Pneumothorax
1. Given the diagnosis of pneumothorax, explain why the paramedic had difficulty ventilating A.W.
• Air escaped from the lung into the pleural space. Eventually, enough air collected in the pleural space to cause the mediastinum to shift twoard the right. The collapsed left lung, increased intrapleural pressure, and rightward shift make it difficult to ventilate A.W.
2. Interpret A.W.’s ABG’s
• Significant respiratory acidosis with profound hypoxemia. A.W. is near death.
3. What is the reason for A.W.’s ABG results?
• 70% of her right lung is collapsed and is not taking part in gas exchange
4. The physician needs to insert a chest tube. What are your responsibilities as the nurse?
Preinsertion:
• Support patient with comfort and emotional needs – see next question for pain med thoughts
• Educate the client and any family that her lung collapsed and that the doctor is going to put a tube in her chest to get rid of the air and help her breath on her own again. Even though the client is stuporous, you assume she can hear you and needs your calm voice and explanations to calm her and provide hope.
• Obtain informed consent for chest tube insertion –
• Set up a chest tube drainage system – fill the water seal to 2 cm and the suction to the ordered level, obtain appropriate size chest tube trocars (28 and 32 F is my guess for this lady and situation), obtain thoracotomy tray (chest tube insertion tray) found in ER, ICU, and materials management department which can be retrieved by the nursing supervisor.
• Baseline assessment of respirations, work of breathing, breath sounds, and oxygenation status (O2 saturation)
• Prepare a CXR requisition form for placement check after the insertion is complete (doesn’t really matter now or after, but if you have time get it ready now)
Postinsertion:
• Monitor air leak and any drainage
• Reassess respiratory status as indicated
• Assure portable CXR is done for placement
• Assure proper functioning
• Air escaped from the lung into the pleural space. Eventually, enough air collected in the pleural space to cause the mediastinum to shift twoard the right. The collapsed left lung, increased intrapleural pressure, and rightward shift make it difficult to ventilate A.W.
2. Interpret A.W.’s ABG’s
• Significant respiratory acidosis with profound hypoxemia. A.W. is near death.
3. What is the reason for A.W.’s ABG results?
• 70% of her right lung is collapsed and is not taking part in gas exchange
4. The physician needs to insert a chest tube. What are your responsibilities as the nurse?
Preinsertion:
• Support patient with comfort and emotional needs – see next question for pain med thoughts
• Educate the client and any family that her lung collapsed and that the doctor is going to put a tube in her chest to get rid of the air and help her breath on her own again. Even though the client is stuporous, you assume she can hear you and needs your calm voice and explanations to calm her and provide hope.
• Obtain informed consent for chest tube insertion –
• Set up a chest tube drainage system – fill the water seal to 2 cm and the suction to the ordered level, obtain appropriate size chest tube trocars (28 and 32 F is my guess for this lady and situation), obtain thoracotomy tray (chest tube insertion tray) found in ER, ICU, and materials management department which can be retrieved by the nursing supervisor.
• Baseline assessment of respirations, work of breathing, breath sounds, and oxygenation status (O2 saturation)
• Prepare a CXR requisition form for placement check after the insertion is complete (doesn’t really matter now or after, but if you have time get it ready now)
Postinsertion:
• Monitor air leak and any drainage
• Reassess respiratory status as indicated
• Assure portable CXR is done for placement
• Assure proper functioning