Care of the patient with a Chest Tube Cabrillo College国立大学与胸管的病人的护理.ppt

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Care of the patient with a Chest Tube Cabrillo College国立大学与胸管的病人的护理.ppt

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* * Transudate: fluid that passes through a membrane; compared w/an exudate, has fewer cellular elements. Exudate: any fluid from the body w/a high concentration of protein, cells, or solid debris. Empyema: collection of purulent fluid in the pleural space * * A tension pneumothorax can kill Chest wall is intact Air enters the pleural space from the lung or airway, and it has no way to leave There is no vent to the atmosphere as there is in an open pneumothorax Most dangerous when patient is receiving positive pressure ventilation in which air is forced into the chest under pressure * Mediastinal shift can quickly lead to cardiovascular collapse The vena cava and the right side of the heart cannot accept venous return With no venous return, there is no cardiac output No cardiac output = not able to sustain life * N26 Chest Tubes Cabrillo College ADN/C. Madsen RN, MSN * Symptoms depend on cause, and how quickly or slowly it develops. Cyanosis – but very late sign of hypoxia Small 15% Observe patient’s CXR for further collapse Lung re-expands at a rate of 1.25% per day Moderate 15-60% Patient symptomatic, chest tube is indicated Large 60 % Chest tube is indicated * * N26 Chest Tubes Cabrillo College ADN/C. Madsen RN, MSN * * N26 Chest Tubes Cabrillo College ADN/C. Madsen RN, MSN * * This system works if only air is leaving the chest If fluid is draining, it will add to the fluid in the water seal, and increase the depth As the depth increases, it becomes harder for the air to push through a higher level of water, and could result in air staying in the chest * For drainage, a second bottle was added The first bottle collects the drainage The second bottle is the water seal With an extra bottle for drainage, the water seal will then remain at 2cm Many years ago, it was believed that suction was always required to pull air and fluid out of the pleural space and pull the lung up against the parietal pleura However, recent research has shown that suction may actuall