Notes

What causes a spontaneous pneumothorax?

Trauma, wound, blood vessel rupture, bleb rupture, increased PEEP ventilation injury, catheter insertion puncture, thoracentesis.

respiratory acidosis- hypoventilation Treatment

put on vent, bipap, give o2

respiratory alkalosis- hyperventilation Treatment

lower mech rate, SEDATE, pain fever

metabolic acidosis  (DKA, DIARRHEA malnutrition, kidney failure, sepsis) Treatment

Sodium bicarb drip

Metabolic alkalosis - vomiting Treatment

Antiemetic Zofran

What is an open pneumothorax?

A pneumothorax caused by a penetrating wound such as a stab or gunshot.

What is a closed pneumothorax?

A pneumothorax caused by blunt trauma such as a fall or motor vehicle accident.

What is a tension pneumothorax?

Air enters the pleural space but cannot escape, increasing pressure on the mediastinum.

What are signs of a tension pneumothorax?

Tracheal deviation, JVD, hypotension from vena cava compression.

Why is tension pneumothorax dangerous?

Rapid air accumulation collapses the lung and decreases cardiac output.

What is the treatment for pneumothorax?

Remove air via thoracentesis, needle aspiration, or chest tube.

Where is a chest tube placed?

Into the pleural space between the ribs, not into the lung.

What are the three chambers of a chest tube system?

Drainage chamber, water seal chamber, suction control chamber.

What is the purpose of the water seal chamber?

Prevents air from entering the pleural space; bubbling indicates air leaving the patient.

What does continuous bubbling in the water seal mean?

There is an air leak.

What is the purpose of the suction control chamber?

Regulates suction applied to the patient and buffers wall suction.

How does wet suction control work?

Bubbling means suction is on; no bubbling means suction is off.

How does dry suction control work?

A dial sets suction; an accordion expands when suction is on.

What should you do if a chest tube box is knocked over?

Replace the box, reconnect tubing, and reset suction/water seal.

Why must a chest tube stay below chest level?

To prevent backflow of air or fluid into the pleural space.

What is normal chest tube drainage per hour?

Up to 70 mL/hr.

When should the doctor be notified about drainage?

If drainage increases, decreases, or becomes bloody.

Why keep sterile water at the bedside?

To create a temporary water seal if the tube disconnects.

Why use petroleum gauze for chest tube dressings?

It creates an occlusive seal to prevent air entry.

How should an occlusive dressing be taped?

On three sides to create a one‑way valve.

Why should chest tubes never be clamped?

Clamping can cause pressure buildup and tension pneumothorax.

What are signs of pneumothorax?

Sudden respiratory distress, tracheal deviation, reduced breath sounds, unequal chest rise, subcutaneous emphysema.

How is pneumothorax diagnosed?

Chest X‑ray; thoracentesis can determine if blood is present.

Where is a chest tube typically inserted?

Mid‑axillary line or at the pneumothorax location.

What position is used for chest tube insertion?

HOB 30–60° with arm raised above head.

What are the three functions of a chest tube system?

Suction control, water seal, drainage collection.

What are contributing factors to pneumothorax and hemothorax?

Trauma, stabbing, gunshot wounds, COPD/emphysema, occluded chest tube, falls in older adults with poor lung compliance.

Why do older adults have higher pneumothorax risk?

They have decreased lung compliance and are more prone to falls.

What is subcutaneous emphysema?

Air trapped under the skin causing a crackling “bubble wrap” sensation.

What does subcutaneous emphysema indicate in a chest tube patient?

Air is leaking into tissues; monitor for worsening.

What does a chest X‑ray show in pneumothorax?

Black = air; white = fluid or collapsed lung.

What is the purpose of a chest X‑ray after chest tube insertion?

To confirm correct placement and lung re‑expansion.

What is the standard chest tube insertion site?

Mid‑axillary line or at the location of the pneumothorax.

What is the nurse’s role during chest tube insertion?

Prepare the drainage system, maintain sterile field, assist provider, monitor patient.

What is the purpose of the suction control chamber?

Regulates the amount of suction applied to the patient.

What is a flutter or Heimlich valve, and what is benefit

A one‑way valve used for small pneumothoraces allowing air out but not in. It is small, portable, and does not require a large drainage box.

What is empyema?

Pus-filled pleural fluid, often thick and cheesy in appearance.

What are complications of chest tubes?

Dislodgement, worsening pneumothorax, excess drainage, tension pneumothorax, infection, bleeding.

What are signs of tension pneumothorax?

Hypotension, tracheal deviation, diminished breath sounds, JVD.

What is pneumonia?

Acute infection of the lung parenchyma/alveoli.

Who is most at risk for pneumonia?

Older adults, young children, immunocompromised individuals.

What are normal respiratory defense mechanisms?

Air filtration, humidification, epiglottis closure, cough reflex, cilia, bronchoconstriction.

What causes pneumonia when defenses fail?

Aspiration, ventilation, pollution, smoking, viral infections, aging, chronic diseases.

What are the three ways organisms reach the lungs?

Aspiration, inhalation of microbes, spread from another infection in the body.

What medications reduce aspiration risk?

