Chest Tubes:
Pneumothorax
- Caused by air in pleural cavity
- Mild tachy, chest pain, cough, absent breath sounds
- Iatrogenic
• Caused by medical problems (Central line, thoracentesis)
- Traumatic penetrating
• Do not remove penetrating object
- Traumatic Blunt
• Lung laceration
• Alveolar rupture
- Tension pneumothorax
• Tracheal deviation!!!!!!!!
Treatment: Thoracentesis, chest tubes
Hemothorax
- Blood in pleural space
Treatment: Chest tube
Hemopneumothorax
- Blood and air in pleural space
Treatment: Chest tube
Chest tube Nursing management
- Maintain patent drainage system
- Observe tidaling
- Observe air leak
- Review medications for anticoagulation meds
- Review for allergies
- Assess pt status
- Encourage deep breathing
- Monitor for complications
- Dressing care
- DO NOT ELEVATE SYSTEM ABOVE CHEST
, - Change atrium when full
- Measure fluid level
- Report >100mL/hr
Perioperative Care:
Risk factors
- Age (Liver, kidney) (more risk for old ppl)
- Immunocompetence (immune system over surveillance) (cancer, HIV, transplant)
- Fluid and electrolyte (hydration status)
- Nutrition (healing process)
- Pregnancy (might not perform)
- Sleep apnea (respiratory issues)
- Obesity (amount of meds, bed retracting)
- Coagulation (blood clots, bleeding risk, heparin, lovenox, aspirin)
-
Diagnostics:
- CMP/BMP
- CBC -> HH, WBC
- PT, PTT, INR
- LFTs
- Type and screen/crossmatch
- BG
- Albumin
- hCG
- EKG
- ECHO
- Chest xray
CONSENT IS OBTAINED BY THE SURGEON
NURSE WAY WITNESS SIGNATURE
, Surgical Consent IDD
1. Pts spouse
2. Pts adult child
3. Pts parent or stepparent
4. Pts adult sibling
5. Pts relative
6. Adult who has exhibited special care and concern or the pt
Circulating Nurse
- Not sterile
- Facilitates progress of surgery
Sterile Nurse
- Sterile
- Documents
Anesthesia Types
Moderate:
- Conscious
- Wisdom teeth
- Does not require advanced airway
- Does not require anesthesiologist
General:
- Requires CRNA, anesthesiologist
- Combo of gas and IV
- Required advanced airway
- Appendectomy / CABG
Local:
- Loss of sensation at site without LOC
- Cavity/ filling/ lidocaine
Regional:
Pneumothorax
- Caused by air in pleural cavity
- Mild tachy, chest pain, cough, absent breath sounds
- Iatrogenic
• Caused by medical problems (Central line, thoracentesis)
- Traumatic penetrating
• Do not remove penetrating object
- Traumatic Blunt
• Lung laceration
• Alveolar rupture
- Tension pneumothorax
• Tracheal deviation!!!!!!!!
Treatment: Thoracentesis, chest tubes
Hemothorax
- Blood in pleural space
Treatment: Chest tube
Hemopneumothorax
- Blood and air in pleural space
Treatment: Chest tube
Chest tube Nursing management
- Maintain patent drainage system
- Observe tidaling
- Observe air leak
- Review medications for anticoagulation meds
- Review for allergies
- Assess pt status
- Encourage deep breathing
- Monitor for complications
- Dressing care
- DO NOT ELEVATE SYSTEM ABOVE CHEST
, - Change atrium when full
- Measure fluid level
- Report >100mL/hr
Perioperative Care:
Risk factors
- Age (Liver, kidney) (more risk for old ppl)
- Immunocompetence (immune system over surveillance) (cancer, HIV, transplant)
- Fluid and electrolyte (hydration status)
- Nutrition (healing process)
- Pregnancy (might not perform)
- Sleep apnea (respiratory issues)
- Obesity (amount of meds, bed retracting)
- Coagulation (blood clots, bleeding risk, heparin, lovenox, aspirin)
-
Diagnostics:
- CMP/BMP
- CBC -> HH, WBC
- PT, PTT, INR
- LFTs
- Type and screen/crossmatch
- BG
- Albumin
- hCG
- EKG
- ECHO
- Chest xray
CONSENT IS OBTAINED BY THE SURGEON
NURSE WAY WITNESS SIGNATURE
, Surgical Consent IDD
1. Pts spouse
2. Pts adult child
3. Pts parent or stepparent
4. Pts adult sibling
5. Pts relative
6. Adult who has exhibited special care and concern or the pt
Circulating Nurse
- Not sterile
- Facilitates progress of surgery
Sterile Nurse
- Sterile
- Documents
Anesthesia Types
Moderate:
- Conscious
- Wisdom teeth
- Does not require advanced airway
- Does not require anesthesiologist
General:
- Requires CRNA, anesthesiologist
- Combo of gas and IV
- Required advanced airway
- Appendectomy / CABG
Local:
- Loss of sensation at site without LOC
- Cavity/ filling/ lidocaine
Regional:
