the exchange of gases via the alveoli, often quantified as the volume of air breathed in per minute that reaches the alveoli and takes part in gas exchange
Alveolar ventilation
a small, air-containing saclike dilation (outpouching) in the lungs where gas exchange takes place with the pulmonary capillary blood (plural: alveoli)
Alveolus
originating within an organism itself; applied to blood transfusion, referring to the person’s own blood
Autologous
an increase in pericardial pressure from an accumulation of fluid or blood in the pericardial sac that can lead to cardiac rupture
Cardiac tamponade
a milky, fatty fluid found in lymph in the gastrointestinal tract and transported to the systemic circulation via the thoracic duct
Chyle
a dry, crackling, or grating sound produced by air in subcutaneous tissue, by air moving through fluid in the alveoli of the lungs, or by bone rubbing against bone
Crepitus
a coiled section of tubing that hangs lower than the rest of the tubing or system
Dependent loop
pus in the pleural (or other body) cavity
Empyema
one of a group of muscles that facilitate respiration by contracting to raise the ribs and rotate them slightly, pushing the sternum forward and enlarging the chest
External intercostal
any material such as fluid, cells, or cellular debris that has escaped from blood vessels and has deposited in tissues or on tissue surfaces, usually as a result of inflammation
Exudate
a collection of fluid containing exudate in the pleural cavity
Exudative effusion
a one-way flutter valve through which air can escape from the chest cavity but cannot re-enter it
Heimlich valve
an accumulation of blood in the pleural cavity
Hemothorax
within an organ’s parenchymal tissue, the functioning cells as opposed to the connective tissue and structural framework, nerves, and blood vessels
Intraparenchymal
the pressure (force) within the pleural cavity (the space formed when the pleural layers spread apart) that is normally negative in relation to intra-alveolar pressure
Intrapleural pressure
a medical instrument that resembles scissors but has blunted grips instead of blades and a locking mechanism for use as a hemostat or clamp; also called Kelly forceps
Kelly clamp
an accumulation of fluid in the pleural cavity as a result of cancer
Malignant pleural effusion
a tube inserted into the mediastinal space (the space between the right and left thoracic cavity that contains the heart, the mainstem bronchus, the thymus gland, and large blood vessels) to drain blood and fluid after cardiac surgery
Mediastinal chest tube
movement of the tissues and organs of the mediastinum to one side of the chest cavity
Mediastinal shift
intermittently compressing a chest tube in the area of a clot for 1 to 2 seconds
Milking
a flow that changes direction periodically or rhythmically; used to refer to the rise and fall of fluid within a closed-chest drainage system with inhalation and exhalation, also called tidaling
Oscillation
serous membrane lining the inner surface of the chest wall, the top of the diaphragm, and the mediastinum
Parietal pleura
serous, lubricating liquid within the pericardial cavity, the space between the layers of the membranes of the pericardium (the fibrous covering that surrounds the heart)
Pericardial fluid
the space between the layers of the membranes of the pericardium, the fibrous covering that surrounds the heart
Pericardial space
the space between the parietal and the visceral pleura
Pleural cavity
an accumulation of fluid in the pleural cavity
Pleural effusion
the space between the parietal and the visceral pleura
Pleural space
a procedure that involves instilling a chemical agent, such as talc, into the pleural space to trigger an inflammatory response that creates scar tissue, improves adhesion between the pleural layers, and reduces the risk of recurrent pneumothorax
Pleurodesis
an accumulation of air or gas in the pleural space
Pneumothorax
systolic blood pressure that is more than 10 mm Hg higher during exhalation than during inhalation, a finding with pericardial effusion and cardiac tamponade
Pulsus paradoxus
an accumulation of air or gas in the pleural space that results from a breach in the visceral or parietal pleura with no apparent external trauma
Spontaneous pneumothorax
compressing a chest tube along the length of the tube to help propel clots and debris toward the collection chamber of the drainage system
Stripping
air in the tissues under the skin that produces a crackling sensation on palpation
Subcutaneous emphysema
a thin, watery mixture containing a soft, soapy powder and used for pleurodesis
Talc slurry
an accumulation of air or gas in the pleural space that results from a lacerated lung or an opening in the chest wall, often a complication of other types of pneumothorax
Tension pneumothorax
referring to the chest
Thoracic
creation of an opening in the chest wall to allow drainage through a tube
Thoracostomy
incision into the pleural space of the chest
Thoracotomy
the rise and fall of fluid within a closed-chest drainage system with inhalation and exhalation
Tidaling
shifting of the trachea (windpipe) to one side
Tracheal deviation
fluid that passes through a membrane
Transudate
blockage in a tube
Tube occlusion
forceful exhalation against a closed glottis, which involves contraction of the abdominal muscles
Valsalva’s maneuver
the process of the exchange of air between the lungs and the environment, including inhalation and exhalation
Ventilation
serous membrane adjacent to the outer surface of the lungs
Visceral pleura
dry suction-control system
-Systems that use dry suction control allow for higher suction pressures by adjusting a dial on the front surface of the system to deliver suction pressure up to -40 cm of water. Some patients need high suction pressures due to a massive air leak from the lung surface, emphysema or viscous pleural effusion, or a reduction in pulmonary compliance
-Systems that use dry suction control allow for higher suction pressures by adjusting a dial on the front surface of the system to deliver suction pressure up to -40 cm of water. Some patients need high suction pressures due to a massive air leak from the lung surface, emphysema or viscous pleural effusion, or a reduction in pulmonary compliance
A patient injured in a motor-vehicle crash is transported to an ED. The provider determines the need for immediate thoracotomy and chest-tube insertion and anticipates the need for maximal suction pressure. The appropriate type of closed-chest drainage system for this patient is a:
-A type of mobile chest drain with a one-way flutter valve that allows air to escape but keeps it from re-entering the chest cavity.
