Chapter_030 FA24

Chapter 30: Lower Respiratory Problems

Overview

• Focus on chest trauma and thoracic injuries

Page 2: Chest Trauma and Thoracic Injuries

• Recognition of the impact of traumatic injuries on respiratory system and mortality.

Page 3: Traumatic Chest Injuries

• Traumatic injuries range from simple rib fractures to cardiorespiratory arrest.

• Classify injuries into:

  • Blunt Trauma: No object penetrates the body, resulting from strikes or impacts.

  • Penetrating Trauma: Involves foreign objects penetrating body tissues.

Page 4: Mechanisms of Injury

Blunt Trauma

• Caused by external forces striking or impacting the chest.

• Can cause shearing, and compression injuries of structures beneath the chest wall.

• Symptoms may appear minor externally but lead to severe internal damage.

Penetrating Trauma

• Involves an object impaling or passing through the body, creating wounds.

Page 5: Fractured Ribs

Characteristics

• Most commonly affect ribs 5 through 9, which are least protected. (could stab an organ)

• Potential damage to pleura, lungs, heart, and other organs.

Manifestations

• Symptoms include:

  • Pain upon inspiration and coughing

  • Splinting (restrictive breathing)

  • Shallow respirations

  • guarding

Page 6: Complications and Treatment for Rib Fractures

Complications

• Potential for atelectasis and pneumonia.

• Avoid tape or thoracic binders. DO NOT!

Treatment Approaches

• Pain management using NSAIDs, opioids, nerve blocks.

• Patient education on:

  • Deep breathing and coughing exercises

  • Use of incentive spirometry

  • Analgesic use

  • Importance of early mobility.

Page 7: Flail Chest

Definition

• Occurs with 3 or more consecutive rib fractures in multiple places leading to unstable chest wall. (unstable segment)

• Results in paradoxical movement:

  • Inspiration: Flail segment retracts inward.

  • Expiration: Flail segment bulges outward.

Consequences

• Leads to inadequate ventilation and increased work of breathing (WOB).

Page 9: Flail Chest: Physical Examination

Findings

• Rapid, shallow respirations

• tachycardia

• bruise, tender

• paradoxical movement of the chest wall

• decreased breath sounds on the affected side

• Asymmetrical chest movement

• Signs of inadequate ventilation

• Splinting and crepitus near fractured areas.

• plural effusion

• hypotension

Diagnostic Studies

• Chest x-ray is the primary diagnostic method to assess rib injuries.

• Prepare chest tube

Page 10: Flail Chest Treatment

Management Strategies

• Ensure adequate lung expansion and adequate oxygenation.

• Effective pain management.

• High flow o2

• Prepare for intubation

• Additional interventions if necessary:

  • Intubation and mechanical ventilation.

  • Surgical fixation of ribs/ wiring.

Page 14: Pneumothorax

Definition

• Condition caused by air entering pleural cavity.

• Results in positive pressure that collapses the lung fully or partially.

Types

• Open Pneumothorax: Identifiable external wound (e.g., sucking chest wound).

• Closed Pneumothorax: No external wound present.

• Spontaneous -

• Latrogenic - Laceration from procedure

• Tension - Rubbing

• Hemothorax - Stab

• Chylothorax - Lymph in plural space

Page 16: Pneumothorax Manifestations

Symptoms

• Small Pneumothorax: Mild tachycardia, dyspnea.

• Large Pneumothorax: Severe respiratory distress with rapid, shallow breaths, low oxygen saturation, and absent breath sounds over the affected area.

Diagnostic Tools

• Chest x-ray to identify air/fluid in pleural space and assess lung volume reduction.

Page 19: Tension Pneumothorax

Seriousness

• Life-threatening accumulation of air in the pleural space that prevents escape, causing increased pleural pressure.

• Clinical manifestations include:

  • Severe dyspnea

  • Tachycardia

  • Tracheal deviation

  • Distended neck veins

  • Cyanosis and diaphoresis.

Page 22: Hemothorax and Chylothorax

Hemothorax

• Presence of blood in pleural space due to various injuries.

• Treatment typically requires a chest tube.

• Low hemoglobin

• Decrease breath sounds

Watch chest tube for large amounts of blood = call MD

Chylothorax

• Presence of lymphatic fluid in the pleural space.

• Treatment may involve conservative methods or surgery (pleurodesis) when necessary.

Page 23: Interprofessional Care for Pneumothorax

Care Approach

• Cover wounds with a three-sided dressing to prevent air entry during inspiration and allow escape during expiration.

• Stabilize impaled objects with bulky dressings without removal.

Page 24: Pneumothorax Treatments

Treatment Options

• Utilization of chest tubes with water-seal drainage.

• Immediate needle decompression for tension pneumothorax; followed by chest tube insertion.

Page 27: Nursing Considerations

Priorities for M.Z.

• Focus on critical assessments and interventions related to M.Z.'s injuries and symptoms in preparation for medical procedures.

Cardia Tamponade

• Monitor vital signs closely, paying special attention to blood pressure and heart rate changes.

• Assess for signs of decreased cardiac output, such as altered mental status or peripheral cyanosis.

Prepare for potential interventions, including pericardiocentesis, to relieve pressure on the heart.

Signs & Symptoms

Muffled heart sounds

Medical emergency

Pericardiocentesis is a procedure used to remove excess fluid from the pericardial sac surrounding the heart.