PPIs (Protonix) and H2 blockers (Pepcid).

What is community-acquired pneumonia (CAP)?

Pneumonia occurring in people not hospitalized within the last 14 days.

What is hospital-acquired pneumonia (HAP)?

Pneumonia occurring 48+ hours after hospital admission.

What is ventilator‑associated pneumonia (VAP)?

Pneumonia occurring 48+ hours after intubation or tracheostomy.

What are key components of the VAP prevention bundle?

HOB ≥ 30°, oral care every 4 hours, suction as needed, early empiric antibiotics.

Why is oral care important for ventilated patients?

Bacteria pool near gums and can be aspirated into the lungs.

What is empiric antibiotic therapy?

Azithromycin and Levaquin (levofloxacin)

What is the most common type of pneumonia?

Viral pneumonia.

Who is at high risk for aspiration pneumonia?

Stroke patients, dementia patients, sedated patients, tube‑fed patients, decreased LOC.

What is silent aspiration?

Aspiration without coughing or choking, often due to impaired gag reflex.

What is necrotizing pneumonia?

Severe pneumonia where lung tissue dies, often due to resistant bacteria.

What is opportunistic pneumonia?

Pneumonia in immunocompromised patients such as HIV, transplant, cancer, or steroid users.

What organism causes cytomegalovirus pneumonia?

Herpes virus.

What is staphylococcal pneumonia?

Pneumonia caused by S. aureus or S. epidermidis, often drug‑resistant.

Why is staphylococcal pneumonia dangerous?

It often follows viral infections like flu or COVID and spreads easily in hospitals.

What is Haemophilus influenzae pneumonia?

A common bacterial pneumonia in infants 1–6 months, transmitted by droplets. cause of acute epiglottitis

What is Klebsiella pneumonia?

Hospital‑acquired pneumonia common in older alcoholic men; can lead to sepsis.

What is pseudomonas aeruginosa pneumonia?

A gram‑negative pneumonia common in ventilated or chronically ill patients; sputum is green with a sweet smell.

What environmental conditions promote pseudomonas growth?

Damp, warm respiratory equipment.

What are viral causes of pneumonia?

Influenza A/B, RSV, parainfluenza.

What is consolidation in pneumonia?

Alveoli fill with fluid and debris, impairing gas exchange.

What lung sound indicates alveolar consolidation?

Crackles.

What lung sound indicates consolidation in bronchioles?

Rhonchi.

What causes decreased gas exchange in pneumonia?

Fluid‑filled alveoli and increased mucus obstructing airways.

What are common symptoms of pneumonia?

Productive cough, green/yellow/rust sputum, fever, chills, dyspnea, chest pain.

What symptoms may older adults show with pneumonia?

Confusion or stupor due to poor oxygenation.

What is hypoxia?

Low oxygen to tissues.

What is hypoxemia?

Low oxygen in the blood.

What are complications of pneumonia?

Atelectasis, pleurisy, pleural effusion, bacteremia, pneumothorax, respiratory failure, sepsis, lung abscess, empyema.

What diagnostics are used for pneumonia?

Chest X‑ray, sputum culture, blood cultures, CBC, ABGs, thoracentesis, bronchoscopy.

What is the priority when a patient is diagnosed with pneumonia?

Prompt administration of antibiotics.

What is empiric therapy in pneumonia?

Broad‑spectrum antibiotics given before the specific organism is identified.

How quickly do patients usually improve after starting pneumonia treatment?

Within 72 hours.

What are signs of improvement in pneumonia?

Afebrile, improved breathing, less nasal flaring, reduced accessory muscle use, decreased chest discomfort.

What supportive care is used for pneumonia?

Oxygen, analgesics, antipyretics, rest/activity balance, pulmonary hygiene.

What is pulmonary hygiene?

Techniques to clear mucus such as deep breathing, coughing, mucolytics, fluids, suctioning.

What are risks of suctioning?

Trauma, hypotension, bradycardia.

What is bronchial lavage?

Instilling saline and suctioning to clear secretions.

What is percussional therapy?

Chest percussion to break up secretions.

Why is hydration important in pneumonia?

It thins secretions for easier clearance.

Why must hydration be used cautiously in HF or COPD patients?

They are prone to fluid overload.

What type of meals are recommended for pneumonia patients?

Small, frequent, high‑calorie meals.

Why monitor weight in pneumonia patients?

Poor appetite and increased work of breathing can cause weight loss.

What past medical history is important in pneumonia assessment?

Recent antibiotics, abdominal/thoracic surgery, intubation, tube feedings.

What lifestyle change should pneumonia patients be taught?

Stop smoking.

Why encourage mobility in pneumonia patients?

Movement improves lung expansion and secretion clearance.

What are signs of poor gas exchange?

Restlessness, tachypnea, nasal flaring, accessory muscle use.

What lung sounds may be heard in pneumonia?

Crackles, rhonchi, friction rub.

What vital sign changes may occur with pneumonia?

Tachycardia, fever, or hypothermia in severe cases.

What mental status changes may occur in pneumonia?

Confusion or altered LOC due to hypoxia.

What ABG abnormalities may be seen in pneumonia?

Low PaO₂, high PaCO₂ in severe cases.