Blunt trauma occurs when the chest strikes or is struck by an object. List what the impact can cause to:
Rib and sternal fractures can lacerate lung tissue
In a high-velocity impact the shearing force ma result in laceration or tearing of the aorta
Compression of the chest may result in contusion, crush injury, and organ rupture
List respiratory assessments of chest trauma
- Skin signs
- Breath sounds
Dyspnea, resipiratory distress
cough with or without hemoptysis (blood)
Cyanosis of mouth, face, fingers, mucous membranes
Audible air escaping from chest wound
Decreased O2 sat
List cardio assessment of chest trauma
- Heart sounds, rhythm
- Chest: sensation, sounds
Rapid, thready pulse
narrowed pulse pressure
Asymmetric BP values in arms
Distended neck veins
Muffled Heart sounds, dysrhythmia
Chest: pain and/or crunching sound with heart sounds
What do these manifestations indicate and what are the interventions?
Dyspnea, decreased movement of chest wall
Diminished or absent breath sounds on the affected side
hyperresonance to percussion
Pneumothorax: chest tube insertion with flutter valve or chest drainage system
What do these manifestations indicate and what is the intervention?
Dyspnea, diminished or absent breath sounds, dullness to percussion, decreased Hgb, shock depending on blood volume lost.
Hemothorax (blood in peural space, may or may not occur in cojunction with pneumothorax): chest tube insertion with chest drainage system. Autotransfuson of collected blood, treatment of hypovolamia as necessary
How would you dress a sucking chest wound?
Cover with a nonporous dressing taped on three sides.
What does this indicate:
Air trapped in pleural sace that shifts organs and increases intathoracic pressure
This is a medical emergency that requires needle decompression followed by chest tube insertion with chest drainage system
Define a Flailed Chest and its manifestations.
Fx of two or more ribs with loss of chest wall stability
You will see paradoxic movement of chest wall, resp. distress.
Interventions: O2 and analgesics prn. Stabilize flail with positive pressure (CPAP) or intubation and mechanical ventilation.
What is this term: blood rapidly collects in pericardial sa, compresses myocardium because the pericardium does not stretch.
What does it prevent the heart from doing? What will you see with the patient?
Cardiac tamponade: Prevents the ventricles from filling
When preparing the CDU (chest drainage) for wet suction, you want to add __a__ cm of sterile water in the water-seal chamber, and __b__cm of sterile water in the suction control chamber
In regards to the CDU, what is tidaling?
How is tidaling affected when the patient is on positive pressure ventilation?
In the CDU's water seal chamber, it will measure the amount of negative pressure in the pleural cavity by looking at the water level in the chamber.
If there is no air leak in the patient's pleural cavity, the water level should rise during inhalation, and fall during exhalation. This is tidaling and is an indicator of a patent pleural chest tube.
Tidaling will have the opposite direction during inhalation and exhalation with positive pressure ventilation.
At the top of the water seal chamber with a CDU is a high negative float valve and high negative relief chamber. What is the purpose of these two things?
These are safety features maintain the water seal in the event of high negative pressures, which can be caused by:
- respiratory distress, vigorous coughing, crying
- chest tube stripping
- decreasing or d/c of suction
The high negative float valve will impede the flow of water if the water level rises above -20cm, allowing as much negativity as needed for inspiration
The relief chamber will vent excessive negative pressure, preventing respiratory compromise.
What can virorous milking or stripping of chest tube cause?
Can create dangerously high negative pressures. This can put the patient at risk for mediastinal trauma.
A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?
A patient with a chest tube is at risk for a tension pneumothorax due to the risk of pressure building up in the intrapleural space. Therefore, the nurse would want to monitor the patient for this and if tracheal deviation is present this is a major sign a tension pneumothorax. All the other options are normal findings. The water seal chamber will have intermittent (not excessive) bubbling because of the air that will be leaving the intrapleural space. The water seal chamber will flucutate up and down when the patient breathes in and out, and it is normal for the patient to have tenderness at the insertion site of the chest tube.
A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?
Which of the following measures best determines that a patient who had a pneumothorax no longer needs a chest tube?
The chest tube isn’t removed until the patient’s lung has adequately reexpanded and is expected to stay that way. One indication of reexpansion is the cessation of fluctuation in the water-seal chamber when suction isn’t applied. The chest X-ray should show that the lung is reexpanded. Drainage should be minimal before the chest tube is removed. An ABG test isn’t necessary if clinical assessment criteria are met.
A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered intravenously (IV), but the client's vital signs do not improve. A central venous pressure line is inserted, and the initial reading is 20 cm H^O. The most likely cause of these findings is which of the following? (Normal CVP = 0-8, 15-20 = usually indicates inability of the right atrium to accommodate the current blood volume)
Pericardial tamponade occurs when there is presence of fluid accumulation in the pericardial space that compresses on the ventricles causing a decrease in ventricular filling and stretching during diastole with a decrease in cardiac output. . This leads to right atrial and venous congestion manifested by a CVP reading above normal.
Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?
Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.
After a lateral crushing chest injury, obvious right-sided paradoxic motion of the client's chest demonstrates multiple rib fraactures, resulting in a flail chest. The complication the nurse should carefully observe for would be:
Mediastinal structures move toward the uninjured lung, reducing oxygenation and venous return.
In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:
Because of restricted respiratory movement, a recumbent, immobilize patient is at particular risk for respiratory acidosis from poor gas exchange; atelectasis from reduced surfactant and accumulated mucus in the bronchioles, and hypostatic pneumonia from bacterial growth caused by stasis of mucus secretions.
T or F: During a mediastinal shift, the heart and great vessels will shift to the affected side