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7/28/2019 Respiratory Examination and Assessment
1/19
RCdelaPea, RN, RM, MAN1
RESPIRATORY EXAMINATION ANDASSESSMENT
A. Abnormal patterns of breathing
1. Sleep Apnea
- Cessation of airflow for more than 10 secondsmore than 10 times a night during sleep
Causes: obstructive (e.g. obesity with uppernarrowing, enlarged tonsils, pharyngeal softtissue changes in acromegaly orhypothyroidism)
2. Cheyne-Stokes- Periods of apnea alternating with periods ofhyperpnoea
pathophysiology: delay in medullary
chemoreceptor response to blood gas changes
Causes
brain damage (e.g. trauma, cerebral,hemorrhage)
3. Kussmaul's (air hunger)- deep rapid respiration due to stimulation ofrespiratory centre
Causes: metabolic acidosis (e.g. diabetes
mellitus, chronic renal failure)
4. Hyperventilation
complications: alkalosis and tetany
causes: anxiety
5. Ataxic (Biot)
irregular in timing and deep
causes:brainstem damage
6. Apneustic
post-inspiratory pause in breathing
causes:brain (pontine) damage7. Paradoxical
the abdomen sucks with respiration (normally, itpouches uotward due to diaphragmatic descent)
causes: diaphragmatic paralysis
B. Cyanosis
1. Refers to blue discoloration of skin andmucous membranes, is due to presence ofdeoxygenated hemoglobin in superficial bloodvessels
2. Central cyanosis = abnromal amout ofdeoxygenated haemoglobin in arteries and that
blue discoloration is present in parts of bodywith good circulation such as tongue
3. Peripheral cyanosis = occurs when blood
supply to a certain part of body is reduced, andthe tissue extracts more oxygen from normalfrom the circulating blood, e.g. lips in coldweather are often blue, but lips are spared
4. Causes of cyanosis
Central cyanosis
high altitude
massive pulmonary embolism
hunt (cyanotic congenitalheart disease)
methaemoglobinaemia, sulphaemoglobinaemia
Peripheral cyanosis
cyanosis
c output: left ventricular failureor shock
Position: patient sitting over edge of bedGeneral appearance
Dyspnea
normal respiratory rate < 14 each minute
tachypnea = rapid respiratory rate
are accessory muscles being used
(sternomastoids, platysma, strap muscles ofneck) - characteristically, the accessory musclescause elevation of shoulders with inspiration andaid respiration by increasing chest expansion
Cyanosis
Character of cough
ask patient to cough several times
lack of usual explosive beginning may indicatevocal cord paralysis (bovine cough)
muffled, wheezy ineffective cough suggestsairflow limitation
Very loose productive cough suggests excessivebronchial secretions due to:
- Chronic bronchitis
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The Face
Eyes
Horner's syndrome? (Constricted pupil, partialptosis and loss of sweating which can be due to
apical lung tumor compressing sympatheticnerves in neck)
Nose
Polyps? (Associated with asthma)
Engorged turbinates? (Various allergicconditions)
Deviated septum? (Nasal obstruction)
Mouth and tongue
Look for central cyanosis
Evidence of upper respiratory tract infection (areddened pharynx and tonsillar enlargement withor without a coating of pus)
Broken tooth - may predispose to lung abscessor pneumonia
Sinusitis is indicated by tenderness over thesinuses on palpation
Some patients with obstructive sleep apneawill be obese with a receding chin, a small
pharynx and a short thick neck
The Trachea
toward the side of the lung lesion
upper mediastinal masses, such as retrosternalgoiter
s itmove inferiorly with each inspiration) is a signof gross overexpansion of the chest because ofairflow obstruction
The Chest: inspection
Shape and symmetry of chest
Barrel shaped
compared with lateral diameter
causes: hyperinflation due to asthma,emphysema
Pigeon chest (pectus carinatum)
localized prominence (outward bowing ofsternum and costal cartilages)
causes:
manifestation of chronic childhood illness (dueto repeated strong contractions of diaphragmwhile thorax is still pliable)
rickets
Funnel chest (pectus excavatum)
localizeddepression of lower end of sternum in severecases, lung capacity may be restricted
Harrison's sulcus
inner depression of lower ribs just abovecostal margins at site of attachment ofdiaphragm
causes:
severe asthma in childhood
rickets
Kyphosis, exaggerated forward curvature ofspine
Scoliosis, lateral bowing
Kyphoscoliosis: causes:
involving grey matter of cord)
reduce lung capacity and increase work ofbreathing)
Lesions of chest wall
- previous thoracic operations or chestdrains for a previous pneumothorax or pleural
effusion
rformed to removeTB, but no longer is because of effective anttuberculosis chemotherapy) involved removal oflarge number of ribs on one side to achieve
