Respiratory Examination and Assessment

7/28/2019 Respiratory Examination and Assessment

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RCdelaPea, RN, RM, MAN1

RESPIRATORY EXAMINATION ANDASSESSMENT

A. Abnormal patterns of breathing

1. Sleep Apnea

- Cessation of airflow for more than 10 secondsmore than 10 times a night during sleep

Causes: obstructive (e.g. obesity with uppernarrowing, enlarged tonsils, pharyngeal softtissue changes in acromegaly orhypothyroidism)

2. Cheyne-Stokes- Periods of apnea alternating with periods ofhyperpnoea

pathophysiology: delay in medullary

chemoreceptor response to blood gas changes

Causes

brain damage (e.g. trauma, cerebral,hemorrhage)

3. Kussmaul's (air hunger)- deep rapid respiration due to stimulation ofrespiratory centre

Causes: metabolic acidosis (e.g. diabetes

mellitus, chronic renal failure)

4. Hyperventilation

complications: alkalosis and tetany

causes: anxiety

5. Ataxic (Biot)

irregular in timing and deep

causes:brainstem damage

6. Apneustic

post-inspiratory pause in breathing

causes:brain (pontine) damage7. Paradoxical

the abdomen sucks with respiration (normally, itpouches uotward due to diaphragmatic descent)

causes: diaphragmatic paralysis

B. Cyanosis

1. Refers to blue discoloration of skin andmucous membranes, is due to presence ofdeoxygenated hemoglobin in superficial bloodvessels

2. Central cyanosis = abnromal amout ofdeoxygenated haemoglobin in arteries and that

blue discoloration is present in parts of bodywith good circulation such as tongue

3. Peripheral cyanosis = occurs when blood

supply to a certain part of body is reduced, andthe tissue extracts more oxygen from normalfrom the circulating blood, e.g. lips in coldweather are often blue, but lips are spared

4. Causes of cyanosis

Central cyanosis

high altitude

massive pulmonary embolism

hunt (cyanotic congenitalheart disease)

methaemoglobinaemia, sulphaemoglobinaemia

Peripheral cyanosis

cyanosis

c output: left ventricular failureor shock

Position: patient sitting over edge of bedGeneral appearance

Dyspnea

normal respiratory rate < 14 each minute

tachypnea = rapid respiratory rate

are accessory muscles being used

(sternomastoids, platysma, strap muscles ofneck) - characteristically, the accessory musclescause elevation of shoulders with inspiration andaid respiration by increasing chest expansion

Cyanosis

Character of cough

ask patient to cough several times

lack of usual explosive beginning may indicatevocal cord paralysis (bovine cough)

muffled, wheezy ineffective cough suggestsairflow limitation

Very loose productive cough suggests excessivebronchial secretions due to:

- Chronic bronchitis


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The Face

Eyes

Horner's syndrome? (Constricted pupil, partialptosis and loss of sweating which can be due to

apical lung tumor compressing sympatheticnerves in neck)

Nose

Polyps? (Associated with asthma)

Engorged turbinates? (Various allergicconditions)

Deviated septum? (Nasal obstruction)

Mouth and tongue

Look for central cyanosis

Evidence of upper respiratory tract infection (areddened pharynx and tonsillar enlargement withor without a coating of pus)

Broken tooth - may predispose to lung abscessor pneumonia

Sinusitis is indicated by tenderness over thesinuses on palpation

Some patients with obstructive sleep apneawill be obese with a receding chin, a small

pharynx and a short thick neck

The Trachea

toward the side of the lung lesion

upper mediastinal masses, such as retrosternalgoiter

s itmove inferiorly with each inspiration) is a signof gross overexpansion of the chest because ofairflow obstruction

The Chest: inspection

Shape and symmetry of chest

Barrel shaped

compared with lateral diameter

causes: hyperinflation due to asthma,emphysema

Pigeon chest (pectus carinatum)

localized prominence (outward bowing ofsternum and costal cartilages)

causes:

manifestation of chronic childhood illness (dueto repeated strong contractions of diaphragmwhile thorax is still pliable)

rickets

Funnel chest (pectus excavatum)

localizeddepression of lower end of sternum in severecases, lung capacity may be restricted

Harrison's sulcus

inner depression of lower ribs just abovecostal margins at site of attachment ofdiaphragm

causes:

severe asthma in childhood

rickets

Kyphosis, exaggerated forward curvature ofspine

Scoliosis, lateral bowing

Kyphoscoliosis: causes:

involving grey matter of cord)

reduce lung capacity and increase work ofbreathing)

