MDC 4 EXAM 2
Chest Injury and Complex Respiratory
● Pneumothorax S/S, nsg assessment, indications
○ Air enters the pleural space and causes a loss of negative pressure in
the chest cavity, leading to lung collapse. Air enters on inspiration and
cant get out!
○ Risk factors: occlusion of chest tube, vent and rib fractures
○ S/S
■ Diminished breath sounds on the affected side,
asymmetrical chest expansion, deviated trachea to
unaffected side, low CO2, low BP, tachycardia, JVD,
tachypnea, anxiety
○ Treatment
■ Simple: Occlusive dressing with chest tube insertion.
■ Tension: needle decompression thoracostomy
○ Assessment:
■ Vitals, labs, CO2 levels, cardiac, respiratory, ABG
● Rib Fracture S/S, assessment
○ From trauma, sports, GSW, etc.
○ Problem is the trauma can cause punctured liver, spleen, lung
contusion or lacerations that can compromise blood and the
vasculature from a small ink or scratch.
■ Any trauma of chest can lead to hemothorax
○ Patient will have PAIN! Will need heavy pain medication.
○ Teach patients how to splint when coughing.
○ Will need vitals, cardiac and respiratory assessments.
○ Watch for bruising!
○ Simple will need to heal on its own.
○ Prevent complications with exercise and breathing.
● Flail Chest S/S, assessment, tx on a vent
○ Will have 2-3 fractures of the ribs causing free floating
segment
○ S/S
■ Paradoxical chest movements
■ Dyspnea
■ Cyanosis
■ Low BP
■ Elevated HR
○ Treatment: place patient on vent and intubate! PEEP to open
alveoli.
, ○ Complication that must be monitored for: PNEUMOTHORAX
● ARDS
○ Occurs after lung injury- direct or indirect causing inflammation that
increases alveoli to allow entry of fluid.
○ Causes: shock, trauma, nervous system injury, emboli, infection, toxic
gas inhalation, aspiration, blood transfusions, bypass, near drowning
incident,sepsis.
○ Trigger is systemic inflammatory responses
○ Often called non cardiac related pulmonary edema
○ S/S
■ Refractory hypoxemia
■ SOB,d dyspnea
■ Tachycardia
■ Cyanosis
■ Bilateral pulmonary edema
■ Crackles
■ Pink frothy sputum
■ X Ray with broken glass lung appearance
○ Treatment
■ Prone patient
■ PEEP needed on vent
● COMPLICATIONS: pneumo and low BP
■ Steroids and fluids
■ Treat cause
○ Care
■ Airway
■ Cardiac monitoring
■ Vent
● Post Op complications of chest surgery and emergency treatment
○ Hemothorax: chest tube
○ Hypovolemic Shock or hypovolemia: fluids, blood and blood products,
○ Hemorrhage: pt goes to OR
● Tx of patients on a vent and troubleshooting measures, nursing interventions,
precautions for prevention of VAP/ ventilator acquired PN
○ While patient is on the Vent
■ Have ambu bag at bedside incase vent acts up- can alway bag
valve them if needed!
■ Assess respiratory function every 2 hrs
■ Monitor labs
■ Promote communication
■ Pain management
, ■ Turning every 2 hrs
■ Sterility when suctioning
■ Sputum color
■ Nutrition
■ Wash hands to prevent infection
■ Weights
○ VAP: from being on the vent for too long
■ Preventing VAP: HOB elevated 30 degrees, mouth care
Q2hrs, suction PRN
● No petroleum with oral care! Give CHG oral rinse
○ Types of Vent modes
■ Continuous Mechanical Ventilation/ AC : full support for patient
where each breath is a vented breath. Patient is paralyzed.
■ Synchronized Intermittent: Partial support where patient takes
breath without assistance but can be turned down as needed for
weaning.
○ Alarms- my guess is they ask you a question about alarm and what to
do
■ Low Pressure: vent might be leaking as no pressure is
reaching patient. Look for disconnnections, leaks, poor
connections.
■ High Pressure: look for obstruction, blocked airway,
pneumo, edema, bronchospasm, secretion, cough, kinks.
■ High respirations: patient is waking up, anxious or in
pain.
● S/S Anxiety on vent: tachycardia, dilated pupils,
○ Other Complications
■ Barotrauma from excess distention of alveoli
■ Increased ICP/ Hepatic congestion: reduce PEEP
■ Ulcers: prevent with PPI or turning the tube.
■ Irritation from the ET tube to throat.
● Indication of the need for a rapid response team on newly extubated
patient
○ If the patient cannot maintain their own airways or are not meeting
enough oxygen demands by themselves
○ Any type of stridor or wheezing or SOB
○ Stay with patient entire time.
○ Remember to place them HOB elevated 30 degrees, o2, cardiac
monitor, take set vitals
○ ABGS, pulse ox, EKG, suction may be ordered or done
○ SEE THIS PATIENT FIRST BECAUSE IT LIFE THREATENING!