permanent collapse of affected lung
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radiotherapy; there is a sharp demarcationbetween abnormal and normal skin
Diffuse swelling of chest wall and neck
causes:
pneumothorax
rupture of esophagus
Prominent veins
cause: superior vena cava obstruction
Asymmetry of chest wall movements
looking down the clavicles during moderaterespiration - diminished movement indicatesunderlying lung disease
show delayed ordecreased movement
causes of reduced chest wall movements onone side are localized:
localized pulmonary fibrosis
consolidation
collapse
pleural effusion
pneumothroax
causes of bilateral reduced chest wallmovements are diffuse:
diffuse pulmonary fibrosis
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The Chest:palpation
chest expansion
place hands firmly on chest wall with fingersextending around sides of chest (fugyre 4.5)
as patient takes a big breath in, the thumbsshould move symmetrically apart about 5 cm
reduced expansion on one side indicates a lesionon that side
note: lower lobe expansion is tested here; upperlobe is tested for on inspection (as above)
apex beat
(discussed in cardiac section)
for respiratory diseases:
- can becaused by:
collapse of lower lobe
localized pulmonary fibrosis
- can becaused by:
pleural effusion
tension pneumothorax
is hyper expanded secondary to chronic airflowlimitation
vocal fremitus
palpate chest wall with palm of hand whilepatient repeats "99"
front and back of chest are each palpated in 2comparable positions with palms; in this waydifferences in vibration on chest wall can bedetected
causes of change in vocal fremitus are the sameas those for vocal resonance (see later)
ribs
gently compress chest wall anteroposteriorly andlaterally
localized pain suggests a rib fracture (may besecondary to trauma or spontaneous as a resultof tumor deposition or bone disease)
The Chest:percussion
with left hand on chest wall and fingers slightlyseparated and aligned with ribs, the middle
finger is pressed firmly against the chest; pad ofright middle finger is used to strike firmly themiddle phalanx of middle finger of left hand
percussion of symmetrical areas of:
posterior (back) (ask patient to move elbowsforward across the front of chest - this rotates thescapulae anteriorly, i.e. moves it out of the way)
percussion over a solid structure (e.g. liver,consolidated lung) produces a dull note
percussion over a fluid filled area (e.g. pleuraleffusion) produces an extremely dull (stony dull)note
percussion over the normal lung produces aresonant note
percussion over a hollow structure (e.g. bowel,pneumothorax) produces a hyperresonsant note
liver dullness:
percussing down the anterior chest in mid-clavicular line
llness is 6thrib in right mid-clavicular line
sign of hyperinflation usually due toemphysema, asthma
cardiac dullness:
usually present onleft side of chest
decrease in emphysema or asthma
The Chest: auscultation
breath sounds
introduction
one should use the diaphragm of stethoscope tolisten to breath sound in each area, comparing
each side
remember to listen high up into the axillae
remember to use bell of stethoscope to listen tolung from above the clavicles
quality of breath sounds
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normal breath sounds
chest, produced in airways rather than alveoli(although once they had been thought to arisefrom alveoli (vesicles) and are therefore called
vesicular sounds)
and longer on inspiration than on expiration; andthere is no gap between the inspiratory andexpiratory sounds
bronchial breath sounds
being filtered by the alveoli, and thereforeproduce a different quality; they are heard overthe trachea normally, but not over the lungs
there is a gap between inspiration and expiration
solid lung conducts the sound of turbulence inmain airways to peripheral areas withoutfiltering
- lung consolidation (lobar pneumonia) -common
- localized pulmonary fibrosis - uncommon
- pleural effusion (above the fluid) - uncommon
- collapsed lung (e.g. adjacent to a pleuraleffusion) - uncommon
large cavity have an exaggerated bronchialquality)
intensity of breath sounds
causes of reduced breath sounds include:
emphysema)
orax
added (adventitious) sounds
two types of added sounds: continuous(wheezes) and interrupted (crackles)
wheezes
both
- airway
narrowing
narrowing
- asthma (often high pitched) - due to musclespasm, mucosal edema, excessive secretions
- chronic airflow diseases - due to mucosaledema and excessive secretions
- carcinoma causing bronchial obstruction -
tends to cause a localized wheeze which ismonophonic and does not clear withcoughing
