RespNotes2009 - RNSG2432ONLINENOTES Module1::...

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RNSG 2432 ONLINE NOTES Module 1: Respiratory Disorders: Pleural and Thoracic Injury Marnie Quick, RN, MSN, CNRN *These notes are an expansion of the Lewis textbook and other required  references. They should be used together. Etiology/Pathophysiology 1. Normal physiology as it relates to pleural and thoracic Injuries. a. Pleura- tightly connected two-layered thin membrane that lines the inner chest  wall and hold the lungs to the thoracic wall. The visceral pleura lines the lung  surface; parietal pleura lines the inner chest wall (Lewis p.589 Fig 28-7). b. The pleura produce a lubricating serous pleura fluid that allows the lungs to  move during breathing. c. On inspiration, the chest wall expands and the diaphragm moves downward,  increasing the lung volume. d. The pleural cavity (potential space between the two-layered pleura) becomes  negative in relation to atmospheric pressure (756 mg Hg) when inspiration  occurs. This allows for air to enter the lungs. e. Rib cage surrounds and protect the lungs and internal thoracic organs (Lewis  p.589 Fig 28-7) 2. Chest trauma caused by blunt and/or penetrating trauma and may cause injury to  the internal organs- major blood vessels- aorta, vena cava, etc.; and the heart,  etc. (Lewis 585 Table 28-18) 3. Disease may also cause injury to the chest/lungs- lung infections, pneumonia, TB  , lung abscess, pulmonary embolus, cancer. 4. Pneumothorax (Lewis p.587 Fig 28-5) a. Closed- no external wound; spontaneous pneumothorax; injury from  mechanical ventilator , broken ribs, COPD blebs rupture b. Open- air enters plural space opening in chest wall (Lewis 587 Fig 28-4B)  gunshot/stab wound; surgical thoracotomy. Do not remove if object still in  place. Use vented dressing to decrease chance of tension pneumothorax.
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c. Tension- Medical emergency due to mediastinal shift causing death from  inadequate CO and severe hypoxemia (Lewis 587 Fig 28-5) Air trapped in  pleural space> high intrapleural pressures> tension on heart and great  vessels 5. Hemothorax is blood in the pleural space a.
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