FUNDAMENTALS OF NURSING 3.

Oncotic Pressure = Governed by albumin (Major

NURSING PROCEDURES protein in the body) = Prevents Third
Intravenous Therapy – last resort (least to most Spacing/Interstitial Space – Nonfunctional (Ex.
invasive) EDEMA, ANASARCA, ASCITES)
 WHAT: medical regimen that aims to *Decrease oncotic pressure – third spacing
supplement/provide/fluids/MEDICATIONS/ TPN (Total Parenteral Nutrition)
NUTRITION for patients  Also known as hyperalimentation
 WHY: patient is deficient in (*ALIMENTARY = GIT CANAL) = HYPER MEANS
fluid volume or deliver OF PROVIDING NUTRITION = IV ROUTE
needed medicine that  Last Resort – EXPENSIVE, RICH IN GLUCOSE –
requires immediate effect attracts infection (STERUILE
(BENEFIT) TECHNIQUE/SURGICAL ASESPSIS)
 COMPLICATIONS:  FOR WHOM: Rich, SEVERE ANOREXIA –
INFILTRATION, PHLEBITIS, chemotherapy, geriatrics, depressed, POST
EXTRAVASATION, GASTRECTOMY, ACUTE PANCREATITIS – REST GIT
AIR/CATHETER EMBOLISM, FLUID OVERLOAD (GOAL: LESSEN STIMULATION OF PANCREAS) =
 WHERE: IDEAL VEIN: site of insertion is usually NPO FLUIDS AND NUTRITION VIA IV) = NPO –
distal, away from joint (PREVENT FLUIDS AND NUTRITION VIA IV)
DISLODGEMENT), non-dominant (ADLS), soft, o Contains CHO, CHON, Fats, vitamins
and elastic vein but can have central access minerals, medications. = DOCTOR
 CONTRAINDICATIONS: AV FISTULA ARM (used ORDER – components of the TPN
for dialysis) and POST MASTECTOMY (Removal o Compounded by registered pharmacist
of the breast) – 2 – 4 hrs
KINDS OF IV FLUIDS o Expiration – 24 hours
OSMOTIC PRESSURE o Avoid abrupt discontinuation because it
 Hypotonic – LOWER CONCENTRATION – WATER may cause a rebound effect – rebound
GOES INSIDE THE CELL - cells swell – *EXAMPLE hypoglycemia (DIZZINESS, BLURRY
LESS THAN 0.9% NACL (0.33 NaCL, 0.45NaCL, VISION, ALTERED LOC, TREMORS)
0.67NaCL)  Management for hypoglycemia: IV priority
 Hypertonic – HIGHER CONCENTRATION – (D5050W > D10 > D5)
WATER GOES OUTSIDE THE CELL - shrink cells –  Accurate administration is required – use
*EXAMPLE D5 PLUS OTHER SOLUTION: D5LR, infusion pump
D5NSS, D10W, D5050  Watch out for glucose levels – CBG monitoring –
 Isotonic – PNSS (universal normal: 70 – 110 mg/dl, IDEALLY: PRICK @
diluent), D5W (GLUCOSE), SIDES (lesser pain and more accuracy)
LR – BURNS (VOLUME  Usually uses central line – prone to infection
EXPANDER) – dehydration,  STERILE/ASEPTIC/SURGICAL ASESPSIS
ALSO CONTRAINS SODIUM NURSING CONSIDERATIONS: Insertion
BICARBONATE – ALKALINE  Wash hands, STERILE
– balances metabolic GLOVES
acidosis (BURNS –  Tourniquet should be 2
hyperkalemia, – 6 inches above
hyponatremia) insertion site (*GERIA –
VISIBLE AND FRAGILE
TYPES OF PRESSURE VEINS) = DO NOT USE
1. Osmotic Pressure = Movement of fluids from TOURNIQUET, PROPER
lower to higher concentration SKIN: SKIN TAUT
2. Diffusion = Movement of Gases from higher to
lower concentration (alveolar gas exchange)