-This device is appropriate for a small or partial pneumothorax and does not collect fluid.
-It cannot accommodate this patient’s need for high suction pressures
-This device is appropriate for a small or partial pneumothorax and does not collect fluid.
-It cannot accommodate this patient’s need for high suction pressures
What is a Heimlich valve?
-A traditional closed-chest water-deal drainage system regulates the amount of suction by the height of the water in the suction-control chamber, typically applying a suction pressure of -20 cm of water to the pleural cavity
-This type of system might not deliver the higher suction pressures this patient requires
-This type of system might not deliver the higher suction pressures this patient requires
How does a water-seal system work?
-A type of mobile chest drain with a one-way valve that attaches directly to the chest tube to collect fluid.
-This device is appropriate for a small or partial pneumothorax. It cannot accommodate this patient’s need for high suction pressures.
-This device is appropriate for a small or partial pneumothorax. It cannot accommodate this patient’s need for high suction pressures.
What is a pneumostat?
About 150 mL/hr over the past 2 hours
-after the first few hours, the nurse should report drainage that exceeds 70 mL/hr. Patients who lose as much as 100 mL of blood every 15 min might require autotransfusion within 6 hr.
-after the first few hours, the nurse should report drainage that exceeds 70 mL/hr. Patients who lose as much as 100 mL of blood every 15 min might require autotransfusion within 6 hr.
A nurse is caring for a patient who has a chest tube in place attached to water-seal drainage. Which of the following observations about the drainage should be reported if found 5 hr after insertion?
(1) A total of 400 mL since insertion
-The nurse should expect 100 to 300 mL of fluid during the first 3 hr after pleural insertion of a chest tube. Since this is 2 hr after that, this amount of drainage is within the expected reference range.
(2) A gush of fluid when repositioning the patient
-A sudden gush of drainage with a position change is often retained blood and not active bleeding. Unless the total amount exceeds the expected range for this patient at this time, there is no need to report this.
(3) A significant decrease in drainage over the past 3 hr
-The nurse should expect 100 to 300 mL of fluid during the first 3 hr after pleural chest-tube insertion. It declines after about 2 hr, so this is an expected finding.
-The nurse should expect 100 to 300 mL of fluid during the first 3 hr after pleural insertion of a chest tube. Since this is 2 hr after that, this amount of drainage is within the expected reference range.
(2) A gush of fluid when repositioning the patient
-A sudden gush of drainage with a position change is often retained blood and not active bleeding. Unless the total amount exceeds the expected range for this patient at this time, there is no need to report this.
(3) A significant decrease in drainage over the past 3 hr
-The nurse should expect 100 to 300 mL of fluid during the first 3 hr after pleural chest-tube insertion. It declines after about 2 hr, so this is an expected finding.
A nurse is caring for a patient who has a chest tube in place attached to water-seal drainage. What are some normal/expected observations about the drainage if found 5 hr after insertion?
continuous bubbling in the water-seal chamber
-Excessive and continuous bubbling in the water seal chamber indicates an air leak in the drainage system. The nurse should use rubber-tipped clamps to try to locate the leak by clamping the tube momentarily at various points along its length.
-Excessive and continuous bubbling in the water seal chamber indicates an air leak in the drainage system. The nurse should use rubber-tipped clamps to try to locate the leak by clamping the tube momentarily at various points along its length.
A nurse is caring for a patient who is 6 hr postoperative and has a chest tube in place attached to a closed-chest water seal drainage system. The nurse should observe for which of the following indications of a problem in the drainage system?
(1) Constant bubbling in the suction-control chamber
-The nurse should expect constant, gentle bubbling in the suction control chamber. Vigorous bubbling in this chamber can disturb the patient, and it also increases the rate of water evaporation while decreasing the amount of suction.
(2) Fluctuations in the fluid level in the water-seal chamber
-The nurse should expect to see fluctuation with inspiration and exhalation, as it reflects the expected pressure changes in the pleural space during respiration. Fluctuation stops when the lung has re-expanded, but it can also stop when the tubing is obstructed, a dependent loop hangs below the rest of the tubing, or the suction source is not functioning.
(3) Occasional bubbling in the water-seal chamber
-The nurse should expect continuous bubbling in the water-seal chamber initially and occasional bubbling after that. The bubbles indicate the removal of air from the pleural space, which is the expected result.