crackles
pitched crackles) and creptitations (highpitched crackles)
airways on expiration and sudden openingon inspiration
- suggests disease of small airways
- characteristic of chronic airflow limitation
- are only heard in early inspiration
- suggests disease confined to alveoli
- may be fine, medium or coarse
- fine crackles - typically caused bypulmonary fibrosis
- medium crackles - typically caused by leftventricular failure (due to presence ofalveolar fluid)
- coarse crackles - tend to change withcoughing; occur with any disease that leadsto retention of secretions; commonly occur
in bronchiectasis
pleural friction rub
surfaces rub together, a continuous orintermittent grating sound may be heard
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secondary to pulmonary infarction orpneumonia
vocal resonanance
gives information about lungs' ability to transmitsounds
consolidated lung tends to transmit highfrequencies so that speech heard throughstethoscope takes a bleeting quality(aegophony); when a patient with aegophonysays "bee" it sounds like "bay"
listen over each part of chest as patient says"99"; over consolidated lung, the numbers will
become clearly audible; over normal lung, the
sound is muffled
whispering pectoriloquy - vocal resonance isincreased to such an extent that whisperedspeech is distinctly heard
The Heart
lay patient at 45 degrees
measure jugular venous pulse for right heartfailure
examine pericardium; pay close attention topulmonary component of P2 (which is bestheard at 2nd intercostals space on left) andshould not be louder than A2; if it is louder,suspect pulmonary hypertension
cor pulmonale (also called pulmonaryhypertensive heart disease) may be due to:
chronic airflow limitation (emphysema)pulmonary fibrosispulmonary thromboembolism
marked obesitysleep apneasevere kyphoscoliosisThe Abdomen
palpate liver for enlargement due to secondarydeposits of tumor from lung, or right heartfailure
Other
Permberton's sign
inspiratory stridor, and non-pulsatile elevation ofjugular venous pressure
cava obstruction
Feet
edema or cyanosis (clues of corpulmonale)
thrombosis
Respiratory rate on exercise and positioning
dyspnea should havetheir respiratory rate measured at rest, atmaximal tolerated exertion and supine
dyspnea is not accompanied by tachypneawhen a patient climbs stairs, one should considermalingering
abdomen during inspiration when patient issupine (indicating diaphragmatic paralysis)
Temperature: fever may accompany any acute orchronic chest infection
DIAGNOSTIC EVALUATION 1. Skin Test:Mantoux Test or Tuberculin Skin Test
infected or has been exposed to the TB bacillus.
PPD (Purified ProteinDerivatives).
intradermally usually inthe inner aspect of the lower forearm about 4inches below the elbow.
48 to 72 hours after injection.
(+) Mantoux Test is induration of10 mm ormore.
about 5 mm is considered positive
exposure to MycobacteriumTubercle bacilli
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2. Pulse Oximeter
-invasive method of continuouslymonitoring the oxygen saturation of hemoglobin
forehead, earlobe or bridge of the nose
2 sat levels bymonitoring light signals generated by theoximeter and reflected by the blood pulsingthrough the tissue at the probe
- 100%
- tissues are not receiving enough O2
vasoconstrictors
monoxide Level 3. Chest X-ray
-invasive procedure involvingthe use of x-rays with minimal radiation.
on cue to hold his breath and to do deepbreathing
remove metals from thechest.
out pregnancy first.
5. Computed Tomography (CT Scan) andMagnetic Resonance Imaging (MRI)
CT scan is a radiographic procedurethat utilizes x-ray machine.
MRI uses magnetic field to record theH+ density of the tissue.
It does NOT involve the use of radiation.
The contraindications for this procedure are the
following: patients with implanted pacemaker,patients with metallic hip prosthesis or othermetal implants in the body.
This chest CT scan shows a cross-section of aperson with bronchial cancer. The two darkareas are the lungs. The light areas within thelungs represent the cancer. Clear MRI images oflung airways during breathing. 6. Fluoroscopy
chest in motion
continuous observation of animage reflected on a screen when exposed toradiation in the manner of television screen that
is activated by an electrode beam.
the X-ray beam are visualized on the screen insilhouette
7. Indirect Bronchography
radiopaque medium is instilled directlyinto the trachea and the bronchi and the outlineof the entire bronchial tree or selected areas may
be visualized through x-ray.
anomalies of the bronchial treeand is important in the diagnosis ofbronchiectasis.
