air from entering the pleural cavity) When are thoracentesis usually utilized for a chest trauma? - Correct Answer Usually associated with a chylothorax or a thoracic empyema (ultrasound guided) What procedures are done for those that get frequent pneumothoraxes? - Correct Answer Pleurectomy, which is the removal of that pleural space (the benefit of not having a pleural space outweighs the risk) Pleurodesis, which is done to produce adhesions between parietal and visceral lining (either chemically or mechanically) What's a common complication of rib fractures? why? - Correct Answer Pneumonia (Rib fractures hurt, which results in less coughing, deep breathing. They get atelectasis - collapsed alveolar sacs) Pneumothorax (Broken ribs can be jagged or sharp, which can lacerate the lung/pleural space) What's the treatment for rib fractures? - Correct Answer Treat the pain, prevent respiratory complications Splint area, give them oxygen, raise HOB to ease breathing, administer medications (opioids, NSAIDS) What's the definition of a flail chest? - Correct Answer It's a rib fracture consisting of 3 or more broken ribs (in a row) and those 3 ribs have to be fractured in 2 or more places It's an unstable segment of bone (a free segment) That flail piece is not contributing to lung expansion which causes instability of that chest wall. What's the hallmark sign of Flail Chest? - Correct Answer *Paradoxical chest movement* d/t the lack of lung expansion & instability of that chest wall Tachypnea Shallow respirations (can't take a full deep breath) Tachycardia (compensating)