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.