Nursing interventions BEFORE Bronchogram
sea foods or iodine oranesthesia
-op meds: atropine SO4 and valium,topical anesthesia sprayed; followed by localanesthetic injected into larynx. The nurse musthave oxygen and anti spasmodic agents ready.
Nursing interventions AFTER Bronchogram
-lying position
client
8. Bronchoscopy
direct inspection andobservation of the larynx, trachea and bronchithrough a flexible or rigid bronchoscope.
lighted bronchoscope into thebronchial tree for direct visualization of thetrachea and the tracheobronchial tree.
and collect specimen for biopsy
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surgically
tracheobronchial tree
obstructing the tracheobronchial tree
-operative atelectasis
Bronchoscopy
re to the patient, tell himwhat to expect, to help him cope with theunknown
Atropine (to diminish secretions) isadministered one hour before the procedure
Valium is given to sedate patient and allayanxiety.
Topical anesthesia is sprayed followedby local anesthesia injected into the larynx
NPO for 6-8 hours
lenses
supine withhyperextended neckduring the procedure
Bronchoscopy
Side lying position
with.
cough and gagreflex.
cyanosis, hypotension,tachycardia, arrhythmias, hemoptysis,and dyspnea. These signs and symptoms
indicate perforation of bronchial tree.Refer the patient immediately!
9. Lung Scan
a radioisotope, scans is taken with a scintillationcamera.
distribution and blood flow inthe lungs. (Measure blood perfusion)
Confirm pulmonary embolism or otherblood- flow abnormalities
procedure:
procedure
ed.
10. Sputum Examination
sputum: Gross appearance, Sputum C&S,AFB staining, and for Cytological examination/Papanicolaou examination
Early morning sputum specimen is to becollected (suctioning or expectoration)
plain water
sterile container.
beforethe first dose of anti-microbial therapy.
forthree consecutive mornings.
11. Biopsy of the Lungs
lung tissue
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- Transbronchoscopic biopsydone duringbronchoscopy,
- Percutaneous needle biopsy
- Open lung biopsy
procedure:
the patients chart.
Pneumothorax and air embolism
hemoptysis andhemorrhage
12. Lymph Node Biopsy
13. Pulmonary Function Test / Studies
-invasive test
diffusing capacity
chodilators or narcotics usedbefore testing
LUNG VOLUMES: (ITER) Inspiratoryreserve volume (3000 mL)
following a normal quiet inhalation.
Tidal volume (500 mL)
normal quiet breathing
Expiratory reserve volume (1100 mL)
following the normal quiet exhalation
Residual volume (1200 mL)
ains in the lungsafter forceful exhalation
LUNG CAPACITIES: Functional Residual
Capacity (ERV 1100 mL + RV 1200 mL =2300 mL )
after normal, quiet exhalation
Inspiratory Capacity (TV 500 mL + IRV 3000mL = 3500 mL)
maximally after a normal expiration
Vital capacity (IRV 3000 mL + TV 500 mL +
ERV 1100 mL = 4600 mL)
exhaled after a maximum inhalation
Total Lung Capacity (IRV 3000 mL + TV 500mL + ERV 1100 mL + RV 1200 mL = 5800 mL)
14. Arterial Blood Gas
re ableto provide adequate oxygen and remove CO2
able to reabsorb or excrete bicarbonate.
arterial blood for tissueoxygenation, ventilation, and acid-base status
rformed on areas wheregood pulses are palpable (radial, brachial, orfemoral). Radial artery is the most commonsite for withdrawal of blood specimen
10-ml. Pre-heparinized syringe toprevent clotting of specimen
container with ice toprevent hemolysis
Allenstest to assess for adequacy of collateralcirculation of the hand (the ulnar arteries)
15. Pulmonary Angiography
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-ray pictures of thepulmonary blood vessels (those in the lungs).
seen in an X-ray, a contrast material is injected
into one or more arteries or veins so that theycan be seen.
