NUR 504 Exam 2 Respiratory and Renal questions with accurate answers

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NUR 504 Exam 2 Respiratory and Renal questions with
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accurate answers ||




Pleural effusion: - ✔✔an abnormal collection of fluid in the pleural space (space around
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lungs) ||




-symptomatic >300 mL of fluid || || || ||




transudate pleural effusion: - ✔✔-occurs d/t increased hydrostatic pressure or low plasma
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oncotic pressure || ||




conditions that alter hydrostatic or oncotic pressure in the pleural space such as CHF,
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cirrhosis , nephrotic syndrome || || || ||




-a clear build up of fluid
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-low in protein and LDH
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Exudative pleural effusion: - ✔✔occurs d/t inflammation or infection
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-ex. pneumonia, cancer, viral infection, PE
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-high in protein and LDL
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-will be a thick purulent fluid
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dx test: fluid culture
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risk factors for a pleural effusion: - ✔✔-trauma --> causes inflammation and irritates the
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pleural lining || ||




-increased pressure in the lungs --> HF, PE, end stage liver failure, post open heart surgery
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-infection --> complication of pneumonia, cancer, or inflammatory disorders
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Labs for pleural effusion: - ✔✔-culture and sensitivity (to look for bacteria or infection)
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-CBC (will see elevated monocytes (inflammation), elevated neutrophils (bacterial),
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elevated lymphocytes (viral) || || ||




-lactate ||




-cytology analysis (if malignancy is suspected) || || || || ||




dx testing for a pleural effusion: - ✔✔-chest X-ray (to see if there is fluid accumulation)
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-CT scan || ||




-pleural fluid sample via thoracentesis
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-ultrasound ||




-pleural biopsy || ||




-thoracoscopy ||




-bronchoscopy



S/S pleural effusion: - ✔✔-dyspnea
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-*non-productive cough* || ||




-pleuritic chest pain (worsens with deep breathing; we can give them a pillow for relief)
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-decreased chest wall movement (because they have shallow respirations and constriction)
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severe symptoms: over 300 mL of fluid
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-tachypnea ||




-tachycardia ||




-decreased breath sounds || || ||




-dullness on percussion || || ||




-egophony (increased resonance of voice sounds heard when auscultating the lungs)
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non-surgical treatment for pleural effusion: - ✔✔treat the underlying condition
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-diuretics (to get rid of excess fluid) || || || || || || ||




-antibiotics (if its caused by an infection) || || || || || || ||




-albumin (because they have low protein) || || || || || ||




-corticosteroids (for inflammation) || || ||




-anti-inflammatory agents || ||




-immunosupressents



*thoracentesis:* - ✔✔surgical treatment for a pleural effusion || || || || || || || ||




-patient is positioned in an orthopnic position
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-fluid is extracted at the base of the lung because fluid gravitates toward the bottom
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-a collection bag may be needed if there is a large amount of fluid extracted
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other surgical treatment for pleural effusion: - ✔✔-pleurodesis --> collapses the space
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between the layers of fluid preventing future accumulation
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-chest tube || ||




-pleurectomy --> surgical incision into the pleura to surgically remove affected pleura
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-pleuropneumonectomy --> full removal of the lung || || || || || || ||




-pleuro lobectomy --> partial removal of the lung
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*Chest tubes:* - ✔✔Purpose --> to drain fluid, blood or air from the lung or pleural cavity
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Use --> pleural effusion, hemothorax, pneumothorax
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-First chamber: drainage collection chamber
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-Second chamber: water seal (prevents air from moving back up the tubing into the chest)
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-third chamber: suction regulator
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absence of tidaling = the lung has fully re-expanded or there is an obstruction in the chest
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tube ||




continuous bubbling = air leak || || || ||




Chest tube interventions: - ✔✔tidaling:
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-fluid should fluctuate with respirations (Bubbling)
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-fluid should be measured hourly at first and then q 4-8 hrs per policy
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air leak:
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-continuous bubbling in the water seal chamber (second chamber) || || || || || || || ||




-check the tubing and the site of insertion
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-assess pts lung sounds and respiratory effort
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-NEVER strip or clamp the tubing || || || || || ||




-copious amounts of drainage/ purulent drainage on the dressing is NOT normal
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-when removing a chest tube encourage coughing at regular intervals to prevent an air
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embolism ||




-keep the drainage system lower than the patients chest
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accidental removal of the chest tube from insertion site:
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-cover site with a 3 sided occlusive dressing, pretroleum dressing to give an air seal
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