Upload
preston-bennett
View
241
Download
6
Tags:
Embed Size (px)
Citation preview
Pleural effusion
Etiology/Patho- excess fluid pleural space- may contain pus
(empyema) or blood Occurs with local disease- lung cancer, pneumonia,
trauma or systemic disease (heart failure/liver/renal disease)
Common manifestations/complications Dyspnea, pleuritic pain, dec/absent breath sounds,
limited chest wall movement
Pleural effusion- therapeutic interventions Diagnostic tests Treatment- thoracentesis-
p 1145 Treatment- underlying
cause Treatment- administer O2
B. Pleural injury: pneumothorax
Etiology/Patho- air in pleural space- p. 1147 Spontaneous Traumatic Tension
Common manifestations/complications p. 1147 with illustrations
Pleural injury: pneumothorax therapeutic interventions
Diagnostic tests- chest X-ray; O2 sats; ABG’s High Fowlers; O2; rest to dec O2 demand Treatment depends on severity Treatment- chest tube Treatment- Heimlich valve on chest tube Treatment- throacotomy tube
C. Pleural injury: hemothorax Blood in pleural space Caused by trauma; lung
malignancy; pulmonary embolus; complication anticoagulant therapy
Like pneumothorax- lung can collapse
Manifestations similar to pneumothorax; blood loss symptoms
Pleural injury:A. pleural effusion; B. pneumothorax & C. hemothorax
Nursing assessment specific to pleural injury Health history- resp disease, injury, smoking,
progression of symptoms Physical exam- degree of apparent resp distress, lung
sounds, O2 sat, VS, LOC, neck vein distention, position of trachea
Pertinent nursing problems and interventions Impaired gas exchange Risk for injury Home care
Thoracic Injury Etiology/path
Rib fractures- most common; flail chest- 2 or more ribs fractured; pulmonary contusion- alveoli arterioles rupture
Common manifestations Rib fractures- pain on inspiration, shallow breathing Flail chest- severe dyspnea, cyanosis, tachypnea, paradoxial
chest, crepitus Pulmonary contusion- may not see 12-24 hrs post injury, inc
resp diff, restless, chest pain, coughing up sputum
Subcutaneous emphysema caused by air escaping into subcutaneous tissue from pneumothorax- feels like crackles or tissue paper
Thoracic Injury: Therapeutic interventions Diagnostic test- all require chest X-ray; ABG’s Rib fracture- analgesics; do not restrict chest movement Flail chest-
Mild- deep breathing, pain management intercostal nerve blocks
Resp distress- intubation and mechanical ventilation- positive pressure to stabilize flail chest; external fixation
Pulmonary contusion- endotracheal tube and mechanical ventilation; bronchoscopy to remove secretions to prevent atelectasis