  Cleanse site with chlorhexidine swab, vertical 2. Circulatory overload – d/t rapid infusion
with higher friction Prevention: Infusion
 Insert catheter with bevel up – FACILITATE Pump (accurate
ADMINISTRATION administration)
 Check patency by pushing 5 ml NSS (WITHOUT Clinical SX:
RESISTANCE), BACKFLOW OF BLOOD – CHECKED Crackles/Rales/Wet
BEFORE MEDICATION ADMINISTRATION breath sounds,
 Sign of patency – no resistance, with backflow distended jugular vein
of blood Other Sx: Increase
 Max IV DAYS = UPDATED: 4 DAYS Blood pressure, Increase HR and RR (vascular resistance)
Management: Slow Down infusion, KVO (10 to 15
Question: 4 Patients with IVT reactions. Which is the drops/min), elevate HOB (promote lung expansion),
Priority? Report , DO – Best drug: Diuretics (best diuretics:
Furosemide/Lasix – K wasting (WOF: Hypokalemia),
1. Patient with DOB and CRACKLES – FLUID diuresis (give in the morning, preventing sleep
OVERLOAD disturbance), check BUN and CREA – renal function
2. Patient with RASHES @ CHEST – AIR/CATHETER
EMBOLISM – MOST SEVERE IVT REACTION 3. Phlebitis – inflammation of the vein (phlebo)
3. Patient with RED and WARM site – Cause: poor hygiene –
INFLAMMATION = PHLEBITIS – Stable both nurse and patient
4. Patient with COOL and WET DRESSING – *Nurse has more fault
Infiltration due to improper hygiene
(Gloves)
IVT COMPLICATION: SX: REDNESS/RUBOR,
1. Air (min 10 mL)/ Catheter embolism WARM TO
Prevention: Prime IV TOUCH/CALOR, PAIN/DOLOR, SWELING/TUMOR, LOSS
line OF FUNCTION/FUNCTIO LAESSAE (cardinal sx of
Complication Emboli: inflammation)
Obstruct blood flow – Cause: vesicant solutions –
decrease O2/ischemia – irritating to the vein –
anaerobic respiration – EXTRAVASATION (clinical sx:
byproduct: lactic acid – skin sloughing)
toxic to tissues – tissue *Prevention – use bigger veins
injury – necrosis – more blood – better dilution,
Clinical Sx: Rashes/Petechiae @ Chest (Pulmonary dilute with PNSS (examples of
embolism), Chest pain (Cardiac embolism), Altered LOC vesicant solutions – CHEMO,
(Cerebral embolism) = Compensatory mechanism = PAIN, ANTBIOTICS, KCL,
Increase HR, RR, Hypotension CALCIUM GLUCONATE)
Management: STOP (Prevent further dislodgement of Management: STOP, REMOVE, RESTART – IDEALLY:
emboli), Position – Modified Trendelenburg – Goal: Trap opposite arm, distal. *SITUATIONAL (av fistula/post
Emboli @Right Atrium, O2, BEDREST, Report to the mastectomy @opposite arm) – If you have no choice
Doctor – XRAY (locate the emboli), BEST DRUG: SAME ARM, PROXIMAL TO THE PREVIOUS VEIN, WARM
Morphine – opioid – depressant – decrease HR – COMPRESS – vasodilation 10 – 15 mins
decrease workload of the heart

*MORPHINE (HAM – HIGH ALERT MEDS – CHECKED BY

2RNS)
 4. Infiltration – “OUT OF THE VEIN” catheter  1st q15 mins, if stable next hour
transfuses to the tissues – fluid leak q30
Cause: Too much movement  Drop Factor – 15 drops per