Lesions of chest wall

- previous thoracic operations or chestdrains for a previous pneumothorax or pleural

effusion

rformed to removeTB, but no longer is because of effective anttuberculosis chemotherapy) involved removal oflarge number of ribs on one side to achieve

permanent collapse of affected lung


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radiotherapy; there is a sharp demarcationbetween abnormal and normal skin

Diffuse swelling of chest wall and neck

causes:

pneumothorax

rupture of esophagus

Prominent veins

cause: superior vena cava obstruction

Asymmetry of chest wall movements

looking down the clavicles during moderaterespiration - diminished movement indicatesunderlying lung disease

show delayed ordecreased movement

causes of reduced chest wall movements onone side are localized:

localized pulmonary fibrosis

consolidation

collapse

pleural effusion

pneumothroax

causes of bilateral reduced chest wallmovements are diffuse:

diffuse pulmonary fibrosis


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The Chest:palpation

chest expansion

place hands firmly on chest wall with fingersextending around sides of chest (fugyre 4.5)

as patient takes a big breath in, the thumbsshould move symmetrically apart about 5 cm

reduced expansion on one side indicates a lesionon that side

note: lower lobe expansion is tested here; upperlobe is tested for on inspection (as above)

apex beat

(discussed in cardiac section)

for respiratory diseases:

- can becaused by:

collapse of lower lobe

localized pulmonary fibrosis

- can becaused by:

pleural effusion

tension pneumothorax

is hyper expanded secondary to chronic airflowlimitation

vocal fremitus

palpate chest wall with palm of hand whilepatient repeats "99"

front and back of chest are each palpated in 2comparable positions with palms; in this waydifferences in vibration on chest wall can bedetected

causes of change in vocal fremitus are the sameas those for vocal resonance (see later)

ribs

gently compress chest wall anteroposteriorly andlaterally

localized pain suggests a rib fracture (may besecondary to trauma or spontaneous as a resultof tumor deposition or bone disease)

The Chest:percussion

with left hand on chest wall and fingers slightlyseparated and aligned with ribs, the middle

finger is pressed firmly against the chest; pad ofright middle finger is used to strike firmly themiddle phalanx of middle finger of left hand

percussion of symmetrical areas of:

posterior (back) (ask patient to move elbowsforward across the front of chest - this rotates thescapulae anteriorly, i.e. moves it out of the way)

percussion over a solid structure (e.g. liver,consolidated lung) produces a dull note

percussion over a fluid filled area (e.g. pleuraleffusion) produces an extremely dull (stony dull)note

percussion over the normal lung produces aresonant note

percussion over a hollow structure (e.g. bowel,pneumothorax) produces a hyperresonsant note

liver dullness:

percussing down the anterior chest in mid-clavicular line

llness is 6thrib in right mid-clavicular line

sign of hyperinflation usually due toemphysema, asthma

cardiac dullness:

usually present onleft side of chest

decrease in emphysema or asthma

The Chest: auscultation

breath sounds

introduction

one should use the diaphragm of stethoscope tolisten to breath sound in each area, comparing

each side

remember to listen high up into the axillae

remember to use bell of stethoscope to listen tolung from above the clavicles

quality of breath sounds


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normal breath sounds

chest, produced in airways rather than alveoli(although once they had been thought to arisefrom alveoli (vesicles) and are therefore called

vesicular sounds)

and longer on inspiration than on expiration; andthere is no gap between the inspiratory andexpiratory sounds

bronchial breath sounds

being filtered by the alveoli, and thereforeproduce a different quality; they are heard overthe trachea normally, but not over the lungs

there is a gap between inspiration and expiration

solid lung conducts the sound of turbulence inmain airways to peripheral areas withoutfiltering

- lung consolidation (lobar pneumonia) -common

- localized pulmonary fibrosis - uncommon

- pleural effusion (above the fluid) - uncommon

- collapsed lung (e.g. adjacent to a pleuraleffusion) - uncommon

large cavity have an exaggerated bronchialquality)

intensity of breath sounds

causes of reduced breath sounds include:

emphysema)

orax

added (adventitious) sounds

two types of added sounds: continuous(wheezes) and interrupted (crackles)

wheezes

both

- airway

narrowing

narrowing

- asthma (often high pitched) - due to musclespasm, mucosal edema, excessive secretions

