380 likes | 1.11k Views
Respiratory . Pleural and Thoracic Injury. Pleural injury : Normal physiology- visceral, parietal pleura & pleural space. A. Pleural injury: pleural effusion. Pleural effusion. Etiology/Patho-
E N D
Respiratory Pleural and Thoracic Injury
Pleural injury: Normal physiology- visceral, parietal pleura & pleuralspace
Pleural effusion • Etiology/Patho- • excess fluid pleural space- may contain pus (empyema) or blood • Occurs with local disease- lung cancer, pneumonia, trauma or systemic disease (heart failure/liver/renal disease) • Common manifestations/complications • Dyspnea, pleuritic pain, dec/absent breath sounds, limited chest wall movement
Pleural effusion- therapeutic interventions • Diagnostic tests • Treatment- thoracentesis- p 1145 • Treatment- underlying cause • Treatment- administer O2
B. Pleural injury: pneumothorax • Etiology/Patho- air in pleural space- p. 1147 • Spontaneous • Traumatic • Tension • Common manifestations/complications • p. 1147 with illustrations
Pleural injury: pneumothorax therapeutic interventions • Diagnostic tests- chest X-ray; O2 sats; ABG’s • High Fowlers; O2; rest to dec O2 demand • Treatment depends on severity • Treatment- chest tube • Treatment- Heimlich valve on chest tube • Treatment- throacotomy tube
Old three glass bottle system– operating principles still the same
What do you do if chest tube comes out? seal on three sides
After chest X-ray confirms reexpantion-the chest tube is removed- Note tight seal
C. Pleural injury: hemothorax • Blood in pleural space • Caused by trauma; lung malignancy; pulmonary embolus; complication anticoagulant therapy • Like pneumothorax- lung can collapse • Manifestations similar to pneumothorax; blood loss symptoms
Pleural injury:A. pleural effusion; B. pneumothorax & C. hemothorax • Nursing assessment specific to pleural injury • Health history- resp disease, injury, smoking, progression of symptoms • Physical exam- degree of apparent resp distress, lung sounds, O2 sat, VS, LOC, neck vein distention, position of trachea • Pertinent nursing problems and interventions • Impaired gas exchange • Risk for injury • Home care
Thoracic Injury • Etiology/path • Rib fractures- most common; flail chest- 2 or more ribs fractured; pulmonary contusion- alveoli arterioles rupture • Common manifestations • Rib fractures- pain on inspiration, shallow breathing • Flail chest- severe dyspnea, cyanosis, tachypnea, paradoxial chest, crepitus • Pulmonary contusion- may not see 12-24 hrs post injury, inc resp diff, restless, chest pain, coughing up sputum
Subcutaneous emphysema caused by air escaping into subcutaneous tissue from pneumothorax- feels like crackles or tissue paper
Thoracic Injury: Therapeutic interventions • Diagnostic test- all require chest X-ray; ABG’s • Rib fracture- analgesics; do not restrict chest movement • Flail chest- • Mild- deep breathing, pain management intercostal nerve blocks • Resp distress- intubation and mechanical ventilation- positive pressure to stabilize flail chest; external fixation • Pulmonary contusion- endotracheal tube and mechanical ventilation; bronchoscopy to remove secretions to prevent atelectasis
Pleural effusion: nursing assessment and pertinent nursing problems/interventions • Health history • Physical exam • All require observation for lung symptoms • Pertinent nursing problems • Acute pain • Ineffective airway clearance • Impaired gas exchange • Home care