Respiratory Module Lower Respiratory Tract Infections Lecture 6

Respiratory Module

Lower Respiratory Tract InfectionsLecture 6

Atelectasis

• Definition– Closure or collapse of

alveoli

Atelectasis: Pathophysiology

• Can occur as a result of alveolar ventilation or

• any type of blockage • that impedes the

passage of air to and from the alveoli

Atelectasis: Etiology

• #1 post-op• secretions or mucus

plug• Chronic airway

obstruction– i.e. lung CA

• Excessive pressure on the lungs

Atelectasis: Risk Factors

• Altered breathing patterns

• Retained secretions• Pain• LOC• Immobility• Prolonged supine

position• Post-op

Atelectasis: Clinical Manifestations

• “The development of Atelectasis usually is insidious”– Cough– sputum production– low-grade fever

Atelectasis: Clinical Manifestations

• If Atelectasis involves a large amount of lung tissue S&S include– Marked resp. distress– Dyspnea (orthopnea)– Pulse?

• Tachycardia– Respiratory rate?

• Tachypnea– Pleural pain– Central cyanosis

Atelectasis: Assessment and Diagnostic Findings

• breath sounds – – Crackles

• Chest X-ray – patchy infiltrates– consolidated area

Atelectasis: Assessment and Diagnostic Findings

• SpO2 – < 90%

• PaO2 – < 80

• PaCO2– > 45

• HCO3-– to compensate

• ABG analysis– Resp. acidosis

Atelectasis: Prevention

• Frequent turning• Early mobilization• Strategies to expand the

lungs – Deep breathing – Incentive Spirometry

(IS)

Atelectasis: Prevention

• Strategies to manage secretions– Directed cough– Suctioning– Nebulizer– Chest physical

therapy– fluids

Atelectasis: Management

• Goal:– to ventilation and

secretions

• Frequent turning• Early amb.• Lung volume expansion

maneuvers

Atelectasis: Management

• Coughing• PEEP• Bronchoscope

Atelectasis: Management

• If due to bronchial obstruction– Coughing– Suctioning– Chest physiotherapy– Nebulizers– Bronchodilators– Endotracheal

intubation & mechanical ventilation

Atelectasis: Management

• If due to compression of the lung tissue– Decrease the

compression– Thoracentesis– Chest tubes

Small Group Questions

1. What can a nurse due to prevent a patient from acquiring Atelectasis?

2. Which patients are most likely to acquire Atelectasis?

3. How is Atelectasis treated?4. Describe the ABG’s of a patient with Atelectasis.5. Name 4 S&S of Atelectasis.

Acute Tracheobronchitis

AKA• Bronchitis• Acute Bronchitis

Acute Tracheobronchitis

Pathophysiology• Inflammation of the

mucous membranes of the trachea & bronchial tree

• Follows URI

Acute Tracheobronchitis

• What pathogen is most commonly responsible for tracheobronchitis?

A. BacteriaB. VirusC. FungusD. Parasite

Acute Tracheobronchitis

Etiology/Contributing factors

• Infection• Inhalation of irritants– Sulfur dioxide– Nitrogen dioxide– Air pollutants

• May be a complication of bronchial asthma

Acute TracheobronchitisClinical Manifestations• Usually self limiting• Durations

– Several days• Sputum

– Mucopurulent• Cough

– Dry, irritation, dyspnea• Pain

– Sternal soreness• Fever / chills• Headache / gen. malaise

Acute Tracheobronchitis

Diagnostic findings• Sputum C&S• Chest x-ray • Breath sounds– Sonorous wheezes– Stridor

• Symptoms

Acute Tracheobronchitis

Treatment• Symptomatic• Bed rest• Cool vapor• Steam• Moist heat to chest• If bacterial– Antibiotics

Acute TracheobronchitisNursing interventions• Enc bronchial hygiene• Enc TCDB / fluids• Position– HOB

• Caution against over exertion relaps

• Auscultate BS• Check V/S

Acute Tracheobronchitis

Prevention• Treat URIComplications• Bronchopneumonia

Small group questions???1. Describe the pathophysiology of tracheobronchitis?2. What is the usual causative agent for tracheobronchitis?3. What does self-limiting mean?4. What breath sounds are associated with

Tracheobronchitis?5. Identify a nursing diagnosis for tracheobronchitis?6. Name for nursing comfort measures for a pt. with

tracheobronchitis?