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16. Ventilation - Perfusion Scan
nuclear scan test that is performed to measurethe supply of blood through the lungs.
detect the location of the radioactive particles asblood flows through the lungs.
ability of air to reach all portions of the lungs.The perfusion scan measures the supply of bloodthrough the lungs.
performed to detect a pulmonary embolus. It isalso used to evaluate lung function in peoplewith advanced pulmonary disease such as COPD
and to detect the presence of shunts (abnormalcirculation) in the pulmonary blood vessels.
17. Thoracentesis
ocedure suing needle aspiration ofintrapleural fluid or air under local anesthesia
fluid
insertion of the needle
pressure sensation will befelt on insertion of needle
roper position:
Upright or sitting on the edge of the bed
Lying partially on the side, partially on theback
the patient on the affected side, asordered, for at least 1 hour to seal the puncturesite
unaffected side to preventleakage of fluid in the thoracic cavity
RESPIRATORY CARE MODALITIES 1.Oxygen Therapy
dry gas that supports combustion
21% oxygen from theenvironment in order to survive
Hypoxemia
o Increased pulse rate
o Rapid, shallow respiration and dyspnea
o Increased restlessness or lightheadedness
o Flaring of nares
o Substernal or intercostals retractions
o Cyanosis
Low flow oxygen provides partial oxygenationwith patient breathing a combination ofsupplemental oxygen and room air. Low-flowadministration devices:
o Nasal Cannula 24-45% 2-6 LPM
o Simple Face Mask 0-60% 5-8 LPM
o Partial Rebreathing Mask 60-90% 6-10 LPM
o Non-rebreathing Mask 95-100% 6-15 LPM
o Croupette
o Oxygen Tent
High flow oxygen provides all necessaryoxygenation, with patients breathing only
oxygen supplied from the mask and exhalingthrough a one-way vent. High flowadministration devices
o Venturi Mask 24-40% 4-10 LPM
provides accurate amount of oxygen.
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o Face Mask
o Oxygen Hood*
o Incubator / isolette*
Note: * can be used for both low and high flowadministration
checking nares, nose and applying gauze orcotton as necessary
COPD patients receive onlyLOW flow oxygen because these personsrespond to hypoxia, not increased CO levels.
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2. Tracheobronchial suctioning
semi or high Fowlersposition
sterile gloves, sterile suction catheter
Hyperventilate client with 100% oxygenbefore and after suctioning
-5 lengthof catheter insertion) without applying suction.Three passes of the catheter is the maximum,with 10 seconds per pass.
during withdrawal ofcatheter
than 120 mmHg
rotate whileapplying intermittent suction
take only 10 seconds(maximum of 15 seconds)
of the chest.
3. Bronchial Hygiene Measures
a. Steam inhalation
follows:
- to liquefy mucous secretions - to warm and
humidify air - to relieve edema of airways - tosoothe irritated airways - to administermedication
dependent nursing function
t and explain the purpose ofthe procedure
-Fowlers position
prevent irritation
surface.
1218 inches away from theclients nose or adjust distance as necessary
towel to prevent burns due to dripping ofcondensate from the steam. Assess for rednesson the side of the face which indicates firstdegree burns.
therapy for1520 minutes
and coughing exercises after the procedure tofacilitate expectoration of mucous secretions.
procedure.
-care of equipment.
b. Aerosol inhalation
bronchodilators or mucolytic-expectorants.
. c. Medimist inhalation
ministerbronchodilators or mucolytic-expectorants.
4. Chest Physiotherapy (CPT)
and vibration, and breathing retraining. Effectivecoughing is also an important component.
l secretions,improved ventilation, and increased efficiencyof respiratory muscles.
use gravity to assist in the removal of secretions.
percussion or vibration.eathing exercises and breathing retraining
improve ventilation and control of breathing anddecrease the work of breathing.
respiratory disorders like COPD, cystic fibrosis,lung abscess, and pneumonia. The therapy isbased on the fact that mucus can be knocked orshaken from airways and helped to drain fromthe lungs.Postural drainage
secretions.
promote flow of drainage from different lungsegments using gravity.
lung segments to promote drainage.
-15minutes depending on tolerability.
Percussion
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through the chest wall to the bronchi.
hands over the areas were secretions are located.
ne, kidneys,breast or incision and broken ribs. Areas shouldbe percussed for 1-2 minutes
Vibration
are placed on clients chest and gently but firmlyrapidly vibrate hands against thoracic wallespecially during clients exhalation.
stimulate cough.