- chronic airflow diseases - due to mucosaledema and excessive secretions

- carcinoma causing bronchial obstruction -

tends to cause a localized wheeze which ismonophonic and does not clear withcoughing

crackles

pitched crackles) and creptitations (highpitched crackles)

airways on expiration and sudden openingon inspiration

- suggests disease of small airways

- characteristic of chronic airflow limitation

- are only heard in early inspiration

- suggests disease confined to alveoli

- may be fine, medium or coarse

- fine crackles - typically caused bypulmonary fibrosis

- medium crackles - typically caused by leftventricular failure (due to presence ofalveolar fluid)

- coarse crackles - tend to change withcoughing; occur with any disease that leadsto retention of secretions; commonly occur

in bronchiectasis

pleural friction rub

surfaces rub together, a continuous orintermittent grating sound may be heard


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secondary to pulmonary infarction orpneumonia

vocal resonanance

gives information about lungs' ability to transmitsounds

consolidated lung tends to transmit highfrequencies so that speech heard throughstethoscope takes a bleeting quality(aegophony); when a patient with aegophonysays "bee" it sounds like "bay"

listen over each part of chest as patient says"99"; over consolidated lung, the numbers will

become clearly audible; over normal lung, the

sound is muffled

whispering pectoriloquy - vocal resonance isincreased to such an extent that whisperedspeech is distinctly heard

The Heart

lay patient at 45 degrees

measure jugular venous pulse for right heartfailure

examine pericardium; pay close attention topulmonary component of P2 (which is bestheard at 2nd intercostals space on left) andshould not be louder than A2; if it is louder,suspect pulmonary hypertension

cor pulmonale (also called pulmonaryhypertensive heart disease) may be due to:

chronic airflow limitation (emphysema)pulmonary fibrosispulmonary thromboembolism

marked obesitysleep apneasevere kyphoscoliosisThe Abdomen

palpate liver for enlargement due to secondarydeposits of tumor from lung, or right heartfailure

Other

Permberton's sign

inspiratory stridor, and non-pulsatile elevation ofjugular venous pressure

cava obstruction

Feet

edema or cyanosis (clues of corpulmonale)

thrombosis

Respiratory rate on exercise and positioning

dyspnea should havetheir respiratory rate measured at rest, atmaximal tolerated exertion and supine

dyspnea is not accompanied by tachypneawhen a patient climbs stairs, one should considermalingering

abdomen during inspiration when patient issupine (indicating diaphragmatic paralysis)

Temperature: fever may accompany any acute orchronic chest infection

DIAGNOSTIC EVALUATION 1. Skin Test:Mantoux Test or Tuberculin Skin Test

infected or has been exposed to the TB bacillus.

PPD (Purified ProteinDerivatives).

intradermally usually inthe inner aspect of the lower forearm about 4inches below the elbow.

48 to 72 hours after injection.

(+) Mantoux Test is induration of10 mm ormore.

about 5 mm is considered positive

exposure to MycobacteriumTubercle bacilli


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2. Pulse Oximeter

-invasive method of continuouslymonitoring the oxygen saturation of hemoglobin

forehead, earlobe or bridge of the nose

2 sat levels bymonitoring light signals generated by theoximeter and reflected by the blood pulsingthrough the tissue at the probe

- 100%

- tissues are not receiving enough O2

vasoconstrictors

monoxide Level 3. Chest X-ray

-invasive procedure involvingthe use of x-rays with minimal radiation.

on cue to hold his breath and to do deepbreathing

remove metals from thechest.

out pregnancy first.

5. Computed Tomography (CT Scan) andMagnetic Resonance Imaging (MRI)

CT scan is a radiographic procedurethat utilizes x-ray machine.

MRI uses magnetic field to record theH+ density of the tissue.

It does NOT involve the use of radiation.

The contraindications for this procedure are the

following: patients with implanted pacemaker,patients with metallic hip prosthesis or othermetal implants in the body.

This chest CT scan shows a cross-section of aperson with bronchial cancer. The two darkareas are the lungs. The light areas within thelungs represent the cancer. Clear MRI images oflung airways during breathing. 6. Fluoroscopy

chest in motion

continuous observation of animage reflected on a screen when exposed toradiation in the manner of television screen that

is activated by an electrode beam.

the X-ray beam are visualized on the screen insilhouette

7. Indirect Bronchography

radiopaque medium is instilled directlyinto the trachea and the bronchi and the outlineof the entire bronchial tree or selected areas may

be visualized through x-ray.

anomalies of the bronchial treeand is important in the diagnosis ofbronchiectasis.

