401 Unit 2 - Pneumothorax, Hemothorax, Pleural Effusion, and Flail Chest

a (pneumothorax/hemothorax) is a collection of air within the pleural cavity that builds pressure and causes the lungs to collapse

pneumothorax

a (pneumothorax/hemothorax) is collection of blood within the lungs building pressure and causing the lungs to collapse

hemothorax

__________ pneumothorax occurs when a blunt or penetrating trauma creates a one-way valve for air to flow into the pleural space but not back out

a. traumatic

b. open

c. iatrogenic

d. tension

a. traumatic

________ pneumothorax occurs when the chest wound is large enough that air passes freely through the thoracic cavity; aka a "sucking chest wound"

a. traumatic

b. open

c. iatrogenic

d. tension

b. open

____________ pneumothorax occurs due to a diagnostic or therapeutic procedure such as a central line placement

a. traumatic

b. spontaneous

c. iatrogenic

d. tension

c. iatrogenic

___________ pneumothorax often occurs in otherwise healthy people, but can also occur as a complication secondary to certain medical conditions like COPD

a. traumatic

b. spontaneous

c. iatrogenic

d. tension

b. spontaneous

____________ pneumothorax occurs when air enters the pleural space but has no where to exit, increasing pressure and compressing the lung

a. traumatic

b. spontaneous

c. iatrogenic

d. tension

d. tension

A tall, young male presents with severe pain radiating to his shoulder and states he cannot catch his breath. What form of pneumothorax should be suspected?

a. traumatic

b. spontaneous

c. iatrogenic

d. tension

b. spontaneous

which form of pneumothorax is deemed a clinical emergency requiring immediate intervention?

a. traumatic

b. spontaneous

c. iatrogenic

d. tension

d. tension

true or false: a patient with a tension pneumothorax is at risk for hemodynamic instability due to mediastinal shift increasing pressure on the heart

true

a patient presents with tachycardia, hypotension and a deviated trachea. which of the following actions should be taken?

a. rush to CT for confirmation of a tension pneumothorax

b. elevate head of the bed and place patient on high flow oxygen

c. tell them to exercise and send them home

d. prepare for urgent decompression with large bore needle

d. prepare for urgent decompression with large bore needle

what is the key manifestation of a tension pneumothorax?

a. crackles on auscultation

b. sharp, pleuritic chest pain

c. becks triad

d. all of the above

b. sharp, pleuritic chest pain

which of the following is a potential complication of decompression of a tension pneumothorax?

a. hemorrhage

b. atrial fibrillation

c. pulmonary edema

d. secondary spontaneous pneumothorax

c. pulmonary edema

true or false: tension pneumothorax patients often end up with a chest tube after decompression

true

true or false: a pneumothorax always requires urgent large bore needle decompression

false - unstable cases require decompression, but minor cases may resolve on their own with follow up in 2-4 weeks

which of the following symptoms will NOT be present in patients with a hemothorax?

a. tachypnea

b. decreased breath sounds

c. chest wall asymmetry

d. jugular vein distention

d. jugular vein distention - hemothorax patients are hypovolemic

a (pneumothorax/pleural effusion) is a condition in which infection and inflammation cause buildup of fluid between the visceral and parietal layers of the lungs

pleural effusion

_____________ is the amount of pressure caused by fluid because of gravity causing interstitial fluid to move into the pleural space

hydrostatic pressure

what effect does hydrostatic pressure have on the lungs in pleural effusion cases?

a. reduces ventilation and expansion

b. retains CO2 causing acidosis

c. pushes blood into the lungs

d. causes tissue damage and impairs oxygenation

a. reduces ventilation and expansion

a (transudative/exudative) effusion occurs when fluid leaks in relation to pressure alterations; most commonly caused by heart failure

transudative

(transudative/exudative) effusions occur when protein cells leak through permeable capillaries during the inflammatory response

exudative

which symptom is NOT characteristic to a pleural effusion?

a. dullness on percussion

b. pleuritic chest pain on inspiration

c. pleural friction rub

d. pink, frothy sputum

d. pink, frothy sputum

true or false: empyema is a collection of fluid containing pus that requires immediate drainage

true

a ____________ is the procedure in which a needle is inserted to drain fluid or air from around the lung

a. angiogram

b. thoracentesis

c. CABG

d. thoracotomy

b. thoracentesis

true or false: some minor pleural effusions will resolve on their own

true

which of the following is a common treatment option for pleural effusions?

a. thoracentesis

b. pleruodesis

c. treatment of underlying cause (antibiotics, nitrates, diuretics, etc.)

d. all of the above

d. all of the above

True or false: flail chest occurs when air or fluid builds up around the lungs causing respiratory collapse

false - flail chest occurs when 3 or more adjacent ribs break in two different places

which of the following might occur in patients with flail chest?

a. ineffective ventilation

b. pulmonary contusion (bruising)

c. splinting/stiffening of lung tissue

d. all of the above

d. all of the above

what is the focus of treatment for flail chest?

a. adequate ventilation

b. stabilizing and fixating fractures

c. preventing infection

d. promoting lifestyle changes to prevent reoccurrence

a. adequate ventilation

a patient with flail chest has been placed on CPAP to maintain ventilation. what is the priority of care moving forward?

a. stabilizing and fixating the fractures

b. promoting lifestyle changes to prevent reoccurrence

c. preventing infection

d. pain control

d. pain control

what action should be taken if a chest tube is accidentally dislodged?

a. place a sterile occlusive dressing over it until it can be replaced

b. stick it back in and notify the provider

c. apply pressure to the site to prevent hemorrhage

d. have the patient ambulate to test respiratory status

a. place a sterile occlusive dressing over it until it can be replaced