5. Chest Trauma.docx - Complex Respiratory Alterations...

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Complex Respiratory Alterations RESPIRATORY CLINICAL EXAMPLES: Pleural effusion Chest trauma Thoracic surgery/injury Pulmonary edema Pulmonary embolus Pulmonary hypertension Lung transplant
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PRIOR TO CLASS REVIEW : Lewis Chapter 26 – previous foundational information regarding: a. Normal respiratory system functioning – A & P of respiratory system b. Respiratory assessment parameters – history and physical exam c. Respiratory diagnostic studies (blood, sputum, radiology, endoscopic) d. Tables 26-2 and 26-3 very important READINGS : Lewis, et al., (8 th ed.): Pages 566-583 OBJECTIVES: 1. Discuss mechanisms of pleural effusions, medical management, and nursing care. 2. Differentiate types of chest trauma regarding mechanisms, clinical presentation, treatment, and nursing care. 3. Differentiate types of thoracic surgery regarding indications, preoperative and postoperative nursing care. OUTLINE: I. Chest Trauma Types Table 28-20 A. Blunt trauma 1. May lead to cardiac and/or pulmonary contusion 2. Types of forces associated with blunt trauma a. Acceleration-Deceleration: ( Coup – initial injury; Contracoup – secondary injury ) b. Shearing: massive emergency hemorrhage; aorta can shear right off the heart! c. Compression: ex. car lands on person in accident WHAT YOU SEE ON OUTSIDE MAY NOT DEPICT WHAT IS REALLY GOING ON INSIDE!! B. Penetrating trauma Foreign body goes into chest wall, increasing pressure inside wall; collapsed lung. 1. Atmospheric pressure enters pleural space: no lung sounds on affected side. II. Fractured Ribs A. “Hallmark of severe trauma” (If 1 st and 2 nd rib are broken; shortest, thickest, most protected) -Ribs 5 and 6 are least protected; most often broke. Risk for lung puncture (pneumothorax) B. Flail Chest: patients have two or more broken ribs, disruption of chest wall protecting lung. Will see chest suck in with inspiration and affected side comes out with expiration because it is not able to expand appropriately. --CPR commonly causes flail chest and possible hemothorax 1. Results from multiple rib III. Pneumothorax A. Definition: Air in the pleural space with partial or complete lung collapse B. Types of pneumothorax 1. Closed pneumothorax ( spontaneous ) a. No external wound b. Causes : blebs (small lung aneurysm/blister that pops); coughing REALLY hard; mechanical ventilation (too much positive end expiratory pressure, pops alveoli); broken ribs; esophageal rupture (space for air to move into cavity) 2. Open pneumothorax Fig. 28-4 a. Air enters through an opening in the chest wall ( Sucking chest wound ) Dressing with three sides taped (want to let air out!!- otherwise may cause tension pneumothorax) 3. Tension pneumothorax Fig. 28-5 a. Air in the pleural space that cannot escape. b. Causes a mediastinal shift and tracheal deviation to the unaffected side Compresses lung on the good side; compressed heart; may shear off aorta.
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