Karteikarten
453: Test 1 Chest Trauma and Thoracic Injuries
Karten in diesem Stapel (43)
- 1Two major categories of chest trauma/thoracic injuriesBlunt: Body is stuck by a blunt object
Penetrating Trauma: Foreign body impales or passes through body tissues. Open injury. - 2What is the primary management of a chest trauma/thoracic injuryAirway
- 3In blunt force trauma what is acceleration/deceleration?Example: car decelerates after hitting object but organs accelerate
- 4Other factors to consider with blunt force traumasshearing force (tissue riding over and ripping)
crush/asphyxiation
organ/lung damage underneath - 5S/S of Asphyxiation (crush)Petechiae in the whites of the eyes, cheeks, face.
Look at marking on the front and back of the patient.
Crushing pressure can become systemic not just localized to injury - 6Examples of penetrating traumaGSW (gun shot wound)
stabbing
impalement - 7___________ is when there is air in the pleural space resulting in partial collapse of the lung.Pneumothorax
- 8With a pneumothorax the pressure in the lung goes from a ________ pressure to a ________ pressureNegative Pressure → Positive Pressure
- 9Clinical manifestations of a pneumothorax depend on size but include:Respiratory Distress (shallow, rapid resps; dyspnea; air hunger; O2 desaturation)
Chest pain
cough
ABSENT BREATH SOUNDS - 10the presence of lymphatic fluid in the pleural space due to a leak in the thoracic ductChylothorax
- 11Blood in the pleural space, may or may not occur in conjunction with pneumothorax.Hemothorax
- 12The increased air in the pleural space shifts organs and increases intrathoracic pressureTension pneumothorax
- 13How to treat a traumatic open (sucking) pneumothorax1. Ensure patent airway and administer 02
2.Get IV access and start fluids
3. Cover sucking chest wound with occlusive vented dressing taped on 3 sides
Stabilize impaled objects. Don't remove.
4. Stabilize flail rib segment
5.If no spinal injury place pt in a semi-Fowler's position or what is easiest to breath. - 14This type of pneumothorax can occur due to laceration or puncture of the lung during medical procedures. Transthoracic needle aspiration is the leading causeIatrogenic pneumothorax
- 15A _____________ pneumothorax typically occurs due to the rupture of small blebs (air-filled blisters) located on the apex of the lung.spontaneous
- 16Spontaneous pneumothorax is the rupture of Blebs or _______ in COPD, Asthma, Cystic Fibrosis, and Pneumonia patients.Bullae (air or pus filled in PLEURAL SPACE)
- 17Another name for spontaneous pneumothoraxclosed pneumothorax
- 18Why is it important to allow air to escape for a open pneumothorax?Prevent tension pneumothorax, acts as a one way valve
- 19The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are early signs of this?MOSTLY: SOB and TACHYCARDIA
Also: dyspnea, O2 deceleration, decreased or absent breath sounds, diaphoresis - 20The rapid accumulation of air in the pleural space without the ability to escape is a pneumothorax. What are late signs of this?NVD/JVD, cyanosis Unilateral movement of the chest and tracheal deviation
- 21____________ is when air escapes in the pleural space and goes into the SQ space. Crackles felt upon palpation. Signs of a pneumothorax.Subcutaneous Emphysema
- 22How much blood loss from a auto transfusion or chest tube is to much?about a unit =16oz =450 mL
- 23Causes of hemothorax includeOpen Pneumothorax
Trauma
Malignancy
Anticoagulant Therapy
pulmonary embolus
torn pleural adhesions - 24Causes of chylothorax include trauma, surgical procedures and malignancy. Therapy includes:Conservative therapy:
chest drainage
bowel rest (increases tenfold after digestion of fats)
parenteral nutrition
Invasive therapy: surgery and pleurodesis (artificial production of adhesions between the parietal and visceral pleura) - 25Treatment of pneumothorax depends on severity. Collaborative care includes:Preserve Hemodynamic stability
CXR
ABGs
Chest-tube
Heimlich/flutter valve: valve opens whenever the pressure in the chest is greater than atmospheric pressure. Ex. expiration
needle venting - 26When a chest tube is set to water seal is it ok if there is persistent bubbling of air through the water?No. Can bubble slightly with inspiration. Persistent bubbling indicates an air leak in the lung. Bubbling in the first 24 hours is more normal.
- 27What can happen if a chest tube is clamped?Tension pneumothorax. Should never be clamped.
- 28Chest tubes can be water sealed, to gravity or connected to _________suction
- 29The drainage bottle of a chest tube should always be kept ________ the level of the patient, otherwise its contents will siphon back into the chest cavity.Below
- 30Nursing management of a chest tube. What to look for1. Assess vital signs, lung sounds, and pain.
2. Assess for manifestations of reaccumulation of air & fluid in the chest (↓ or absent breath sounds) & signs of infection
3. Assess for SQ emphysema at tube site.
4. Encourage the patient to breathe deeply periodically to facilitate lung expansion and to prevent atelectasis or pneumonia - 31Drainage of a chest tube how much is to much?Book: >100mL of drainage
class: pint (450 mL)
Consistency or color change should be reported to the physician - 32After a chest tube is removed should a CXR be performed?yes
- 33Most common type of traumatic chest injuryFractured Ribs
5-10 most commonly fractured
Remember whats underneath! - 34Two or more ribs in two or more separate locations will cause thisFlail chest
- 35What type of movement is associated with flail chest?Paradoxical movement: respiration are reversed, with the chest wall moving in during inspiration and out during expiration
- 3615% of all MVA deaths are due to this. It occurs due to a shearing or compression (between sternum and spine)Aortic tear
- 37Aortic tears can cause cardiac tamponade. What is cardiac tamponade?Rapid collection of blood in the pericaridal sac, reducing filling
- 38S/S of cardiac tamponade (medical emergency)Muffled, distant heart tones
↓B/P
NVD
↑CVP - 39Cardiac contusion what is the most common arrhythmia?VTach
- 40Drug of choice for hemothorax and why?Toradal- NSAID- anti- inflammatory.
No more then 5 days due to ulcers - 41Who can remove a chest tube?Physician or APRN (unless patient is deceased)
- 42What to do if a chest tube is disconnected or is pulled out?Reconnect immediately. If its completely out cover with a 3 sided dressing
- 43Cardiac TamponadeRapid collection of blood in the pericaridal sac, reducing filling
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- Karteikarten am 453: Test 1 Chest Trauma and Thoracic Injuries , erstellt von brittny beauford am 29/01/2017.
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