-The nurse should expect constant, gentle bubbling in the suction control chamber. Vigorous bubbling in this chamber can disturb the patient, and it also increases the rate of water evaporation while decreasing the amount of suction.
(2) Fluctuations in the fluid level in the water-seal chamber
-The nurse should expect to see fluctuation with inspiration and exhalation, as it reflects the expected pressure changes in the pleural space during respiration. Fluctuation stops when the lung has re-expanded, but it can also stop when the tubing is obstructed, a dependent loop hangs below the rest of the tubing, or the suction source is not functioning.
(3) Occasional bubbling in the water-seal chamber
-The nurse should expect continuous bubbling in the water-seal chamber initially and occasional bubbling after that. The bubbles indicate the removal of air from the pleural space, which is the expected result.
What are some expected findings with chest tubes?
have the patient splint the affected side during coughing
-It is essential for a patient with a chest tube to cough, not only to prevent postoperative complications, but also to help drain the pleural space and expand the lungs. Splinting the affected side, such as with a pillow, can help minimize the pain of coughing. The nurse should also administer analgesia to help reduce the pain of coughing and other activities.
-It is essential for a patient with a chest tube to cough, not only to prevent postoperative complications, but also to help drain the pleural space and expand the lungs. Splinting the affected side, such as with a pillow, can help minimize the pain of coughing. The nurse should also administer analgesia to help reduce the pain of coughing and other activities.
A nurse is caring for a patient who has a chest tube in place attached to a closed-chest water-seal drainage system following thoracic surgery. Which of the following strategies should the nurse use to help promote comfort for this patient?
Upright positioning of a patient with a chest tube allows optimal lung expansion. The nurse should elevate the head of the bed at least 30° and preferably higher
What is the optimal position for a patient who has a chest tube?
Keep the collection device upright at all times
-The closed chest drainage system must be upright at all times to ensure that the tubing drains optimally and the system functions correctly
-The closed chest drainage system must be upright at all times to ensure that the tubing drains optimally and the system functions correctly
A nurse is planning education for a patient who has a chest tube in place attached to a closed-chest drainage system following surgery for lung cancer. Which of the following should the nurse emphasize to the patient when he is ready to ambulate freely?
Submerge the end of the chest tube in 1 inch of sterile water
-This action creates a water seal and prevents air from entering the pleural space through the open end of the chest tube when the patient inhales
-This action creates a water seal and prevents air from entering the pleural space through the open end of the chest tube when the patient inhales
While providing care for a patient who has a chest tube in place attached to a closed-chest drainage system, the nurse accidentally disconnects the chest tube from the system. Which of the following should the nurse do to prevent a serious complication while preparing to reconnect the system?
-Milking the tube involves intermittently compressing it in the area of the clot for 1 to 2 seconds.
-This action could increase negative pressure within the system to a level that can damage the pleural tissue.
-This action could increase negative pressure within the system to a level that can damage the pleural tissue.
What does milking a chest tube involve?
make sure the air vent is open
-Some closed chest drainage systems and suction devices contain a vent from the water-seal chamber. This allows the drainage unit to remain vented without suction.
-So, the nurse should make sure this exit vent is open when disconnecting the suction source.
-Other systems allow air to exit through the suction-control tubing. With these systems, the nurse should keep the suction-control tubing uncapped and free from occlusion to prevent a buildup of air inside the pleural cavity.
-Some closed chest drainage systems and suction devices contain a vent from the water-seal chamber. This allows the drainage unit to remain vented without suction.
-So, the nurse should make sure this exit vent is open when disconnecting the suction source.
-Other systems allow air to exit through the suction-control tubing. With these systems, the nurse should keep the suction-control tubing uncapped and free from occlusion to prevent a buildup of air inside the pleural cavity.
A nurse is preparing to transport to radiology a patient who has a chest tube and a closed-chest wet-suction drainage system. The provider allows disconnecting the drainage system from the suction source during transportation. Which of the following must the nurse do when detaching the suction source?
subcutaneous emphysema
-Palpating the area surrounding the insertion site helps identify crepitus, a dry, crackling, or grating sound. This is the classic manifestation of subcutaneous emphysema, which indicates that air is leaking into the subcutaneous tissue surrounding the chest-tube insertion site.
-Palpating the area surrounding the insertion site helps identify crepitus, a dry, crackling, or grating sound. This is the classic manifestation of subcutaneous emphysema, which indicates that air is leaking into the subcutaneous tissue surrounding the chest-tube insertion site.
A nurse is assessing a patient who has a chest tube in place attached to a closed-chest water-seal drainage system. When the nurse palpates the area around the chest-tube insertion site, she is checking for
-By auscultating the patient’s breath sounds and also by checking various parameters of the system, such as fluctuation in the water-seal chamber.
How should a nurse evaluate lung re-expansion?
-Visible clots in the tubing and an absence of drainage
What are some indications of an obstruction in the chest tube or the drainage system’s tubing?