Pneumonia

Pathophysiology• An inflammatory process in which there is

consolidation – caused by exudates filling the alveolar spaces.

• Gas exchange cannot take place in consolidated area

PneumoniaCausative agents• Viral pneumonia• Bacterial Pneumonia

– Streptococcus pneumoniae– Pneumocystis Pneumonia

• Fungal pneumonia• Radiation pneumonia• Chemical pneumonitis• Aspiration pneumonia• Hypostatis pneumonia

Pneumonia

Which of the following components of respiration would pneumonia affect? (there may be more than one answer)

A. VentilationB. PerfusionC. Diffusion

Pneumonia FYI

• Most common cause of death from infectious agents

• 66,000 deaths / year• $$$

PneumoniaProgression of events• Inflammation • Exudate • movement of O2 and CO2 • WBC migrate into the alveoli • Fill air-containing spaces• ventilation • PaO2 ?–

Pneumonia - Classifications• Community-acquired pneumonia– CAP– Community or < 48 hr after hospitalization

• Hospital-acquired pneumonia– HAP– Nosocomial – (CDC: 15-20% all pt get HAP)

• Immuno-compromised host– Pneumocystis pneumonia (PCP)

• Aspiration

• Mrs. Sickly is admitted to Sierra View District Hospital on Wednesday Morning at 0930 AM for severe back pain and general declining state. She is 82 years old. On Friday morning at 0600 AM the nurse notes decreased breath sounds in the left lung, a productive cough and crackles. The doctor orders a chest x-ray which shows consolidation in the base of the left lung. She has pneumonia. What type of pneumonia does she have?

A. Community acquired pneumoniaB. Nosocomial pneumoniaC. Immuno-compromised host D. Aspiration

Pneumonia: Risk factors

• Immunosuppressant• Smoking• Prolonged immobility• Depressed cough reflex• NPO• Alcohol intoxication• Gen. anesthetic or opiod• Advanced age

Pneumonia

S&S: bacterial• Onset:

– Sudden• Pain:

– Severe chest pain– sharp– Guarding– mobility (affected side)

• Temperature– High temp (>106)– Chills

• Cough– Painful

• Sputum– Rust colored

• Breathing– Shallow– Rapid rate– Wheezing & crackles– Decreased BS

• Peristaltic activity– Slows down

• PaO2– – Cyanotic

Pneumonia: S&S: viral pneumonia

• Blood cultures:– Sterile

• Sputum– Copious

• Temperature– Seldom chills

• Respirations– Slow– Wheezing & crackles– Diminished BS

• Pulse– Slow

• PaO2– – Cyanotic

• Viral less severe than bacterial

• Mortality is low

Pneumonia

S&S Elderly• General deterioration• Weakness• Abd. Symptoms• Anorexia• Confusion• Tachycardia• Tachypnea

• Do Not C/O– Cough– Pain– Fever – Sputum

Pneumonia

Dx • Sputum C&S• CBC / WBC–

• Bacteria–

• Viral

• ABG’s• Chest x-ray

• What is a normal WBC count?– 5,000 – 10,000 mm3

Pneumonia

• What would you expect the ABG’s of a person with bacterial pneumonia to have?

• PaO2?

• PaCO2?

• pH• HCO3

- ? - Why?

• Analysis?

Pneumonia

Treatment• Antibiotics?• Rest• Fluids– – Humidifier

• Antipyretic• Anti-tussive?

• Analgesics• Anti-histamines• Nasal Decongestants• O2 • Mucolytic drug– Alivaire– Via – nebulizer

Pneumonia: Nrs. diagnosis

• Ineffective airway clearance: r/t copious secretions• Activity intolerance: r/t impaired resp. function• Risk for deficient fluid volume: r/t fever & dyspnea• Imbalanced nutrition: less than body requirement• Deficit knowledge: about the treatment regimen and

preventive health measures

Pneumonia – Nursing Interventions

• Improve airway patency– Hydration• 2-3 L/day• Humidifier

– TCDB– Lung expansion maneuvers• Incentive spirometer

– Chest physiotherapy– O2

Pneumonia – Nursing Interventions

• Promoting rest & conserving energy–Position• Semi-fowler• Affected side for pain

– Turn frequently–Moderate activity only

• Promoting fluid intake– 2 L/day

Pneumonia – Nursing Interventions

• Maintaining nutrition–Gatorade– Ensure

• Promoting the patients knowledge

Pneumonia

Prevention• Vaccine– Pneumonia– Flu

• Treat URI• Avoid irritants

Pneumonia

Complications• Shock • Respiratory failure• Atelectasis • Pleural effusion• Superinfection

Pneumonia: Small Group Questions

1. Describe the pathophysiology of pneumonia.2. What is the difference btw bacterial and viral

pneumonia?3. What causes pneumocystis carinii?4. What leads to hypostatis pneumonia?5. What lab values are associated with bacterial

pneumonia? / viral pneumonia?

