MSN 377: Exam 3 Questions And Answers Verified 100% Correct

MSN 377: Exam 3 Questions And Answers Verified 100% Correct What is the suction pressure usually ordered to be set at? - ANSWER Amount of water -20 cm H2O (can vary between -10 to -40) How can you tell the wet suction of the chest drainage system has been initiated? How can you tell the dry suction of the chest drainage system has been initiated? - ANSWER Wet suction: gentle bubbling is present Dry suction: visual alert that indicates working suction Is informed consent necessary for a chest tube insertion? What equipment is needed for a chest tube insertion? - ANSWER Informed consent is required for chest tube insertion Equipment: -Thoracotomy tray -CDU -Chest tube -Bottle of sterile water -1% lido -Suction tubing and collection container -Occlusive dressing How is a wet suction CDU prepared? - ANSWER Add sterile water to the 2 cm mark in the water-seal chamber Add sterile water to the 20-cm mark (or per order) in the suction control chamber How is a dry suction CDU prepared? - ANSWER Add sterile water to the fill line of air- leak meter Attach suction tubing Increase suction until the bellows-like float moves across the display window How should a patient be positioned when undergoing chest tube insertion? - ANSWER Arm on affected side raised above the head to expose the mid-axillary area HOB 30 - 60 degrees What kind of gauze is used over the chest tube insertion site? - ANSWER Occlusive, petroleum gauze dressing What can occur if the chest tube is clamped? - ANSWER Increase risk for tension pneumothorax In what position should the CDU be in at all times? - ANSWER Dependent position What potential complications can occur in a patient with a CDU? - ANSWER Rapid removal of pleural fluid: 1000 ml - notify provider Subcutaneous emphysema: introduction of air into the subcutaneous tissues; feels like bubble wrap Bleeding Atelectasis Infection Accidental disconnection When is a chest tube removed? What should be done prior to its removal? What should be done following removal? - ANSWER When the lung is re-expanded or the fluid drainage is minimal/has ceased Prior to removal: -24 hours: chest tube to gravity/without suctioning --Making sure the lung remains inflated -30 - 60 minutes prior to removal: pre-medicate with pain meds -Pt should be instructed to hold breath while tube is pulled out After removal: -Occlusive petroleum bandage applied while tube is removed F/u CXR When might a thoracotomy be performed? What is the most common approach for a thoracotomy? - ANSWER Tumor Infection Trauma Posterolateral approach What surgical approach might be used instead of a thoracotomy due to reduced post-op pain, decreased length of stay, decreased morbidity, and few complications? - ANSWER Video-Assisted Thoracoscopic Surgery (VATS) What should be done (work up/education) prior to a thoracotomy or video-assisted thoracoscopic surgery? - ANSWER PFTs, ABGs: confirm respiratory stability Cardiac work up: determine if any heart involvement that should be addressed during the surgery Educate: -Smoking cessation for at least a month before the surgery to improve oxygenation Post-op expectations: oxygen, intubation, chest tubes What should be included in the post-op respiratory assessment for a patient following thoracic surgery? - ANSWER Respiratory rate, effort Sputum eval Lung sounds Chest tube drainage What is the respiratory condition where fluid accumulates in the pleural space, exerting pressure on the lung and decreasing gas exchange? What is this condition indicative of? - ANSWER Pleural effusion: fluid collection between the parietal and visceral pleura Indicative of disease What is the difference between transudate, exudate, and empyema when it comes to pleural effusion? - ANSWER Transudate: caused by an abnormality in the patient's fluid regulation system Exudate: inflammatory reaction to an external cause, resulting in edema