Nursing interventions BEFORE Bronchogram

sea foods or iodine oranesthesia

-op meds: atropine SO4 and valium,topical anesthesia sprayed; followed by localanesthetic injected into larynx. The nurse musthave oxygen and anti spasmodic agents ready.

Nursing interventions AFTER Bronchogram

-lying position

client

8. Bronchoscopy

direct inspection andobservation of the larynx, trachea and bronchithrough a flexible or rigid bronchoscope.

lighted bronchoscope into thebronchial tree for direct visualization of thetrachea and the tracheobronchial tree.

and collect specimen for biopsy


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surgically

tracheobronchial tree

obstructing the tracheobronchial tree

-operative atelectasis

Bronchoscopy

re to the patient, tell himwhat to expect, to help him cope with theunknown

Atropine (to diminish secretions) isadministered one hour before the procedure

Valium is given to sedate patient and allayanxiety.

Topical anesthesia is sprayed followedby local anesthesia injected into the larynx

NPO for 6-8 hours

lenses

supine withhyperextended neckduring the procedure

Bronchoscopy

Side lying position

with.

cough and gagreflex.

cyanosis, hypotension,tachycardia, arrhythmias, hemoptysis,and dyspnea. These signs and symptoms

indicate perforation of bronchial tree.Refer the patient immediately!

9. Lung Scan

a radioisotope, scans is taken with a scintillationcamera.

distribution and blood flow inthe lungs. (Measure blood perfusion)

Confirm pulmonary embolism or otherblood- flow abnormalities

procedure:

procedure

ed.

10. Sputum Examination

sputum: Gross appearance, Sputum C&S,AFB staining, and for Cytological examination/Papanicolaou examination

Early morning sputum specimen is to becollected (suctioning or expectoration)

plain water

sterile container.

beforethe first dose of anti-microbial therapy.

forthree consecutive mornings.

11. Biopsy of the Lungs

lung tissue


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- Transbronchoscopic biopsydone duringbronchoscopy,

- Percutaneous needle biopsy

- Open lung biopsy

procedure:

the patients chart.

Pneumothorax and air embolism

hemoptysis andhemorrhage

12. Lymph Node Biopsy

13. Pulmonary Function Test / Studies

-invasive test

diffusing capacity

chodilators or narcotics usedbefore testing

LUNG VOLUMES: (ITER) Inspiratoryreserve volume (3000 mL)

following a normal quiet inhalation.

Tidal volume (500 mL)

normal quiet breathing

Expiratory reserve volume (1100 mL)

following the normal quiet exhalation

Residual volume (1200 mL)

ains in the lungsafter forceful exhalation

LUNG CAPACITIES: Functional Residual

Capacity (ERV 1100 mL + RV 1200 mL =2300 mL )

after normal, quiet exhalation

Inspiratory Capacity (TV 500 mL + IRV 3000mL = 3500 mL)

maximally after a normal expiration

Vital capacity (IRV 3000 mL + TV 500 mL +

ERV 1100 mL = 4600 mL)

exhaled after a maximum inhalation

Total Lung Capacity (IRV 3000 mL + TV 500mL + ERV 1100 mL + RV 1200 mL = 5800 mL)

14. Arterial Blood Gas

re ableto provide adequate oxygen and remove CO2

able to reabsorb or excrete bicarbonate.

arterial blood for tissueoxygenation, ventilation, and acid-base status

rformed on areas wheregood pulses are palpable (radial, brachial, orfemoral). Radial artery is the most commonsite for withdrawal of blood specimen

10-ml. Pre-heparinized syringe toprevent clotting of specimen

container with ice toprevent hemolysis

Allenstest to assess for adequacy of collateralcirculation of the hand (the ulnar arteries)

15. Pulmonary Angiography


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-ray pictures of thepulmonary blood vessels (those in the lungs).

seen in an X-ray, a contrast material is injected

into one or more arteries or veins so that theycan be seen.