Pneumonia: Small Group Questions

6. What is Nosocomial pneumonia7. Identify 5 risk factors for developing pneumonia8. What medications might be administered to treat a

pt. with pneumonia?9. What nursing education would you give to a patient

with pneumonia?10. What ABG’s are associated with pneumonia?11. What are the gerontological considerations of

caring for the elderly in regards to pneumonia?

SARS

• Severe Acute Respiratory Syndrome

• Viral respiratory illness • Caused by a coronavirus

SARS

• FYI– First reported in Asia

2003– 8098 people worldwide

dx with SARS in 2003– 774 died!

SARS

• Mode of transmission– Respiratory droplet

• When infected person coughs or sneezes

• The droplet gets on another's mucous membranes or

• On a surface that is touch by another and then they touch their own mucous membranes

SARS

S&S• Initial– High fever– H/A– Body aches– Mild resp. symptoms– After 2-7 days

• After 2-7 days– Dry cough– Progressive hypoexmia

– Pneumonia

SARS

• Treatment– Same for viral

pneumonia• Infection control– Limit transmission

• Neg pressure rooms• Protective equipment• Good cleaning or hands

and room• Contain secretions

Tuberculosis

• AKA– TB– Consumption

Tuberculosis - FYI

• Causes more death than any other disease. 2 billion world wide, 15 million in the US

Tuberculosis - FYI

• When it becomes active it kills 60% of those not treated. Amounts to about 3 million deaths each year. In the US about 20,000 TB cases become active each year.

Tuberculosis - FYI

• When treated, about 90% of those with active TB survive!

Tuberculosis

• Pathophysiology– Mycrobacterium

tuberculosis– Tubercle bacillus

Question?

• TB is caused by a(n)?A. BacteriaB. VirusC. FungusD.ParasiteE. Little green bugs!

Tuberculosis

Pathophysiology• Mode of transmission– Air-borne

• alveoli• Multiplies in alveoli

Tuberculosis

• Immune response phase– Macrophages attack TB– TB has waxy cell wall that protects it from

macrophages– Immune system surrounds the infected

macrophages– Forms a Lesion– Called a Tubercle

Tuberculosis

• Dormant /latent phase– Contagious?

• No

– Symptomatic?• No

– PPD?• positive

– chest x-ray?• Negative

Tuberculosis

• Active phase– If an infected person has a weakened immune

system, – the TB escapes and infects the body

Tuberculosis

• 5-10% become active• Only contagious when

active• Primarily affect lungs

but…– Kidneys– Liver– Brain– Bone

Tuberculosis

Etiology• Assoc. w/

– Poverty– Malnutrition– Overcrowding– Substandard housing– Inadequate health care

• Elderly• HIV• Prison

TuberculosisS&S (active phase)• NOC sweats• Low grade fever• Wt loss• Chronic productive cough

– Rust colored sputum– Thick

• Hemoptysis • SOB

Tuberculosis

Diagnostic exams• PPD – Mantoux skin test– > 10mm in diameter– induration – Indicates:

• Latent TB – Read

• 48-72 after – Intradermal: 15-degrees– Do not rub

Tuberculosis

• Diagnostic tests– X-ray

• Cavities or lesions

– Symptoms– Acid Fast Bacillus

TuberculosisTreatment• INH

– isonicotinyl hydrazine – Isoniazid – Toxic to the liver

• Rifampin– Turns urine red

• Streptomycin– Causes 8th cranial nerve damage– Acoustic nerve

Tuberculosis: treatment

• Rx toxic to liver and CNS

• Must take >6months• Usually take > one at a

time• Not contagious after

2wks of treatment

• INH - TUBERCULOSIS MEDICATIONYour positive skin test reaction shows that you have been exposed to tuberculosis at some time in the past. The tuberculosis germ is still present in your body. If your chest x-ray is normal, you do NOT have active TB disease.

