Chest Tubes and Tracheostomy's (Ch. 28 &30) Exam 2 -Solved 2023

Increased air and fluid in the pleural space causes: - ANSWER--Deviation of the heart, trachea and other lung. Conditions that require pleural drainage by chest tube: - ANSWER--A rupture on the surface of the lung (allowing air and/or fluid to escape into the pleural space while the chest remains intact) -A penetration into the chest wall allowing external air/fluid from within the body to enter the pleural space Pneumothorax - ANSWER-Air that has entered the pleural space. -Trauma, mechanical ventilation (overexpansion), spontaneous, tension -Can develop during the tracheotomy procedure if the chest cavity is entered Hemothorax - ANSWER-Blood that has entered the pleural space. -Thoracic surgery, chest trauma, rib fractures. Pleural Effusion - ANSWER-Increase in the pleural fluid. -Common with lung and breast cancer Empysema - ANSWER-Accumulation of pus in the pleural cavity. Chlyothorax - ANSWER-Accumulation of lymphatic fluid in the pleural cavity. Spontaneous Pneumothorax - ANSWER-More prevalent in young men who are tall, slender build perhaps associated with a growth spurt where the chest wall grows faster than the rest creating a discrepancy in the pleural fluid/space. Tension Pneumothorax - ANSWER-When air continues to leak into the pleural space with no way of escape. Creates rapid build up of pressure and the pressure becomes positive causing the lung to completely collapse. -The heart can become displaced leading to decreased cardiac output. -Moves to one side of the chest. Tension Pneumothorax S/S - ANSWER-Increased RR and effort, dyspnea, chest pain, decreased movement on the effected side of the chest, decreased breath sounds, falling BP, rising pulse, tracheal deviation. Pneumothorax S/S - ANSWER-Shortness of breath, cyanosis, chest pain, absent or diminished breath sounds, increased respiratory effort, increased respiratory rate, asymmetrical chest rise, subcutaneous crepitus, increased pulse, tracheal deviation. B: 17-year old male with tall, slender build - ANSWER-Who is at most risk of a spontaneous pneumothorax? A: 32 year old asthmatic female B: 17 year old male with tall, slender build C: 24 year old male motocross racer D: 45 year old female with breast cancer What is the purpose of a Chest Tube? - ANSWER-There's air, blood, pus, or a combination of those in the pleural space causing problems. By removing those things with a chest tube, we can alleviate the pressure and invite the lung to reinflate. -Allows air and fluid to escape the pleural space but not re-enter. Where is the chest tube inserted? - ANSWER--If the purpose is to drain air, it is normally inserted near the second intercostal space. -If fluid is to be removed, it is usually placed between the 5th and 6th intercostal space. -Sometimes two tubes are used at each location if air and blood are present. What is the purpose of petroleum gauze on the insertion site of a chest tube? - ANSWER-To help create an airtight seal. How long is the tube for a chest tube? - ANSWER-6 feet. What is the first chamber in the chest tube system? - ANSWER-The collection chamber. -Fluid and blood collect and can be measured - typically every hour for the first 24-hours -The air escapes through the tube into the second chamber. What is the second chamber in the chest tube system? - ANSWER--Water Seal -Filled with 2 cm of water -Allows air to escape through the water and up into the tube at the top, but not air to backflow up the tube and into the pt. -Tidaling movement of the water in the chamber to follow the inhalation and exhalation in the lungs. -The water bubbles from the trapped air in the pleural space being sucked into the water seal. What is the third chamber in the chest tube system? - ANSWER--Suction control Chamber. -Controls the amount of negative suction applied in the pleural space. -the gentle bubbling is caused by the air that escaped from the water seal chamber when it goes up and out of the third chamber and the pull from the suction will create a gentle bubbling in this chamber as it pulls on the water filled chamber. Advantages of using a wet system chest tube: - ANSWER--The negative pressure needed can be evaluated more closely allowing the clinician to see the changes in the water level as it related to healing. Disadvantages of using a wet system chest tube: - ANSWER--The water can evaporate, so it must be monitored frequently to consider refilling. -If the unit is knocked over, it must be replaced. Advantages of using a dry system chest tube: - ANSWER--It can be knocked over and it is relatively easy to set up. Disadvantage of using a dry system chest tube: - ANSWER--It cannot be assessed as precisely as a wet system. What is normal in the chest tube experience? - ANSWER--Drainage in the collection chamber