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16. Ventilation - Perfusion Scan

nuclear scan test that is performed to measurethe supply of blood through the lungs.

detect the location of the radioactive particles asblood flows through the lungs.

ability of air to reach all portions of the lungs.The perfusion scan measures the supply of bloodthrough the lungs.

performed to detect a pulmonary embolus. It isalso used to evaluate lung function in peoplewith advanced pulmonary disease such as COPD

and to detect the presence of shunts (abnormalcirculation) in the pulmonary blood vessels.

17. Thoracentesis

ocedure suing needle aspiration ofintrapleural fluid or air under local anesthesia

fluid

insertion of the needle

pressure sensation will befelt on insertion of needle

roper position:

Upright or sitting on the edge of the bed

Lying partially on the side, partially on theback

the patient on the affected side, asordered, for at least 1 hour to seal the puncturesite

unaffected side to preventleakage of fluid in the thoracic cavity

RESPIRATORY CARE MODALITIES 1.Oxygen Therapy

dry gas that supports combustion

21% oxygen from theenvironment in order to survive

Hypoxemia

o Increased pulse rate

o Rapid, shallow respiration and dyspnea

o Increased restlessness or lightheadedness

o Flaring of nares

o Substernal or intercostals retractions

o Cyanosis

Low flow oxygen provides partial oxygenationwith patient breathing a combination ofsupplemental oxygen and room air. Low-flowadministration devices:

o Nasal Cannula 24-45% 2-6 LPM

o Simple Face Mask 0-60% 5-8 LPM

o Partial Rebreathing Mask 60-90% 6-10 LPM

o Non-rebreathing Mask 95-100% 6-15 LPM

o Croupette

o Oxygen Tent

High flow oxygen provides all necessaryoxygenation, with patients breathing only

oxygen supplied from the mask and exhalingthrough a one-way vent. High flowadministration devices

o Venturi Mask 24-40% 4-10 LPM

provides accurate amount of oxygen.


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o Face Mask

o Oxygen Hood*

o Incubator / isolette*

Note: * can be used for both low and high flowadministration

checking nares, nose and applying gauze orcotton as necessary

COPD patients receive onlyLOW flow oxygen because these personsrespond to hypoxia, not increased CO levels.


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2. Tracheobronchial suctioning

semi or high Fowlersposition

sterile gloves, sterile suction catheter

Hyperventilate client with 100% oxygenbefore and after suctioning

-5 lengthof catheter insertion) without applying suction.Three passes of the catheter is the maximum,with 10 seconds per pass.

during withdrawal ofcatheter

than 120 mmHg

rotate whileapplying intermittent suction

take only 10 seconds(maximum of 15 seconds)

of the chest.

3. Bronchial Hygiene Measures

a. Steam inhalation

follows:

- to liquefy mucous secretions - to warm and

humidify air - to relieve edema of airways - tosoothe irritated airways - to administermedication

dependent nursing function

t and explain the purpose ofthe procedure

-Fowlers position

prevent irritation

surface.

1218 inches away from theclients nose or adjust distance as necessary

towel to prevent burns due to dripping ofcondensate from the steam. Assess for rednesson the side of the face which indicates firstdegree burns.

therapy for1520 minutes

and coughing exercises after the procedure tofacilitate expectoration of mucous secretions.

procedure.

-care of equipment.

b. Aerosol inhalation

bronchodilators or mucolytic-expectorants.

. c. Medimist inhalation

ministerbronchodilators or mucolytic-expectorants.

4. Chest Physiotherapy (CPT)

and vibration, and breathing retraining. Effectivecoughing is also an important component.

l secretions,improved ventilation, and increased efficiencyof respiratory muscles.

use gravity to assist in the removal of secretions.

percussion or vibration.eathing exercises and breathing retraining

improve ventilation and control of breathing anddecrease the work of breathing.

respiratory disorders like COPD, cystic fibrosis,lung abscess, and pneumonia. The therapy isbased on the fact that mucus can be knocked orshaken from airways and helped to drain fromthe lungs.Postural drainage

secretions.

promote flow of drainage from different lungsegments using gravity.

lung segments to promote drainage.

-15minutes depending on tolerability.

Percussion


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through the chest wall to the bronchi.

hands over the areas were secretions are located.

ne, kidneys,breast or incision and broken ribs. Areas shouldbe percussed for 1-2 minutes

Vibration

are placed on clients chest and gently but firmlyrapidly vibrate hands against thoracic wallespecially during clients exhalation.

stimulate cough.