• TB germs can live in your body without making you sick. This is called TB infection, and this is what you have. Your immune system has trapped the TB germs. However, if your immune system or body defenses go down, as can happen with stress, long-term illnesses, old age, or other stressors such as alcohol abuse, the TB germs may multiply and develop into active TB disease. TB germs can affect other organs besides the lungs.

• We recommend that you take preventive medicine now, before your TB infection becomes active TB disease. This medicine, taken every day for six or nine months, will kill the TB germs in your body so that you will not develop active TB disease. The medicine you will be taking is Isoniazid - also called “INH.” This medicine may deplete your body’s stores of vitamin B6, so you will also be given additional vitamin B6, to counteract possible side effects from a lack of this vitamin.

Tuberculosis

Nursing Dx• Impaired gas exchange• Ineffective airway

clearance• Anxiety• Knowledge deficit• Alt. nutrition

TuberculosisPreventative measures• Clean well ventilated living areas• Resp. isolation

– Negative pressure room

• Vaccine?– BCG– Does not prevent TB– Causes a + PPD

• If exposed take– INH

Tuberculosis

Complications• Malnutrition• S/E of medication

treatment• Multi-drug resistance• Spread of TB infection

Small Group Questions

1. What type of pathogen is TB?2. What is the mode of transmission?3. What are the classic S&S of TB ?4. How to administer and read a PPD?5. If a pt is PPD +, what does that mean?

Small Group Questions

6. What is the standard screening method of TB?

7. That medications are used to treat TB, what are their side effects?

8. Where in the US is TB most prevalent? Why?

Lung Abscess

Pathophysiology• Localized necrotic lesion of the lung

parenchyma containing purulent material • Lesion collapses and forms a cavity

Lung Abscess

Etiology / contributing factors

• Aspiration• Obstruction of the

bronchi

Risk Factors:• Any one at risk for

aspiration is at risk for lung abscess!– Impaired cough reflex– CNS disorders– NGT– Alcoholism– LOC

Lung Abscess

S&S• Most often Rt or left

side?– Right

• Varied– Dyspnea– Weakness– Fever– Malodorous sputum

– Blood sputum– Pleurisy– Anorexia

Lung Abscess

Dx• Absent / decreased BS• Chest x-ray• Sputum culture• Bronchoscopy

Lung Abscess

Tx• IV antimicrobial– Lg amounts

• Chest drainage– Chest physiotherapy– TCDB

• Diet– Protein

• ↑

– Calories• ↑

– Catabolic state• Bronchoscopy – Drain lesion

• Long recovery

Lung Abscess

Prevention• Antibiotics with dental

work• Tx pneumonia• HOB w/ NGT

Lung Abscess

Complications• Broncho-pleural fistula

Small Group Questions1. Describe the pathophysiology of a lung abscess in

your own words?2. What is the most common etiology of a lung

abscess?3. How is a lung abscess treated? – non-

pharmaceutical.4. What nursing education can a nurse give to patient

at risk of developing a lung abscess?5. What diet is usually prescribed to a patient with a

lung abscess?

Pleurisy

Pathophysiology• Pleural membranes

become inflamed• ‘catch” or rub on I• The parietal pleura has

nerve endings• The visceral pleura does

not have nerve endings

Pleurisy

Etiology/Contributing factors• Usually related to

another underlying respiratory problem/disease– Pneumonia– TB– Tumor/cancer– Trauma

Pleurisy

S&S• #1 pain – with respiration– movement– deep breath, cough,

sneeze– localized (usually one

side or the other)

– Sharp pain on inspiration– when hold their breath– as fluid develops

• Shallow-rapid breathing

Pleurisy

• Dx exams/procedures– S&S – Auscultation ?

• pleural friction rub • lower, lateral, anterior

– X-ray– Thoracentesis

Pleurisy

Tx• Underlying cause• Control pain – Analgesics– Topical application or

heat or cold– Indomethacin (Indocin)

(NSAID)– Narcotics

• Nerve block• Antibiotics

Pleurisy

Nursing intervention• Rest• Pain sympathy• Lay on ______ side

– Affected• Splint side when DB

and cough– Pillows– Hands

• Complications– Pleural effusion – Atelectasis– Empyema

Pleural Effusion: AKA - Hydrothorax

Pathophysiology• Excess fluid collects in

the pleural space • fluid • to compression of the

lung tissue • atelectasis• Effusion can be

– clear fluid – bloody – purulent

Pleural Effusion

• Pleural Fluid circulated by lymphatic system.