of the patient = PEDIA, minutes
ADULT – TIKTOKERISTS  Example PRBC 250 ML to be
Prevention: SPLINT/PADDED given in 4 hours. Drop rate? 15
BOARD to 16 drops/min
CLINICAL SX: Cold to touch,  Whole blood (450ml) to be
wet dressing, swelling, sluggish flow, pain @ site given in 3hrs. Drop rate? 37 to
Management: STOP. REMOVE. RESTART – ideally: 38 drops/min
opposite arm, situational: same arm, proximal, warm  Stay with the client in the first
compress 10 – 15 mins 15 mins = High Risk for BT
reactions
NURSING PROCEDURES – BLOOD TRANSFUSION  Max time
 Check: o 4 hours for RBC, whole blood
Check doctor’s order, HAM (High alert medications), o (CAN GO SHORTER THAN 4 HRS –
Consent – secured by the MD (explain risks, benefits, EMERGENCY CASES, BUT NO LONGER
alternatives), RN = WITNESS THAN 4 HRS)
Assess religion, e. g. Jehova’s Witness – No natural o 20-30 mins for platelet (dengue,
blood transfusion (PRBC, WHOLE BLOOD), Allow bleeding), albumin – oncotic pressure,
synthetic forms (recombinant platelet, EPOGEN [Sq] cryoprecipitate (for hemoplia), fresh
(Target is Kidney to stimulate RBC production) = increase frozen plasma (volume expander – for
RBC production), Nuepogen (SQ) = Increase WBC px with shock)
Production BLOOD TRANSFUSION REACTIONS
VS – 5 mins before and after (Baseline and Evaluation) 1) Hemolytic Reaction – due to
Equipment needed: alternative IV-line (EMERGENCY incompatibility – hemolysis/rbc
MEDS), PNSS, BT filter (WHOLE BLOOD – K) – Max 2 destruction – micro clots – dislodged @
Units/Bags per filter, gauge 18 – 20 – Adults, PEDIA G20 nephron – ↓ GFR – increase waste and
to 23 fluids (urea and electrolytes) = leads to
*Hemolytic is the worse SE renal failure
 Check: a. Clinical SX: Flank Pain/Lower
o SRBENCH – Checked by 2RNs back pain/ CVA (Costo Vertebral
o Serial# - Compare between Blood bag Angle) TENDERNESS,
and request form hemoglobinuria
o RhESUS sensitivity – POSITVE/NEGATIVE b. Others sx: vomiting,
QUALITY OF BLOOD hypotension, tachycardia,
o Blood type = UNIV DONOR O-, UNIV tachypnea (compensatory
RECIPIENT AB+ mechanism)
o Expiration c. Management: STOP. FLUSH
 SRBENCH NSS. VS. O2. REPORT. DOC (Drug
o Name of Choice): Epinephrine –
o Crossmatching – Reference Blood (px), NAMBAHWAN!
Cardio Pulmonary Clearance > Epinephrine –
o Hospital Number – Unique Sympathetic/Adrenergic Drug *SIDE
 Nursing Considerations EFFECT (EXPECTED) = ↑ – HR RR BP,
o Warm blood at room temperature for Muscle strength, glucose (BUT ↓
30 minutes GIT (Constipated, Dry Mouth) and
o Rule of 15 GUT (Decrease Urinary Output =
Bladder Retention),
 Bronchodilation, Pupillary Dilation.
Blurry vision, photosensitivity
2) Anaphylactic reaction – due to severe
allergic reaction
a. Clinical SX: Bronchospasm
(Wheezes [Exhale], Stridor
[Inhale]), Hypotension, ↑ HR
RR, DOB
b. Management: STOP. FLUSH.
NSS VS. O2. REPORT. DOC: EPI –
Nambawahn!!!