-7 times duringpatient exhalation.Medical and Surgical Nursing RespiratorySystem Lecture Notes Prepared by: MarkFredderick R. Abejo RN,, MAN MS Abejo 13


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Suctioning

Nursing Interventions in CPT

secretions.

secretions by gravity

-10 to 15minutes

mucus secretions

hypotension

expectorate sputum

est done 60 to 90 minutesbefore meals or in the morning upon awakeningand at bedtime.

5. Incentive Spirometry

Types: volume and flow

Device ensures that a volume of air is inhaledand the patient takes deep breaths.

Used to prevent or treat atelectasis

To enhance deep inhalation

Nursing care

Positioning of patient, teach and encourageuse, set realistic goals for the patient, and recordthe results.

6. Closed Chest Drainage (ThoracostomyTube)

the mediastinum or pleural space into acollection chamber to help re-establish normalnegative pressure for lung re-expansion.

Purposes

uralspace

-expand the lungs

Procedure

chest wall at the level of 2nd to 3rd intercostalsspace to release air or in the fourth intercostalsspace to remove fluid.

Types of Bottle Drainage

One-bottle system

-seal

-3 cm of sterileNSS to create water-seal.

-3 feet below the level ofthe chest to allow drainage from the pleura bygravity.

heart to prevent reflux of air or fluid.

tube. The fluctuation synchronizes with therespiration.

continues bubbling means presence of air-leak

In the absence of fluctuation: Suspectobstruction of the device

allows the nurse to milk the tube)

-expansion; (validated by chest x-ray)

Two-bottle system

drainage bottle;

water-seal bottle

(water-seal bottle or the second bottle) andintermittent bubbling with each respiration.

NOTE! IF connected to suction apparatus

1. The first bottle is the drainage and water-sealbottle;

2. The second bottle is suction control bottle.


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3. Expect continuous bubbling in the suctioncontrol bottle;

4. Intermittent bubbling and fluctuation in thewater-seal

5. Immerse tip of the tube in the first bottle in 2to 3 cm of sterile NSS

6. Immerse the tube of the suction control bottlein 10 to 20 cm of sterile NSS to stabilize thenormal negative pressure in the lungs.

7. This protects the pleura from trauma if thesuction pressure is inadvertently increased


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Three-bottle system

is the drainage bottle;

water seal bottle

suction control bottle.

intermittent bubbling andfluctuation with respiration in the water- seal

bottle

GENTLE bubbling in thesuction control bottle. These are the expectedobservations.

continuous bubbli ng

in the WATER seal bottle or if there isVIGOROUS bubbling in the suction control

bottle.

tthe observation at once. Never clamp the tubingunnecessarily.

If there is NO fluctuation in the water sealbottle, it may mean TWO things

lungs have expanded or thesystem is NOT functioning appropriately.

se refers theobservation to the physician, who will order foran X-ray to confirm the suspicion.

Important Nursing considerations

drainage:

ar basis

intervals

tube to prevent tension pneumothorax

What the nurse should do if:

continuous bubbling:

the chest for a few seconds.

bubbling in the water seal bottle stops,the leak is likely in the lungs,

bubbling continues, the leak isbetween the clamp and the bottle chamber.

Next, the nurse moves the clamp towards thebottle checking the bubbling in the water sealbottle.

clamp and the distal part including the bottle.

tent bubbling, it meansthat the drainage unit is leaking and the nursemust obtain another set.

the nurse temporarily kinks the tube and must

obtain a receptacle or container with sterilewater and immerse the tubing.

as replacement. She should NEVER CLAMP thetube for a longer time to avoid tension

pneumothorax.

out, the nurse obtains vaselinized gauze andcovers the stoma.

Removal of chest tubedone by physician

Petrolatum Gauze Suture removal kit Sterilegauze Adhesive tape

-Fowlers position

and do valsalva maneuver as the chest tube is

removed.

-ray may be done after the chest tubeis removed

emphysema; respiratory distress

7. Artificial Airway a. Oral airways- these areshorter and often have a larger lumen. They areused to prevent the tongue form falling

backward. b. Nasal airways- these are longerand have smaller lumen Which causes greater

airway resistance c. Tracheostomy- this is atemporary or permanent surgical opening in thetrachea. A tube is inserted to allow ventilationand removal of secretions. It is indicated foremergency airway access for many conditions.The nurse must maintain tracheostomy care

properly to prevent infection.


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Documents

Respiratory Examination and Assessment