• Can be cause be a break in either system– Respiratory – Lymphatic

Pleural Effusion

Etiology• Symptom rather than a

disease• Generally caused by

another disorder– Heart failure– TB– Pneumonia– Pulmonary embolism– Tumors / Carcinoma

Pleural Effusion

S&S• or absent BS• SOB• Percussion– dull

• Lg amts mediastinum to shift towards…– unaffected side.

• Tracheal deviation away from…– affected side

S&S assoc. w/ the underlying cause.

• i.e. pneumonia:– fever, chills, dyspnea,

cough etc.

Pleural Effusion

DX exams/procedures• Thoracentesis – C&S fluid– Gram stain, acid-fast

bacillus stain• TB

– Cytologic analysis • malignant cells

• X-ray

Pleural Effusion: treatment

• Thoracentesis• Chest tube • Prevent re-accumulation of

fluid• Relieve comfort, dyspnea

and respiratory compromise

• pursed lip and diaphragmatic breathing

• Remove fluids Rx. – Lasix

• Anti-inflammatory + analgesics– Toradol– NSAIDS– Corticosteroids

• Treat underlying cause• Chemical pleurodesis

Pleural Effusion

Nursing intervention• Implement medical

regime• Pain management• Monitor chest tubes• Assist with

thoracentesis

EmpyemaPathophysiology• Collection of pus in the

pleural spaceEtiology• Usually secondary to

pneumonia, TB or lung abscess

Clinical manifestations and treatment

• Same as pleural effusion

• Elevated WBC

Hemothorax

Pathophysiology• Do you want to take a

stab at it?• Blood in the pleural spaceEtiology• Trauma

– #1• Lung CA• Pulm. emboli

Symptoms: • Same as pneumothoraxTreatment• Chest tube• Treat underlying issueNursing Management• Monitor chest tube• Monitor resp. status

Small Group Questions

1. Describe the difference between pleurisy, pleural effusion, hemothorax and empyema.

2. What is the etiology for each of the above disorders?

3. Describe the medical treatment for the above.4. What is the Rx treatment for each of the above?

Pneumothorax

Pathophysiology:• “Accumulation of air

or gas in the pleural cavity”

• Left-sided pneumothorax (on the right side of the image) on CT scan of

the chest with chest tube in place.

Pneumothorax

Anatomy Review- Pleural cavity

• Visceral pleura– Encases lungs

• Pleural space/cavity– Area between pleura– Contains fluid (4ml)– Fluid prevents friction– Fluid circulated by…

• lymph system• Parietal pleura

– Lines chest wall

Pneumothorax

Anatomy review - Breathing• Diaphragm & accessory

muscles move outward • Negative pressure in the

thoracic cavity • Negative pressure pulls air

into the lungs via the nose and mouth

• Diaphragm & accessory muscle relax ()

• air exhaled

Pneumothorax

• If the visceral pleural is perforated or the chest wall & parietal pleural are perforated– air enters the pleural

space – negative pressure is

lost – Lung on the affected

side collapses

Pneumothorax

Classifications of pneumothorax

• Spontaneous pneumothorax– with out injury– Air enters the pleural

cavity via the airway– Farther classified as:

• Primary• Secondary

Pneumothorax

Spontaneous (Primary) Pneumothorax

• Pt. with no known lung disease.

• D/T a rupture of a bulla in the lung.

• Most often tall, thin men between 20 and 40 years old.

Pneumothorax

Spontaneous Secondary Pneumothorax

• occurs in pt. with known lung disease– most often COPD

• Other lung diseases commonly assoc. with– Tuberculosis– Pneumonia– Asthma– cystic fibrosis– lung cancer

• Often severe & life threatening

Pneumothorax

• Traumatic Pneumothorax– D/T injury to the chest

wall– Further classified as

Open or closed

Pneumothorax

Open Pneumothorax• Air enters pleural cavity via

outside• A free communication

between the exterior and the pleural space as through an open wound– blowing wound– sucking wound

• may be caused by a penetrating injury– stab wound,– gunshot wound– impaled object

Pneumothorax

Closed pneumothorax• Air enters the pleural

cavity via lungs• D/t/ blunt chest

trauma– Car crash– Fall– Crushing chest injury

Pneumothorax

Iatrogenic pneumothorax• D/T procedure /

treatment

Pneumothorax

Tension Peumothorax• air accumulates in the

pleural space with each breath.

