Question

1. You are caring for a 34-year-old patient who experienced blunt chest trauma in a motor vehicle crash. A chest tube was inserted to treat a simple pneumothorax and hemothorax. The chest drainage system has drained 400ml of light red fluid during the 1^st 6 hours after insertion. The patient has become increasingly short of breath during the past hour.. What physical assessment skills and strategies would you use to determine potential changes in the patient’s respiratory condition? What are potential causes of this increasing shortness of breath? What would you do to prepare for an emergency situation in this patient?

2. Consider the scenario and answer the following questions.  Case Study: Community Acquired Pneumonia

Teresa, a 20 year old college student, lives in a small dormitory with 30 other students. Four weeks after start of classes, she was diagnosed as having bacterial pneumonia and was admitted to the hospital.

• What intervention can the nurse provide to decrease the viscosity of secretions?
• The nurse is assessing Teresa during the admission process. What manifestations of bacterial pneumonia does the nurse expect to find?
• The nurse assesses Teresa for arterial hypoxemia. What does the nurse understand is the reason why this complication develops?
• The nurse is assessing vital signs and lung sounds every 4 hours. What complications should the nurse monitor for?

Answer 1

1.The physical assessments skills and strategies which has to be used as the baseline and provide preventative care are

• Monitoring the vital signs especially the respiratory rate and the oxygen saturation can identify the basic cause for shortness of breath
• Assess the chest tube site for any pain, bleeding ,discharge , dislodgement
• Oxygen administration and maintenance

The potential cause of shortness of breath can be due to increased chest drainage .

The emergency preparation required to be done here are

• Emergency trolley with medication at ready to use condition
• Equipment required to clamp and remove the drainage as there is excessive drainage (normal 150-200ml/day)
• Ensure rapid response team is available

2.The interventions which can be provided by the nurse to reduce the viscosity of the secretions are

• Administration of antibiotics to treat infection
• Administration of mucolytics to thin out the secretions and expel it
• Chest physiotherapy can be used to mobilise the secretions out of the respiratory tract

The manifestation which can be expected to be found on the patient are

• Respiratory system : short of breath ,cough with secretions
• Increased body temperature due to infection
• Generalized weakness or fatigue
• Increased heart rate and respiratory rate

The arterial hypocrisy in the patient can be probably because of vasoconstriction in the pulmonary and leading to intrapulmonary shunt. This increases the level of carbon dioxide and decrease the level of oxygen in the blood .

The complications which the nurse has to monitor for are

• Pleural effusion
• Abscess in the lungs
• Bacteremia or sepsis
• Emphysema
• Acute respiratory distress syndrome
• Cardiac failure