Bronchodilator (albuterol,
salbutamol), > Steroids (-SONE)
- ↓ immune system – prevents
activation of the mast cells –
prevent activation of the
leukotriene (bronchospasm)
c. Side effect steroids - ↓ immune
system – risk for infection
d. Overdose: Cushings, abrupt
discontinuation – Addisonian
crisis
3) Circulatory Overload
CRACKLES/RALES/WET BS. DISTENDED
JUGULAR VEIN, ↑ BP, HR, RR
 Prevention: Infusion Pump or
aliquot (half bag of blood) ex.
PRBC = 250 ML (one aliquot 125
ml = to be given in 4 hrs) total 2
aliquot
 Management: Slow down/KVO,
VS, O2, REPORT, Best Drug:
Diuretic
4) Iron Overload – Multiple Blood
Transfusion – Thalassemia (X Linked
Genetic trait) – Short RBC lifespan
 Management: Life time BT
 Clinical SX: Hematemesis/Blood
Vomitus, ↓ BP, ↑ HR RR
 Management: STOP. FLUSH.
NSS. VS. O2. REPORT. DOC:
DESFERAL/DEFEROXAMINE,
CHELATION THERAPY (blood
cleansing using a binding agent
= SUCCIMER/CHEMET)
5) Allergic Reaction – itchy skin/urticaria,
rashes
 Management: STOP. FLUSH.
NSS. VS. O2. REPORT. DOC:
antihistamine (SE: DROWSINESS
– PRIO: SAFETY – avoid driving =
operate heavy machinery/
automobile, avoid drinking
alcohol
 SE: Dryness of the ORAL and
NASAL mucosa – prone to injury
 ORAL DRYNESS - ↑ Fluid intake,
Oral Care
>  NASAL DRYNESS – NASAL
SALINE SPRAY (sodium – attracts
water)
6) Febrile reaction – fever and chills
a) Usual case – management:
continue bt, vs, o2, report,
antipyretic –
acetaminophen/paracetamol
b) New Case – first time!
Management: STOP. FLUSH NSS. VS.
O2. REPORT. ANTIPYRETICS.
NURSING PROCEDURES – PULSE OXIMETRY –
– SUPPORTING DATA
 WHAT: non-invasive,
painless procedure
to measure oxygen
saturation in the
blood; measures
oxygen delivery to
peripheral tissues
 WHERE: Finger
(routine) *SHOCK =
blood flow directed
towards CENTRAL
CIRCULATION:
earlobe, nose,
forehead.
 WHY: to detect early
hypoxemia and
prompt treatment;
monitor adequacy
of oxygen delivery
and evaluate
response to therapy

Question: Patient has Pneumonia. Pulse ox
(supporting) level is 90%. PRIO?
Normal 95 – 100%, COPD = 85 – 95%
1. O2 – independent up to 2lpm
2. VS – confirm hypoxia – altered loc, ↑ hr, rr
3. REPORT – last resort. EMERGENCY – ex.
Appendicitis without pain – septic shock, rigid
board like abdomen = peritonitis – medical
emergency
4. DO NOTHING
 pneumonia, pulse ox 90% DOB and
tachycardia = O2
 CHRONIC BRONCHITIS, PULSE OX 88%, W/
DIAPHRAGMATIC BREATHING AND
PRODUCTIVE COUGH, SOB = Do nothing
Nursing Considerations
 Remove nail polish – affects ability of sensor to
accurately measure oxygen saturation
 Display heart rate (peripheral) should be
correlated with patient’s HR – WOF: PULSE
DEFICIT (APICAL minus RADIAL) – example:
apical 80, radial 70 = 10 PULSE DEFICIT =
possible ↓ contractility or vascular disorder
 Hold finger dependent motionless to improve
quality of signal
 Cover finger sensor to occlude ambient light
(sunlight/fluorescent) – ambient light afters
accurate reading of the sensor
 Assess site of oximetry monitoring for
perfusion because pressure ulcer may develop =
CHANGE POSITION EVERY 2 HRS. Document the
O2 therapy that patient is taking
DRIVE FOR BREATHING
 Normal Drive for breathing - ↑ CO2 –
chemoreceptors @ PONS/MEDULLA
OBLONGATA – force px to breathe
 COPD – PATHOLOGY – TOO MUCH CO2 –
defective trigger
o Replacement Trigger: ↓ O2 Levels
(Hypoxic Drive)
o COPD – SPO2 LEVEL 85 TO 95%
o PAO2 70 MMHG AND ABOVE
o Management for COPD: LOW FLOW O2
 Too much O2 can inhibit the
hypoxic drive
NURSING PROCEDURES – ABGS – CONFIRMATORY FOR
O2 STATUS AND ACID BASE BALANCE
 WHAT: performed to evaluate client’s acid base
balance and oxygenation
 HOW: determine oxygen partial pressure
(PaO2), carbon dioxide partial pressure (PaCO2),
bicarbonate level and pH
 WHERE: usual puncture sites are radial artery >
BRACHIAL > femoral artery (rule: least to most
invasive)
 WHY: determine vital measurements for
critically ill and patients with respiratory disease
Question: Patient has cystic fibrosis (↑ secretions
@airways and git). PaO2 level is 70 MMHG. Priority?
