Chapter 1: Gas Exchange and Respiratory Function (Part 3)

Urinalysis with Pregnancy Test

test done bore CT scan with contrast media if patient is suspected to be pregnant

Nursing Procdures

1. Thoracentesis

2. Incentive Spirometry

3. Oxygen Therapy

4. Chest Physiotherpay

Thoracentesis

done to remove air and/or fluid

6th-7th ICS of affected thorax

site of insertion for thoracentesis to remove fluid

2nd-3rd ICS of the affected thorax

site of insertion for thoracentesis to remove air

Thoracentesis

- remind px NOT to cough, breathe deeply, or move suddenly during the procedure

- Removal of fluid no more than 1000 mL during the first 30 minutes - to prevent edema and hypovolemic shock

un-operative side

position of patient after thoracentesis

Incentive Spirometry

- sitting or semi-fowler's position to promote lung expansion

- suck as px would through a straw but more slowly

- 5-10x during waking hour

Oxygen Therapy

- Low flow systems

- High flow systems

Low flow systems

- Nasal Cannula

- Simple Face Mask

- Partial Rebreather Mask

- Nonrebreather Mask

Nasal Cannula

- most common method

- low concentration of O2 24-45% at 2-6 LPM

Simple Face Mask

O2 concentration from 40-60% at 5-8 LPM

Partial Rebreather Mask

- O2 concentration of 60-90% at 6-10 LPM

- allows the patient to rebreathe about the first third of exhaled air in conjunction with oxygen

Nonrebreather Mask

- delivers the highest O2 concentration possible - 95-100% at 10-15 LPM

- one way valves on the mask and between the reservoir bag and the mask prevent the room air and the client's exhaled air from entering the bag so only O2 in the bag is inspired

High Flow Systems

- Venturi Mask

- Face Tent

- Tracheostomy collar

- T-piece/Briggs adapter

Venturi Mask

- most reliable and accurate method of delivering precise concentrations through noninvasive means

- O2 concentration varying from 24-60% at 4-10 LPM

Face tent

used when O2 mask are poorly tolerated

Tracheostomy collar

held in place with elastic band around the neck

T-piece/Briggs Adapter

- used to administer O2 to px with ET tube or tracheostomy tube who is breathing spontaneously

- useful in weaning from MV

Chest Physiotherapy

- mobilize and eliminate secretion, reexpand lung tissue and promote efficient use of respiratory muscles

- postural drainage: patient positioning

- reman in each position for 10-15 minutes and percussion and vibration

Chest Physiotherapy

- avoid performing postural drainage immediately before or within 1 and 1/2 hours before meals to avoid nausea, vomiting, and aspiration

- nebulization: before CPT

Chest Tube Thoracotomy

- to evacuate air or fluid or to help regain negative pressure in clients during or immediately after thoracic surgery, in clients with spontaneous pneumothorax, hemothorax, pneumothorax caused by trauma and massive pleural effusion untreated by repeated thoracentesis

2nd or 3rd ICS along midclavicular or anterior axillary line

site for chest tube placement in pneumothorax

6th or 7th ICS in midaxillary line

site for chest tube placement in hemothorax

3 aspects of chest tube drainage system

- collection chamber

- water seal

- suction chamber

collection chmber

- measures the collected fluid and also allows passage of air to the water cell

water seal

- prevents any entry of air into the thorax and measures any air exiting the system in the air leak portion

- fluctuation is normal

- continuos bubbling = air leak

- absence of fluctuation = lung fully inflated

Suction chamber

- the amount of negative pressure it exert to promote suction effect

- -10 to -20 cmH2O

- continuous bubbling is normal

- intermittent bubbling = check gauge

- no bubbling = check connection

50-500 mL

- normal amount of chest tube drainage in the first 24 hours

- expected to be sanguineous at first then serosanguineous then serous over a few days

- notify HCP if >100 mL/hour

Suctioning

- Oropharyngeal

- Nasopharyngeal

- Tracheal

semi-fowlers or high fowlers

position for suctioning

hyperoxygenate

to be done before suctioning

suctioning

- sterile procedure

- intermittent suctioning

- 10-15 seconds (for oral and naso)

- less than 10 seconds (tracheo)

- allow 20-30 seconds interval