Question

The client has been brought to the Emergency Room with a pleural effusion, complaining of shortness of breath, a dry irritating cough and chest wall pain 6/10. His vital signs are T 102.1 F, P 118, RR 32 and shallow, BP 142/82, SaO2 90% on RA. The provider has ordered a chest tube to be placed due to fluid collection in the pleural space.

• Compare and contrast spontaneous, iatrogenic and tension pneumothoraxes, including their etiologies, manifestations, and treatments.
• Describe 2 nursing interventions that could be provided to help maintain the chest tube and chest drainage system and provide rationale for each.
• The client calls out with shortness of breath. The chest tube has become disconnected from the drainage system and is now contaminated. Write a nurse’s note to describe the situation and what actions were taken to correct it.
• The provider orders Zosyn 3.375 gm to be infused every 6 hours. The pharmacy sends the ordered dose up in a 250 mL bag of NS. The provider orders the dose to be infused over 3 hours. What is the rate to be set on the IV pump? How many grams of Zosyn will the clientreceive each day?

Answer 1

pneumothorax : accumulation of air into the pleural space , which cause a rise in intrathoracic pressure and reduced vital capacity.

types

spontaneous pneumothorax

it is the sudden onset of collapsed lung occure with the rupture of a pulmonary bleb.

in most cases of spontaneous pneumothorax the cause is un known. risk factors include connective tissue disorder,smoking ,activities like scuba driving ,high aititudes and flying.

manifestations: commonly no severe symptoms , collapsed lungs cause sudden onset of sharp chest pain,shortness of breath. in severe case - chest tighhtness,easy fatigue,rapid heart rate, cyanosis of skin , nasal flaring, chest wall retractions.

treatment includes ; supplymental oxygen administration , chest tube insertion according to the severity.

iatrogenic pneumothorax

it is a traumatic pneumothorax that resuilt from injury to the pleura secondary to diagnostic or therapeutic medical intervention.

causes: complication of invasive procedure like pulmonary needle biopsy , placement of central venous line ,positive pressure ventilation.

symptoms - ipsilateral chest pain radiate to neck, back, shoulder, tachycardia, tachypnea ,dyspnea ,hypoxemia , ipsilateral decreased or absent of breath sound, hemodynamic instability.

treatment includes : suppliment oxygenaltion , needle aspiration , chest tube drainage.

tension pneumothorax

occure from a blunt chest injury from mechanical ventilation with high PEEP.

symptoms includes chest pain , shortness of breath, racing heart, followed by shock

treatment - immediate needle decompression ,supportive care

nursing intervention for maintaing chest drainage system

. keep chest tube drainage system lower than patient chest to prevent back flow fluid in to pieural space.

.observe for bubling to varify intrapleural location.

* if chest tube become disconnected , preffered technique is to place the end of the tube in sterile bottle of water. this reestablishes a water seal .

* order zosyn 3.375 gm 6 hrly

rate to be set in infusion pump to infuse 250 ml of medicine for 3 hrs =250 /3 =83.3 ml/hr

total dose of zosyn recieved by the patient in a day = 3.375x 4=13.5 gm