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Respiratory System lecture Notes for nurses

Respiratory System lecture Notes for nurses

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Published by: run.rebel.run on Nov 20, 2008
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01/10/2013

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Respiratory SystemChest TraumaMechanics of Respiration
Breathing- Neg. pressure- pressure in chest cavity lower than atmosphere
Inspiration- Contraction of diaphragm, intercostals musc., chg in thorax (enlarges) & cohesion of  pleura
Expiration- relaxation(Intrapleural pressure is negative at all times) (756mmHg)Hemothorax
collection of blood in the pleural space
o
laceration, puncture, surgery, knife, or gun shot wound
S&S
o
Chest pain
o
Cyanosis
o
Dec BP, inc. pulse, inc. RR 
o
Dyspnea
o
Dullness on percussion
o
Shock 
o
Acidosis/ alklosis state
size
o
Small- less 400,no S&S(clears itself in 10-14 days)
o
Moderate- 500-2000cc,-Pallor, restless, anxiety, inc. HR, dec. BP, chest tightening, bloody sputum, dec. or absent LS on side.
o
Massive-SOB, Inc. HR, Dec. BP, hypoxia, shock (fluid in half of lung), absent LSPleural Effusion
causes: CA, pneumonia, lt side CHF, blocked lymph systemEmphysema
Pus, fluid
PNEUMOTHORAX
closed- chest wall intact
 
o
Spontaneous- may have Hx of COPD, TB, Cystic Fibrosis, Cancer 
o
S&S- sudden sharp pain, cough, sudden SOB, dec. BP, rapid pulse, tightness in chest,asymmetric chest movement, hypersonant,(BP inc. or dec., resp, inc., pulse inc.)
Tension pneumothorax
o
Untreated closed
o
S&S- severe SOB, deviation of larynx to unaffected side, distended neck veins, inc. pulseand RR, dec. BP, SQ emphysema, crepatis, change in PMI, muffled heart tones.( if open to outside do not occlude)
Open- penetration of chest wall
o
S&S- sucking chest wound, chest pain, inc. HR, inc. RR, dec. breath sounds on side of injury, unequal expansion, shallow breathing (resp. alk)
o
TX- cover on three sides with a gauze with patient breathing outMediastinal flutter 
Inspiratory movement- shift to unaffected side
Expiratory movement- shift to affected sideHemo- pnuemothorax
 blood & air in the thoracic cavity
Dx/ Tx is basically the same
o
May see with chest tubes
High or anterior for air 
Low or posteriorlateral for bloodFractured Ribs
 painful and dec. chest movement which can lead to atelectasis
shallow resp., guarding, grunting at end of inspiration, asymmetrical resp., crepitus
Danger: contusion, rib piercing lung
Tx: anesthetic block, analgesics, splint area
 
Flail chest
inspriatory movement- sucking in of ribs
expiratory movement- puffing out of ribs
S&S- extreme distress
o
Desperately tries to breathe in spite of pain
o
Hypoxia, cyanotic, severe SOB
o
Grunting resp
o
Paradoxical movement
Tx: HOB elevated and patent airway
o
Mild= C&DB, suction, pain control, lay on affected side or splint
o
Moderate= fluid restriction, diuretics, steroids, albumin, tx resp
o
Severe= intubate and ventCHEST TUBES
type of drain into the pleural space that also prevents leak of air back into that space
Chest tube placement
o
Air- 2
nd
intercostals space mid cav. Area
o
Liquid- 5
th
intercostals space mid axillary area
o
Open heart- medialstinalPleurodesis
sclerosing agents- doxycycline, minocycline, bleomycin
o
cause inflammation reaction
o
Post care: watch patient may have low grade temp and pleuritic painTYPES OF CHEST DRAINAGE
one bottle
o
expiration- air leaves pleural space
o
inspiration- water will fluctuate upward toward the chest(2cm of H2O in bottle- underwater seal)(intermittent bubbling during expiration)(movement of fluid during expiration/ inspiration is tidaling)

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