Question

ical Thinking Activity Pneumothorax & Chest Tube Insertion NURS 410 A. W., a 52-year-old suddenly grabbed her right side and walking companion, "1 helped her to the By woman disabled from severe emphysema, was walking at a mall when she gasped, "Oh, something just popped." A.W. whispered to her I cant get any air." Her companion yelled for someone to call 911 and nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in piratory intubated, an IV of lactated Ringer's (LR) to KVO keep vein distress. She was open) was started, and she was transported to the nearest emergency department (ED) On and arrival t e ED, the physician auscultates muffled heart tones, no breath sounds on the right the physician that it was difficult arterial blood ABGs on 100% oxygen are sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform to ventilate A.W. A STAT portable chest x-ray (CXR) and gases (ABGs) are obtained. A,W has an 80% pneumothorax on the right, and her pH 7.25, Paco2 92 mm Hg, Pao2 32 mm Hg, HCO3 27 mmol/L, base excess (BE) +5 mmol/L, Sao2 5396. ven the diagnosis of pneumothorax, explain why the paramedic had difficulty ventilating A.W 2. Interpret A.W.'s ABGs. 3. What is the reason for A.W.'s ABG results? 4. The physician needs to insert a chest tube. What are your responsibilities as the nurse? nurse, it is your responsibility to ensure pain control. In A.W's case, would you 6. The ED physician inserts a size 32F chest tube in the sixth intercostal space (ICS), midaxillary li admi inister pain medication before the chest tube insertion? ne. Would you expect to observe an air leak when A.W's chest drainage system is in place and functioning . Would you expect A.W.'s lung to reexpand immediately after the chest tube insertion and 8·The clerk tells you A.W.'s husband has just arrived: A.W. will be admitted to the hospital. How would you address this issue with her husband? 9. You approach A.W's bedside and ask about what looks like 2 healed chest tube sites on her right chest. A.W:'s husband informs you that this is the third time she has had a collapsed lung. He asks whether this trend will continue. How would you respond? 10. A.W. recovers and is discharged home 4 days later with a chest tube and Heimlich valve. The physician connects a one-way (Heimlich) valve between the distal end of the chest tube and a drainage pouch. Discuss the purpose of this device. CASE STUDY PROGRESS A.W. develops several more spontaneous pneumothoraces on the right side and eventually has bleomycin instilled over the right lung to induce scarring. She says, "It felt like someone poured kerosene in and threw a lit match in after it. It was the most painful thing I ever went through." Research the scarring procedure so that you know what it does and why it is necessary. Note: Sclerosing a lung doesn't have to feel like it is burning: it should be managed with adequate pain medication.

Answer 1

Q. No : 1. Answer :

Diagnosis of pneumothorax is done by doing chest X - ray. And by doing CT scan. ( computerized tomography).

Here the portable chest X - ray was done, according to this X - ray she is having 80% of pneumothorax at right side of the lungs.

Pneumothorax : it is one of the respiratory condition in which the air or other gases filled in pleural cavity, it is occurs, disease or any injury to the lung tissues.

Paramedics had difficulty to ventilating because patient is having muffled heart sounds that means fluid accumulate around the heart and difficulty to pump the blood, and low arterial blood pressure and distended neck veins it is one of the emergency condition.

And also no breath sounds on right side and faint sounds on left side and cyanotic spells are there and patient is stuporous.

* and also main thing is patient is having Pneumothorax , so if they ventilate there is a high risk to develop tension Pneumothorax, so this type of patients need tube thoracostomy.

So that the paramedics had difficulty to ventilating the client.

Q. No 2. Answer :

Interpretation of ABG is

" Respiratory Acidosis "

Because here the pH is 7.25 it indicates acidosis, because below 7.35 indicates acidosis.

* pco2 92 mm of hg, if pco2 > 45 mm of hg indicates respiratory acidosis.

* normal bicarbonate levels HCO3 level 27 mmol / l.

So it is Respiratory acidosis.

Q. No 3. Answer :

Here the reason for ABG results that means reason for Respiratory acidosis is, Pneumothorax or respiratory failure, because of that the lungs can not exchange or remove the enough carbon diaxide which is produced by the body ,so excess co2 causes the pH of the blood and other body fluids to decrease so it leads to acidity may increases, it is the cause for respiratory acidosis or ABG results.

Q. No .4. Answer :

Chest tube insertion means intercostal drainage, inserting a tube in to the inter coastal place or inserting through the chest wall into the pleural space to remove excess air or fluids from lungs like in Pneumothorax condition.

Responsibilities of nurse :

* Education the client and attenders regarding procedure.

* Take the consent form from them.

* preparation at the site of insertion.

* prepare the articles which are needed for procedure. Like tube, normal saline, needle, syringes, gloves ect.

* provide emotional and psychological support to clients and attenders.

* Explain risk and benefits.

* collect all lab reports like CT, BT, ect.

* assist to doctor while performing procedure.

* Take X - ray For the site, and confirm it by doctor, whether is it OK.

* apply negative pressure to prevent back flow in to the lungs.

* clear the clots in the tube.

* Record and Report all the things what happens.

This is the nurses responsibility during in chest tube insertion