-7 times duringpatient exhalation.Medical and Surgical Nursing RespiratorySystem Lecture Notes Prepared by: MarkFredderick R. Abejo RN,, MAN MS Abejo 13
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Suctioning
Nursing Interventions in CPT
secretions.
secretions by gravity
-10 to 15minutes
mucus secretions
hypotension
expectorate sputum
est done 60 to 90 minutesbefore meals or in the morning upon awakeningand at bedtime.
5. Incentive Spirometry
Types: volume and flow
Device ensures that a volume of air is inhaledand the patient takes deep breaths.
Used to prevent or treat atelectasis
To enhance deep inhalation
Nursing care
Positioning of patient, teach and encourageuse, set realistic goals for the patient, and recordthe results.
6. Closed Chest Drainage (ThoracostomyTube)
the mediastinum or pleural space into acollection chamber to help re-establish normalnegative pressure for lung re-expansion.
Purposes
uralspace
-expand the lungs
Procedure
chest wall at the level of 2nd to 3rd intercostalsspace to release air or in the fourth intercostalsspace to remove fluid.
Types of Bottle Drainage
One-bottle system
-seal
-3 cm of sterileNSS to create water-seal.
-3 feet below the level ofthe chest to allow drainage from the pleura bygravity.
heart to prevent reflux of air or fluid.
tube. The fluctuation synchronizes with therespiration.
continues bubbling means presence of air-leak
In the absence of fluctuation: Suspectobstruction of the device
allows the nurse to milk the tube)
-expansion; (validated by chest x-ray)
Two-bottle system
drainage bottle;
water-seal bottle
(water-seal bottle or the second bottle) andintermittent bubbling with each respiration.
NOTE! IF connected to suction apparatus
1. The first bottle is the drainage and water-sealbottle;
2. The second bottle is suction control bottle.
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3. Expect continuous bubbling in the suctioncontrol bottle;
4. Intermittent bubbling and fluctuation in thewater-seal
5. Immerse tip of the tube in the first bottle in 2to 3 cm of sterile NSS
6. Immerse the tube of the suction control bottlein 10 to 20 cm of sterile NSS to stabilize thenormal negative pressure in the lungs.
7. This protects the pleura from trauma if thesuction pressure is inadvertently increased
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Three-bottle system
is the drainage bottle;
water seal bottle
suction control bottle.
intermittent bubbling andfluctuation with respiration in the water- seal
bottle
GENTLE bubbling in thesuction control bottle. These are the expectedobservations.
continuous bubbli ng
in the WATER seal bottle or if there isVIGOROUS bubbling in the suction control
bottle.
tthe observation at once. Never clamp the tubingunnecessarily.
If there is NO fluctuation in the water sealbottle, it may mean TWO things
lungs have expanded or thesystem is NOT functioning appropriately.
se refers theobservation to the physician, who will order foran X-ray to confirm the suspicion.
Important Nursing considerations
drainage:
ar basis
intervals
tube to prevent tension pneumothorax
What the nurse should do if:
continuous bubbling:
the chest for a few seconds.
bubbling in the water seal bottle stops,the leak is likely in the lungs,
bubbling continues, the leak isbetween the clamp and the bottle chamber.
Next, the nurse moves the clamp towards thebottle checking the bubbling in the water sealbottle.
clamp and the distal part including the bottle.
tent bubbling, it meansthat the drainage unit is leaking and the nursemust obtain another set.
the nurse temporarily kinks the tube and must
obtain a receptacle or container with sterilewater and immerse the tubing.
as replacement. She should NEVER CLAMP thetube for a longer time to avoid tension
pneumothorax.
out, the nurse obtains vaselinized gauze andcovers the stoma.
Removal of chest tubedone by physician
Petrolatum Gauze Suture removal kit Sterilegauze Adhesive tape
-Fowlers position
and do valsalva maneuver as the chest tube is
removed.
-ray may be done after the chest tubeis removed
emphysema; respiratory distress
7. Artificial Airway a. Oral airways- these areshorter and often have a larger lumen. They areused to prevent the tongue form falling
backward. b. Nasal airways- these are longerand have smaller lumen Which causes greater
airway resistance c. Tracheostomy- this is atemporary or permanent surgical opening in thetrachea. A tube is inserted to allow ventilationand removal of secretions. It is indicated foremergency airway access for many conditions.The nurse must maintain tracheostomy care
properly to prevent infection.
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