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Respiratory

Respiratory . Pleural and Thoracic Injury. Pleural injury : Normal physiology- visceral, parietal pleura & pleural space. A. Pleural injury: pleural effusion. Pleural effusion. Etiology/Patho-

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Respiratory

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  1. Respiratory Pleural and Thoracic Injury

  2. Pleural injury: Normal physiology- visceral, parietal pleura & pleuralspace

  3. A. Pleural injury: pleural effusion

  4. 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

  5. Pleural effusion- therapeutic interventions • Diagnostic tests • Treatment- thoracentesis- p 1145 • Treatment- underlying cause • Treatment- administer O2

  6. B. Pleural injury: pneumothorax • Etiology/Patho- air in pleural space- p. 1147 • Spontaneous • Traumatic • Tension • Common manifestations/complications • p. 1147 with illustrations

  7. Closed and Open Pneumothorax

  8. Open pneumothorax

  9. Pneumothorax with collapsed lung

  10. Mediastinal shift- note what this does to the heart!

  11. 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

  12. When to use chest tubes

  13. Insertion of chest tubes by physician

  14. Placement of chest tubes

  15. X-Ray of chest tube

  16. Chest tubes in place

  17. Old three glass bottle system– operating principles still the same

  18. Water seal drainage

  19. No dependent loops!

  20. Tight seal

  21. Be sure to tape all connections

  22. What do you do if chest tube comes out? seal on three sides

  23. After chest X-ray confirms reexpantion-the chest tube is removed- Note tight seal

  24. 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

  25. Pneumothorax & hemothorax

  26. 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

  27. 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

  28. Right chest injury- fractured rib

  29. Flail chest with paradoxical movements

  30. Subcutaneous emphysema caused by air escaping into subcutaneous tissue from pneumothorax- feels like crackles or tissue paper

  31. 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

  32. External fixation of ribs in flail chest

  33. 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

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