1. O2
2. VS
3. Report
4. Do nothing
Normal levels: ABGS
 PaO2 – 80 – 100 mmhg
 *COPD 70 mmhg and above
 PaCO2 – 35 – 45 mmhg
 HCO3 – 22 – 26 meQ/L
 pH – 7.35 – 7.45
Allen’s Test:
 WHAT: performed before obtaining blood
specimen from radial artery to determine
presence of adequate collateral circulation
“BACKUP CIRCULATION” = ulnar artery
sufficiency
WHY: IF THE ULNAR ARTERY IS INSUFFICIENT –
AND RADIAL ARTERY WAS PUNCTURED – ↓
BLOOD FLOW @ HAND – ISCHEMIA – NECROSIS
– AMPUTATION (PHANTOM PAIN – REAL) - meds
PHANTOM SENSATION – psychological – guided
imagery
 HOW: steps
o Apply direct pressure over the radial
and ulnar artery simultaneously
o While applying pressure, nurse asks
patient to open and close hand
repeated; observe that hand should
blanch
 o Release pressure over ulnar artery while 8. Appropriately label the specimen and transport
maintain pressure over radial artery it on ice to the laboratory.
o Assess the color of extremity distal to 9. On the laboratory form, record the client’s
the point distal to the point temperature and the type of supplemental
o Pinkness should return within 6 – 7 oxygen, mech vent settings that the client is
seconds – if not, ulnar artery is receiving, NAME OF PX, BDAY, DATE AND TIME.
insufficient indicating that radial artery  Extremity Used – NOT NEEDED TO BE
should not be used for blood CHARTED
examination NURSING PROCEDURES - CHEST DRAINAGE
o Document findings SYSTEM/CTT – CHEST TUBE THORACOTOMY
 RESULTS
o PINKNESS IN 1 – 7S – ULNAR IS
SUFFICIENT – SAFE TO USE THE RADIAL
ARTERY
o PINKNESS > 7S – ULNAR ARTERY IS
INSUFFICIENT – NOT SAFE TO USE THE
RADIAL ARTERY = USE THE BRACHIAL
ARTERY.