• The remorseless increase in intrathoracic pressure

• massive shifts of the mediastinum away from the affected lung

• compressing intrathoracic vessels

• cardiovascular collapse

Pneumothorax

Tension Pneumonthorax• a piece of tissue forms

a one-way valve that allows air to enter the pleural cavity but not to escape, overpressure can build up with every breath

Pneumothorax

Etiology / Contributing factors• Spontaneous

– Lung disease - COPD– Tall, thin men

• Traumatic– A penetrating chest wound – Barotrauma

• scuba divers• Iatrogenic Pneumothorax

– * insertion of a central line – * thoracic surgery – * thoracentesis – * pleural or transbronchial

biopsy.

Pneumothorax

Clinical Manifestations (all types)

• Sudden sharp chest pain• Asymmetrical chest

expansion• dyspnea• Cyanosis• Percussion

– Hyper resonance or tympany

• Breath sounds– diminished– Absent

Pneumothorax

Clinical Manifestations (all types)

• Respiratory distress• O2 Sats– decreased

• Tachypnea• Tachycardia• Restlessness/ Anxiety

Pneumothorax

S&S of open pneumothorax

• Cripitus – (subcutaneous

emphysema)

• Sucking chest wound”

Pneumothorax

S&S Tension pneumothorax• cardiac output• Hypotension• Tachycardia (compensatory)• Tachypnea • Mediastinal shift and

tracheal deviation– To the unaffected side

• Cardiac arrest• Distended neck veins

Pneumothorax

Dx exam and tests• HX & PE• Chest x-ray• ABG’s

– Initial PaCO2• Decreased• respiratory alkalosis

– Later ABG’s• Hypoxemia• Hypercapnia• Acidosis

Pneumothorax

Treatment - First aid: Open pneumothorax

• Cover immediately with an occulsive dressing, made air-tight with petroleum jelly or clean plastic sheeting.

Pneumothorax

Tx: Small pneumothorax • Spontaneous recovery– Bed rest– resolve on its own in 1

to 2 weeks

• Remove with small bore needle inserted into the pleural space

Pneumothorax

Tx: Larger pneumothorax• Chest tube • Surgery repair• Pleurodesis

– “glue” – Very painful– Prep with analgesic

• O2• Surgery

Pneumothorax

Nursing interventions• Closely monitor resp status• Frequent assess

– LOC– Color– VS – Chest pain?– Restlessness?

• Chest Tube • Rest/Activity Balance• Sedation • Provide a means for

communicate • Educate patient & family

• Notify MD for:– SpO2 < 90% or Change

Greater Than 5% – Extubation – Respiratory Distress – Inadequate Sedation – Peak Airway Pressure

(Especially with Pressure Control Mode)

Pneumothorax

Complications• Recurrent

pneumothorax – D/C

• smoking • high altitudes• scuba diving• flying in unpressurized

aircrafts

• Cardiac damage

Question?

A client who has been on a ventilator for two days experiences acute respiratory distress accompanied by distended neck veins. The best action of the nurse is to:

A. hand ventilate the client.B. prepare for chest tube insertion.C. call the physician immediately.D. perform emergency chest decompression.

• The question is asking what the nurse should do when a client on a ventilator has these symptoms. When acute respiratory distress occurs along with neck vein distension, cyanosis and tracheal shift are evident, a tension pneumothorax has probably occurred. The client should be removed from the machine and ventilated by hand. Then the physician should be notified (option c). Equipment for chest tube insertion should be gathered (option b) so it will be ready for immediate use by the physician. Emergency chest decompression (option d) should only be attempted after specific training and if the physician will be delayed.

• A patient is being treated with chest tubes because of a pneumothorax. The nurse recognizes that chest tubes may be used to:– Prevent pleural irritation– Regain positive intra-pleural pressure– Remove air from the intra-pleural space– All of the above– None of the above

Small Group Questions

1. What is the pathophysiology of a pneumothorax?2. Describe the anatomy of the pleural membrane

(including nerves endings)3. What is a spontaneous pneumothorax?4. What are some examples of an iatrogenic

pneumothorax?5. Define an open and closed pneumothorax.

Small Group Questions

6. Describe the mediastial shift in an pneumothorax.7. 7. What is the first aid treatment of a traumatic

pneumothorax (include assessment)8. What is Pleurodesis?9. What ABG’s would you expect to see late in a

patient with a pneumothorax?