● Emergency care on a chest trauma in the ED, nursing responsibilities
Chest Injury and Complex Respiratory
● Pneumothorax S/S, nsg assessment, indications
○ Air enters the pleural space and causes a loss of negative pressure in
the chest cavity, leading to lung collapse. Air enters on inspiration and
cant get out!
○ Risk factors: occlusion of chest tube, vent and rib fractures
○ S/S
■ Diminished breath sounds on the affected side,
asymmetrical chest expansion, deviated trachea to
unaffected side, low CO2, low BP, tachycardia, JVD,
tachypnea, anxiety
○ Treatment
■ Simple: Occlusive dressing with chest tube insertion.
■ Tension: needle decompression thoracostomy
○ Assessment:
■ Vitals, labs, CO2 levels, cardiac, respiratory, ABG
● Rib Fracture S/S, assessment
○ From trauma, sports, GSW, etc.
○ Problem is the trauma can cause punctured liver, spleen, lung
contusion or lacerations that can compromise blood and the
vasculature from a small ink or scratch.
■ Any trauma of chest can lead to hemothorax
○ Patient will have PAIN! Will need heavy pain medication.
○ Teach patients how to splint when coughing.
○ Will need vitals, cardiac and respiratory assessments.
○ Watch for bruising!
○ Simple will need to heal on its own.
○ Prevent complications with exercise and breathing.
● Flail Chest S/S, assessment, tx on a vent
○ Will have 2-3 fractures of the ribs causing free floating
segment
○ S/S
■ Paradoxical chest movements
■ Dyspnea
■ Cyanosis
■ Low BP
■ Elevated HR
○ Treatment: place patient on vent and intubate! PEEP to open
alveoli.
, ○ Complication that must be monitored for: PNEUMOTHORAX
● ARDS
○ Occurs after lung injury- direct or indirect causing inflammation that
increases alveoli to allow entry of fluid.
○ Causes: shock, trauma, nervous system injury, emboli, infection, toxic
gas inhalation, aspiration, blood transfusions, bypass, near drowning
incident,sepsis.
○ Trigger is systemic inflammatory responses
○ Often called non cardiac related pulmonary edema
○ S/S
■ Refractory hypoxemia
■ SOB,d dyspnea
■ Tachycardia
■ Cyanosis
■ Bilateral pulmonary edema
■ Crackles
■ Pink frothy sputum
■ X Ray with broken glass lung appearance
○ Treatment
■ Prone patient
■ PEEP needed on vent
● COMPLICATIONS: pneumo and low BP
■ Steroids and fluids
■ Treat cause
○ Care
■ Airway
■ Cardiac monitoring
■ Vent
● Post Op complications of chest surgery and emergency treatment
○ Hemothorax: chest tube
○ Hypovolemic Shock or hypovolemia: fluids, blood and blood products,
○ Hemorrhage: pt goes to OR
● Tx of patients on a vent and troubleshooting measures, nursing interventions,
precautions for prevention of VAP/ ventilator acquired PN
○ While patient is on the Vent
■ Have ambu bag at bedside incase vent acts up- can alway bag
valve them if needed!
■ Assess respiratory function every 2 hrs
■ Monitor labs
■ Promote communication
■ Pain management
, ■ Turning every 2 hrs
■ Sterility when suctioning
■ Sputum color
■ Nutrition
■ Wash hands to prevent infection
■ Weights
○ VAP: from being on the vent for too long
■ Preventing VAP: HOB elevated 30 degrees, mouth care
Q2hrs, suction PRN
● No petroleum with oral care! Give CHG oral rinse
○ Types of Vent modes
■ Continuous Mechanical Ventilation/ AC : full support for patient
where each breath is a vented breath. Patient is paralyzed.
■ Synchronized Intermittent: Partial support where patient takes
breath without assistance but can be turned down as needed for
weaning.
○ Alarms- my guess is they ask you a question about alarm and what to
do
■ Low Pressure: vent might be leaking as no pressure is
reaching patient. Look for disconnnections, leaks, poor
connections.
■ High Pressure: look for obstruction, blocked airway,
pneumo, edema, bronchospasm, secretion, cough, kinks.
■ High respirations: patient is waking up, anxious or in
pain.
● S/S Anxiety on vent: tachycardia, dilated pupils,
○ Other Complications
■ Barotrauma from excess distention of alveoli
■ Increased ICP/ Hepatic congestion: reduce PEEP
■ Ulcers: prevent with PPI or turning the tube.
■ Irritation from the ET tube to throat.
● Indication of the need for a rapid response team on newly extubated
patient
○ If the patient cannot maintain their own airways or are not meeting
enough oxygen demands by themselves
○ Any type of stridor or wheezing or SOB
○ Stay with patient entire time.
○ Remember to place them HOB elevated 30 degrees, o2, cardiac
monitor, take set vitals
○ ABGS, pulse ox, EKG, suction may be ordered or done
○ SEE THIS PATIENT FIRST BECAUSE IT LIFE THREATENING!
● Emergency care on a chest trauma in the ED, nursing responsibilities