Video Sample:
https://www.youtube.com/watch?v=D1tJO0RW9UM

ABGS – GATHERED BY RT > MEDTECH/PHLEBOTOMIST,

RN - ASSIST WHAT – a therapy that involves the removal of air,
Steps in Collection of an arterial blood gas specimen blood, pus or other secretions (positive pressure –
1. Obtain vital signs – BASELINE AND EVALUATION prevent proper ventilation – alveolar
2. Determine whether the client has an arterial collapse/atelectasis = ↓ gas exchange) from the chest
line (used in invasive bp measurement) in place cavity
(allows for arterial blood sampling without WHY
further puncture to the client).  Prevent mediastinal shifting (shift to the good
3. Perform the Allen’s test to determine the side – if at the left side - ↑ pressure @ heart =
presence of collateral circulation cardiac tamponade – congestive heart failure)
4. Assess factors that may affect the accuracy of and lung collapse
the results, such as changes in the O2 settings,  To re-establish negative pressure (normal
suctioning within the past 20 – 30 minutes, and pressure of the lungs)
client’s activities.  GOAL: re-expand the lungs
*px ambulated 30 mins prior to ABGS – FALSE WHERE
LOW RESULTS AMBULATION = VS = FALSE HIGH  Air (light) – 2nd – 3rd ICS
5. Provide emotional support to the client. –  Blood/fluid (heavy) – 7th to above 9th ICS –
Orient - ↓ Anxiety (affect vs) prevent accidental puncture of the underlying
6. Assist with the specimen draw by preparing a organs
heparinized syringe – PREVENT CLOTS (if not NURSING CONSIDERATION FOR INSERTION
already prepackaged). 1. Check doctors order, consent
7. Apply pressure immediately to the puncture site 2. POC: ORTHOPNEIC POSITION/TRIPOD
following the blood draw; maintain pressure for POSITION (sitting and leaning over a bedside
5 minutes or for 10 minutes if the client is taking table)
an anticoagulant. 3. 30 mins before – pain meds =
> SAND BAGS, TRANSRADIAL BANDS ANTICIPATORY/ABORTIVE THERAPY
*ARTERY – HIGH PRESSURE – HIGH CHANCES OF
BLEEDING
 4. INSTRUCTION TO THE PX FOR INSERTION: STAY CHANGE TUBINGS
STILL = AVOID ACCIDENTAL PUNCTURE OF THE
LUNGS – Exhale and hold
5. POST INSERTION – COVER WITH: >BOTTLE B. SIGN OF LUNG
a. KOZIER – STERILE, DRY, NONOCCLUSIVE Directly RE-EXPANSION
GAUZE – prevent tension pneumothorax connected to FOR PLEURAL
b. BRUNNER, POTTER AND PERRY, the patient EFFUSION (fluid)
- MANAGEMENT:
SAUNDERS, LACHARITY = STERILE
ASSESS PX
VASELINIZED/WET DRESSING = prevent
(EUPNEA, EQUAL
air entry, tape @ 3 sides – to prevent BS AND CHEST
tension pneumothorax EXPANSION,
6. CONFIRM LOCATION OF THE CATHETER = CHEST TUBINGS PATENT,
X – RAY REPORT, DO: CXR –
SYSTEMS confirm lung re-
1) OLD SYSTEM = BOTTLE SYSTEM expansion
 BOTTLE = FRAGILE
 HARD TO TRANSFER Bottle - Normal Abnormal
2) NEW SYSTEM = PLEU EVAC (1 CONTAINER = 3 Gravity
CHAMBERS) 2. WATERSEAL INTERMITTENT CONTINUING
 FIBERGLASS – DURABLE 4 TO 20 CM BUBBLING = BUBBLING =
 EASY TO TRANSFER OF STERILE AIR EXIT IS THIRD PARTY! –
WATER INTERMITTENT/ RISK OF AIR
Question: Continuing bubbling in the suction control WITH ENTRY –
INTERVALS PNEUMOTHORAX
bottle = Normal
MANAGEMENT:
A. REPORT TO THE MD
ASSESS PX,
B. DOCUMENT TUBINGS – FIND
C. ASSESS FOR AIR LEAK THE LEAK!!!
D. CLAPM ABOVE THE LEAK MOMENTARILY
CLAMP ABOVE
Bottle - Gravity Normal Abnormal THE LEAK –
1. DRAINAGE <70 ML/HR = >70 ML/HR = TOO prevent air entry.
Patent FAST = REPORT. CHANGE
HYPOTENSION TUBINGS!!!!
