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375 Exam 2
Thoracic Surgery and Chest Tubes
| Term | Definition |
|---|---|
| decortication | removal or stripping thick membrane from visceral pleura, allows for better lung expansion |
| lobectomy | removal of lung lobe, healthy part can expand better |
| thoracotomy | incision into the thoracic cavity; hiatal hernia, aortic aneurysm |
| VATS | less invasive, biopsy, repairs |
| Pre Op thoracic surgery | baseline pulmonary and CV status, emotional support, teaching of pulmonary hygiene, pain control, chest tube, ROM |
| Post Op thoracic surgery | assessment, vitals, pain control multimodal - oral, subq, IV, PCA, epidural, pulmonary hygiene, incision and dressing |
| pleural effusion | fluid buildup in the pleural space; change in pressure and membrane permeability |
| fractured ribs | pain with movement, deep breathing and coughing, shallow respirations, hypoxia, poor ventilation; usually ribs 5 - 9 |
| flail chest | fracture of 3 or more consecutive ribs in 2 or more places; paradoxical respirations, severe pain, dyspnea, cyanosis, diminished breath sounds; goal is adequate ventilation |
| pneumothorax | absent or decreased breath sounds, cyanosis, decreased chest expansion, sharp chest pain, tachycardia and tachypnea |
| pneumothorax interventions | diagnosed through x ray, dressing may be applied to open wound, administer oxygen, high fowler's, chest tube insertion |
| thoracentesis | can relieve symptoms by draining air or excess fluid from the pleural space |
| thoracentesis patient placement | upright with elbows on an overbed table and feet supported, tell the patient not to talk or cough during the procedure; orthopneic |
| thoracentesis post procedure | observe for signs of hypoxia and pneumothorax, verify breath sounds; encourage deep breaths to expand lungs |
| indications for a chest tube | pneumothorax, hemothorax, pleural effusion, post CABG, heart transplant, valve surgery; undergone VAT or a lobectomy |
| chest tube verification | x ray |
| chest tube insertion position | arm raised above the head on the affected side to expose mid axillary area; elevate HOB 45 to lower the diaphragm and reduce the risk for injury |
| chest tube insertion pain control | local anesthetic, pre and post medicate; careful observation of neuro and respiratory efforts |
| subcutaneous emphysema | can occur from air leaking into the tissue surrounding the chest tube insertion site; swelling and crackling felt upon palpation at the site |
| deep breathing post chest tube | reduces risk for atelectasis and shoulder stiffness; incentive spirometer, coughing, ROM exercise |
| chest tube dressing | changed daily, assess for inflammation or infection and culture as needed, according to policy; sterile technique; redress with occlusive dressing, date and time |
| chest tube management | all connections between chest tubes, drainage and drainage collector tight and taped; tubing loosely coiled, free falling below the insertion site; mark time of measurement and fluid level, never compress, milk or strip tubing |
| wet suction system | suction controlled by amount of water put in the chamber; suction connected to wall and dialed until gentle bubbling in suction chamber |
| dry suction system | preferred, easier to maintain; connect to patient, turn dial to suction, can be increased and decreased as needed |
| tidaling | normal, up with inspiration, down with expiration |
| fluctuation stop | problem is resolved, lung has re expanded; assess the chest tube immediately |
| bubbling | not normal, should not see; brisk bubbling may occur when pneumothorax is first evacuated |
| drain system overturn | if system tips over you need a new system |
| large amount of drainage | drainage of 100mL/ hour is too much |
| documentation of chest tube | lung sounds, secretions - describe, oxygen delivery device, chest tube location and system type |
| clamping a chest tube | not done unless right before discontinuation |
| chest tube disconnect from drainage unit | wipe both ends with alcohol and reconnect |
| chest tube pulls out of chest | EMERGENCY, place dressing taped on 3 sides - flutter valve; call provider and prep for insertion with new tube and drainage system |
| removal of chest tubes | pre medicate for pain relief, removed when lungs are re expanded, fluid drainage is minimal |
| breakage of drainage unit | place distal ends of chest tube in 2 cm water in sterile container, replace unit |
| flutter valve | used to remove air from the pleural space, allows for patient mobility |
| client education | cough and deep breathe, splint chest, sit upright; incentive spirometry hourly |
| tension pneumothorax | mediastinal shift occurs when the pleural space is injured and mediastinum pushes to the opposite side |
| 1st chamber | collection chamber, fluid collection |
| 2nd chamber | water seal chamber; contains 2 cm of water and acts as a one way valve so air comes in bubbles out and positive air cannot go back into patient |
| 3rd chamber | suction control chamber - wet or dry |
Created by:
ahommel
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