chest trauma
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| Describe what happens in blunt trauma to chest? | when the chest strike or is struck by an object the impact can cause deceleration, acceleration, shearing and compression of thoracic structures. The external injury may appear minor but but internally the organs may have severe injuries
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| Describe a penetrating trauma to the chest | It is an open injury in which a foreign body impales or passes through the body tissues, creating an open wound. Severity depends on location and if an organ is struck
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| What is a pneumothorax? | Air entering the pleural cavity positive pressure in lung cavity causes the lung to collapse it can be open or closed
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| Describe an open pneumothorax | Air enters through an opening in the chest wall/ parietal outer lining.
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| Describe a closed pneumothorax | The visceral inner lining of the pleural cavity is disrupted . Air enters the pleural space from the lung. There is NO external wound
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| What diagnostic test is used to diagnose a pneumothorax and what are the results if there is one? | A chest Xray is used and the results show air/fluid in the pleural space and reduction in the lung volume
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| Clinical manifestations of a pneumothorax | mild tachypnea
dyspnea
severe respiratory depression
chest pain
cough
hemoptysis
tachycardia
Absent breath sounds over affected area.
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| What is a spontaneous pneumothorax? | It occurs due to the rupture of small blebs ( air filled blisters) located on the apex of the lung.
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| what is PRIMARY spontaneous pneumothorax | When blebs occur in healthy young individuals
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| What is SECONDARY spontaneous pneumothorax | Bleb occur as a result of lung disease like COPD, asthma, cystic fibrosis and pneumonia
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| What habit increases the risk for bleb formation? | smoking
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| Other risk factors for bleb formation | being tall thin
being male
family hx
previous spontaneous pneumothorax
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| What is a iatrogenic pneumothorax? | Laceration or puncture of the lung during medical procedure
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| What type of pneumothorax is a spontaneous pneumothorax? | A closed pneumothorax
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| What is traumatic penetrating chest wound referred to as ? | It is refereed to as a sucking chest wound since air enters the pleural space through the chest wall during inspiration.
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| What kind of dressing is used on a sucking chest wound? | A vent dressing( an occlusive dressing that is secured on 3 sides)
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| What do you do for a if a person has an impaled object in them | DO NOT REMOVE THE OBJECT stabalize with a bulky dressing
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| what can happen to the lung after a rib fracture | It can lacerate the lung and cause air frm lung to enter the laeural space
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| What is a tension pneumothorax? | It is when air enters the pleural space and cannot escape
the mediasternum shifts, there is compression of the good lung and pressure on the heart and great vessels which leads to decrease venous return and decreased CO
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| Clinical manifestations of a tension pneumothorax are? | Dyspnea,
increased HR,
trachea deviation,
absent breath sounds on affected side,
JVD,
cyanosis,
diaphoresis,
anxiety
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| Treatment for a tension pnuemothorax | needle decompression,
chest tube insertion
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| Is a tension pneumothorax a medical emergency? | YES it is they have low CO they can die
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| What is a hemothorax? | It is the accumulation of blood in the pleural space secondary to injury to the chest wall
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| Treatment for a hemothorax? | Chest tube insertion,'
reinfusion of collected blood
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| What is a hemopneumothorax? | blood and air in the pleural space
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| Collaborative care for pnuemothorax | depends on severity
may resolve spontaneously
thoracentesis ( sucking liquid out with syringe)
chest tube
pleurodesis/ plurectomy (surgeries)
needle compression ( for tension pneumothorax followed by a chest tube) Medical emergency
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| What is the most definitive and common treatment for a pneumothorax and a hemothorax? | A chest tube connected to water seal drainage
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| What is the purpose of chest tubes? | Remove air and fluid
reestablishes negative pressure
they are usually 20 inches long and between 12-40 french
the size of french determined by patient condition
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| What are the steps and material needed for a chest tube insertion? | Head of bed 30-60 degrees
Patient is positioned with arm raised above head on affected side
Aseptic technique
sutured
occlusive dressing
confirm placement with chest xray
pain control
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| What are the parts of the water suction plural drainage system? | 1. Collection chamber
2. water seal chamber
3. suction control chamber
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| What is the purpose of the collection chamber? | the collection chamber receives fluid and air from the pleural or mediastinal space
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| What is the purpose of the water seal chamber | it contains 2cm of water that acts as a one way valve
Air from pleural space and collection chamber can escape but it prevented from back flowing to patient
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| what is normal fluctuation of water within the water seal called? | tidaling
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| Increased bubbling in the water seal chamber could indicate what? | that there is an air leak
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| What is the purpose of the water suction control chamber? | the water suction control chamber uses a column of water with the top end vented to the atmosphere to control the amount of suction from the wall regulator. The chamber is typically filled with 20cm of water. Gentle bubbling okay in this area
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| Is gentle bubbling okay in the water suction control chamber? | YES
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| How does the dry suciton control chamber work? | There is no water
A dial is used to chose the desired negative pressure
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| What are the steps in chest tube nursing management | Prepare drainage unit, maintain patency, observe for tidaling in water seal chamber, Assess patient clinical status, ( check VS, BS), check drainage site for infection or subQ emphysema
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| Should we milk or strip the tubing on the pleural drainage system? | NO also don't kink or clamp tubing becseu that creates positive pressure.