Management: PURPOSE: PRESENT NEGATIVE
Assess PX, Tubings, SEAL! FLUCTUATIONS/ FLUCTUATIONS –
Report. Doctors > ALLOWS AIR OSCILLATIONS/ NO AIR EXIT – 2
Order – Elevate TO EXIT BUT TIDALING = CASES!
Bottle – Nearer DOESN’T CHANGE IN A. OBSTRUCTION
the PX chest – ALLOW AIR WATER LEVEL = – ASSESS PX,
slower via gravity RE-ENTRY SIGN OF AIR TUBINGS,
PURPOSE: Empty Drainage EXIT = PATENCY! REPORT, DO –
Collect Bottle – 2 Cases CHANGE
Secretions A. OBSTRUCTION TUBINGS. NEVER
- MANAGEMENT: MILK.
ASSESS PX (DOB, B. SIGN OF LUNG
UNEQUAL BS AND RE-EXPANSION
CHEST EXPANSION, FOR
ASSESS TUBINGS – PNEUMOTHORAX
NOT PATENT, (AIR) –
NEVER MILK, MANAGEMENT:
REPORT – DO - ASSESS PX
 (EUPNEA, EQUAL 1. ASSESS FOR SIGNS OF LUNG RE-EXPANSION
BS AND CHEST A. PNEUMOTHORAX (AIR) – NO
EXPANSION, FLACTUATIONS @ WATER SEAL
TUBINGS PATENT, B. PLEURAL EFFUSION (FLUID) – EMPTY
REPORT, DO: CXR DRAINAGE BOTTLE
– confirm lung re- 2. CONFIRM LUNG – RE-EXPANSION VIA CXR
expansion
3. 30 MINS BEFORE – PAIN MEDS
4. ORIENT – VALSALVA MANEUVER/BEAR DOWN -
Bottle - Gravity
Normal Abnormal
↑ THORACIC PRESSURE MOMENTARILY –
3. SUCTIONCONTINOUS Intermittent PREVENT AIR ENTRY
BOTTLE BUBBLING bubbling –
5. REMOVE – COVER WITH STERILE VASILINIZED
> 20 CM STERILE(Suction problem in the
OCCLUSIVE DRESSING = TAPE @ 4 SIDES
WATER pressure – connection to the
continuous) suction port 6. AUSCULTATE BREATH SOUNDS 30 MINS AFTER
MANAGEMENT: REMOVAL – CHECK FOR POSSIBILITY OF
ASSESS PX AND PNEUMOTHORAX (sign: UNEQUAL BREATH
TUBINGS AND SOUNDS) – report, confirm via CXR
TUBINGS,
REPORT – change
connection
PURPOSE: Vigorous
OPTIONAL! bubbling – too
>ADDS high suction
NEGATIVE pressure – risk of
PRESSURE/ too fast removal
SUCTION – hypotension
*TOO MUCH MANAGEMENT:
SECRETIONS ASSESS PX,
*VISCOUS – EX. SUCTION
PUS = PRESSURE
EMPYEMA/ REPORT, DO - ↓
PYOTHORAX suction pressure

EMERGENCY CASES
1. CTT DISCONNECTED (removed from the bottle)
– submerge into sterile bottle with sterile NSS
*extra bottle and extra nss/sterile water
2. CTT DISLODGED (removed from the px) – cover
site with sterile, vasilinized, occlusive dressing =
tape at 3 sides – prevent tension
pneumothorax.
3. BROKEN BOTTLE – Change with another sterile
bottle with sterile NSS
4. SQ EMPHYSEMA (air bubbles under the skin)
CAUSE: AIR LEAK AT THE INSERTION SITE!
SX: CREPITUS – bubble like sensation under the
skin
MANAGEMENT: REPORT – MARK THE AREA
(BASELINE DATA), REINFORCE DRESSING
CTT REMOVAL