Week 5: Pneumonia, Pneumothorax/Pleural Effusion, Chest Tubes

pneumonia definition

acute infection of parenchyma, results in pus/fluid interfering with lung function and causing hypoxia. most common bacteria - pneumococcal (vaccine!). caused when lung defense mechanisms become incompetent or overwhelmed. bacteria can be aspirated, inhalation, or spread hematogenously (from somewhere else in the body)

pneumonia classifications

community acquired (haven’t been in hospital/long term care for 2 weeks before onset), hospital acquired (48 hr after hospitalization, not present at admission), and ventilator associated (w/in 48 hr of intubation)

VAP prevention

sterile suctioning - inline, clean w/ chlorhexidine

aspiration pneumonia

inhaling oral/gastric material causing inflammation which closes bronchioles. gastric contents → chemical pneumonitis → bacterial infection prevented by sitting at 45 degrees to eat.

pneumonia clinical manifestations

cough, infection symptoms, dyspnea, tachypnea, SHARP pleuritic chest pain, lethargy, fatigue, tachycardia, myalgia. older pts - confusion/stupor, hypothermia. assessment - crackles, increased egophony + fremitus

pneumonia dx studies

chest xray (patchy infiltrates), pulse ox, ABGs - hypoxemia, hypercapnia, acidosis. sputum gram stain, C+S, blood cultures, CBC/diff, thoracentesis, bronchoscopy

pneumonia collab care

vaccines, empiric therapy (start before dx) - IV then oral ATBs when stable, repeat chest xray 6-8 weeks. supportive care - O2, pain, fever, rest. early ambulation, breathing exercises, adequate hydration. small, frequent, high cal, nutritious meals. monitor weight.

pneumonia pt education

full course ATBs, interactions, rest + hydration, no alcohol/smoking, cool mist humidifier or warm bath helps thin mucus, chest xray follow up, vaccines - flu + pneumococcal, avoid URI exposure.

pneumonia complications, MDR pathogens, pleurisy, pleural effusion, bacteremia, pneumothorax, acute resp failure, sepsis/septic shock, lung abscess, empyema (pus)

pleural effusion definition

abnormal collection of fluid in pleural space.

pleural effusion clinical manifestations

dyspnea, cough, sharp chest pain, decreased chest movement, dullness/decreased sounds on affected side.

pneumothorax definition

air entering pleural cavity causing lung to collapse due to positive pressure. can be open due to external trauma or closed with the breakage being inside - bleb rupture (COPD), central venous pressure cath insertion, broken ribs, ventilator

tension pneumothorax

air that can’t escape pleural space → intrapleural pressure compresses blood vessels and heart, causing mediastinal shift and hemodynamic instability. can occur open or closed. medical emergency!

tension pneumothorax manifestations

severe dyspnea, rapid + shallow resp, tachycardia, tracheal deviation towards good side, decreased/absent sounds on affected side, neck vein distention, cyanosis, diaphoresis

hemothorax

blood in pleural space

pneumothorax collab care

cover wound w/dressing secured on 3 sides - prevents entry and allows exit of air. chest tube. immediate needle decompression for tension pneumothorax

chest tube placement

2nd ICS air, 8/9th ICS for fluid

chest tube nursing responsibilities

prepare tube - add water to seal to 2 cm, add water to suction control 20 cm. position pt left side w/ right arm raised above head, elevate HOB. watch for movement or slight bubbling w/breathing. measure and label drainage. keep the system below chest level. sterile technique during changes, occlusive dressing.

chest tube tips and tricks

no bubbling - no/low suction, obstruction, leak is so large suction can’t fix it, or lungs re expanded maybe. too much bubbling - leaking. observe from PT → apparatus. disconnecting - place end into chest tube into sterile water. removal prep - pain meds 60 min before, gather dressing supplies, ask PT to hold breath during procedure, chest xray after. can cause subq emphysema (crepitus) at insertion site.

heimlich chest tube

chronic fluid collection drainage, allows drainage at home. used for cancer mgmt.