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| Where should the chest tube drainage system be placed in relation to the chest? | It should be placed below the chest. NEVER elevate above chest
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| what amount of drainage per hour needs to be reported to the doctor? | 100ml/hour
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| When the collection chamber is is full what should we do? | Change the whole unit. DO NOT TRY TO EMPTY IT
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| What can happen to a patient that has 1-1.5 Liters of pleural fluid removed rapidly? | Reexpanion pulmonary edema or a vasovagal response with symptomatic hypotension
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| What is subcutaneous emphysema? | Air leaking into tissue around chest tube insertion site . A crackling sensation is felt when palpating skin (crack snapple pop)
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| When subcutaneous emphysema occurs in a large amount what can occur | drastic swelling of neck /head which leads to an airway compromise
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| Infection is a complication of chest tubes how can this be prevented? | sterile technique with dressing changes, follow protocol , and use of an occlusive dressing with date and time
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| Chest tube emergent care What do you do if the chest tube drainage is overturned and the water seal is disrupted? | return it to an upright position, have patient take a few deep breaths followed by a forced exhale and cough
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| What do you do if the chest tube is disconnected? | Immerse in 2cm of sterile water until the system is established. Keep a cup taped to the wall.
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| When is a chest tube removed? | when the lungs are reexpanded and there is no drainage or minimal drainage
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| steps to take before a chest tube is removed | the suction is discontinues and chest drain is on water seal for 24hours,
Premedicate the patient with pain meds,
Valsalva maneuver during removal,
apply occlusive dressing,
A chest x ray and monitor for resp. distress
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| why is an xray done after the chest tube removal | to observe for a pneumothorax or reaccumulation of fluid.
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| The ribs that get broken the most are | ribs 5-9
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| What can be damaged by fractures ribs? | the lungs and pleura
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| Clinical manifestations of a rib fracture? | pain,
splinting,
shallow respirations,
,Atelectasis,
pneumonia
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| Treatment for a rib fracture | DO NOT Strap or bind the chest,
NSAIDS, opiods, nerveblockers,
deep breaths,
cough,
Incentive spirometer
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| why don't you strap and bind broken ribs? | because it limits chest expansion
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| What is a flail chest? | it results from the fracture of several consecutive ribs, in two or more separate places, causing an unstable segment
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| what are the clinical manifestations of a flail chest | paradoxic movement during breathing,Inspiration the affected portion is sucked in,Expiration: the affected portion bulges out,
Inadequate ventilation on affected side,increased WOB,Apparent in visual exam,rapid shallow breathing, increased HR, crepitus
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| Diagnostic tests for flail chest | YOU SEE IT, palpation of abnormal respiratory movements, evaluation of crepitus near the rib fractures, chest X-ray, ABGs
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| Treatment for flail chest | Airway management, adequate ventilation, supplemental O2, careful administration of IV fluids, pain control, surgical intervention
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| symptoms of respiratory distress in chest trauma | dyspnea, cough, cyanosis, tracheal deviation, decreased BS, decreased O2 sat, bloody sputum/secretions
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| Symptoms of cardiovascular compromise in chest trauma | rapid thready pulse, decreased BP, JVD, muffled heart sounds, chest pain, dysrhythmias,
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| Emergency nursing interventions for chest trauma | Patent airway, SpO2 more thatn 90, IV access, remove clothing to access injury, stabilize impaled objects, semi fowlers, needle decompression,Assess: VS, cardiac rhythm, Urine output,
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| Abdominal trauma What happens when a solid organ is damaged? | profuse bleeding
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| Abdominal trauma: what happens when a hollow organ is damaged? | contents spill into the peritoneal cavity ( peritonitis)
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| clinical manifestations of abdonail trauma? | pain, guarding, splinting, decreased bowel sounds, bowel sound in chest, rigid hard abdomen, hematemesis, ( decreased RR and decreased CO indicate abdomen compartment syndrome), grey turners sign, cullens sign
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| What is Grey Turner's sign | bruising on the flanks
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| What is Cullen's sign | Blue bruising around belly button
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| Diagnostic tests for abdominal trauma | cat scan, x-ray, peritoneal lavage ( less than 10ml negative more than 10 ml positive), prepare for emergency surgery
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| nursing management for abdominal trauma? | patent airway, NG tube, fluids, foley, NO PAIN MEDS until diagnosis confirmed, prepare for emergency surgery, prevent shock and sepsis, DO NO REMOVE IMPALED OBJECT
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| Charateristics of pelvic trauma | easily missed,
associated with high mortality rate
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| Clinical manifestation of pelvic trauma | swelling, tenderness, ecchymosis, deformity, unusual movement.
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| treatment for Pelvic trauma | Assesss, neurovascular assessment, special mattress, minimize complications ( DVT, PE, sepsis), urinary and bowel function
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| Interventions for limb trauma | Assess neurovascular _ 6Ps, Immobilize, treat compartment syndrome with fasciotomy.
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