Mr. B has been transferred to your floor to wait and see whether
the chest tube allows his lungs to completely re-expand. But when
he arrives, he is in severe respiratory distress. He says "I felt
better before I came into the ER! Is this tube doing
anything?"
You tell the Clinical Nurse Specialist (CNS). As the two of you
move him into the bed, you notice that his chest tube bottle is
lying on its side on the gurney, with air going into it. When you
point this out to the CNS, she immediately grabs the bottle and
sets it upright on the floor. You see air start bubbling through
the fluid right away. "That was the problem!" she says. "They lost
the water seal, and air was going into his chest from the bottle.
You would not believe how many times that happens on transport."
When you examine Mr. B, you have trouble detecting his lung sounds
on the left. Even stranger, his apical heart sound is in the wrong
place – it is over toward the right side of his chest. His
respiration rate and heart rate are both increased, and he is
struggling to breathe. "Let's give him a little oxygen. He'll be a
lot better in a half-hour," says the CNS. "Check back on
him."
Why would accumulation of air in his pleural space cause his heart
sounds to be in the wrong place?
Choose the best explanation.
A. Mr. B's heart has not really moved, but the air in his chest is making it sound different. |
B. The air in Mr. B's chest is making his heart collapse – an emergency! |
C. Because the left side of Mr. B's chest is filling up with air, the organs in his chest are being pushed over to the right. |
D. Because Mr. B's right lung collapsed, his heart moved over into the empty space. |
Answer is C.
Because the left side of Mrs. B chest is filling up with air. The organs in his chest are being pushed over to the right.
Mr. B has been transferred to your floor to wait and see whether the chest tube...
When your clinical ends, Mr. B is resting peacefully. His respiratory rate and heart rate are back to normal, his chest tube is not bubbling anymore, and his breath sounds are even on both sides. Mrs. H is using her spirometer, and the respiratory tech says her vital capacity is a lot better than it was the first time he checked on her. The CNS tells your prof you made a good save in noticing Mr. B's tipped chest tube...
1. Why did the nurse who listened to Mr. JD’s chest not hear breath sounds over the area of infection? 2. How did such a large area of Mr. JD’s lung become involved in the infection so quickly? The alveolar spaces of the lung are connected to one another through many small openings known as the Pores of Kohn. These openings allow equalization of air pressure during inspiration and expiration. Unfortunately in the case of pneumonia, the openings also...
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...
Concept Map - Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts of abdominal pain in the past month but "none as...
Concept Map - Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts of abdominal pain in the past month but "none as...
l Concept Map-Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts of abdominal pain in the past month but "none as bad...
Concept Map - Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts! of abdominal pain in the past month but "none as...
Concept Map - Choledocholithiasis Mr. Tony Burk is a 60y/o retiree admitted to your unit from the emergency room. Upon arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. The patient states that he has had severe upper right quadrant pain that radiates to his back, and he is more comfortable walking bent forward than lying down in bed. He admits to having bouts of abdominal pain in the past month but "none as...
CASE STUDY A 19-year-old female college student presents to the emergency department complaining of chest tightness and dyspnea. She was cutting and trimming the lawn when these symptoms developed. Rhinorrhea and tearing began soon after she went outside and preceded the chest discomfort. Going inside did not relieve her symptoms. During the physical examination, she said, "I have had asthma since childhood, and my mother and brother also have asthma." Her respiratory rate was 30 breaths per minute, and she...
CASE STUDY I A 19-year-old female college student presents to the emergency department complaining of chest tightness and dyspnea. She was cutting and trimming the lawn when these symptoms developed. Rhinorrhea and tearing began soon after she went outside and preceded the chest discomfort. Going inside did not relieve her symptoms. During the physical examination, she said, “I have had asthma since childhood, and my mother and brother also have asthma.” Her respiratory rate was 30 breaths per minute, and...