Page 43 - Critical Care Nursing Demystified

28 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

1. Decreased or absent fremitus is caused by excess air in the lungs and suggestive
of emphysema, pleural thickening or effusion, pulmonary edema, or bronchial ob-
struction. Increased fremitus suggests lung consolidation caused by pneumonia,
lung compression, tumor, or fibrosis.

2. Palpation that produces audible crackling or crepitus indicates subcutaneous
emphysema in which fine beads of air are trapped under the skin. It is caused by

fractured ribs that pierce the lungs and allow air to leak into the subcutaneous tis-
sues or by air leaking from the lung into sutures from chest tube insertion sites.

NURSING ALERT

Increasing stridor or rapidly decreasing stridor with worsening signs of respiratory
distress can indicate that a complete airways occlusion is imminent. The nurse should
attempt to identify and relieve the obstruction. If unsuccessful, a rapid response
should be initiated so help can be obtained right away.

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2 Diagnostic procedures are performed to assess and detect the presence and
severity of disease in the pulmonary system. Chest x-rays, sputum cultures, and
arterial blood gases usually do not require a separate special consent form. The
more invasive diagnostic tests like lung scans, bronchoscopy, and thoracentesis
require that the performing practitioner explain the risks, benefits, and compli-
cations to the patient, and a consent for the procedure is usually required. Vital
signs before and after such procedures as well as a thorough pulmonary assess-
ment should be performed.
The following are common diagnostic procedures.

1. Chest x-ray
This is an essential noninvasive diagnostic tool for evaluating respiratory
disorders, infiltration, and abnormal lung shadows, as well as identifying
foreign bodies. Chest x-rays in critical care settings are also used to check
and monitor the effectiveness and placement of tubes and lines such as an
endotracheal tubes, chest tubes, and pulmonary artery lines.
Normal lung fields appear black because they are air-filled spaces. Thin,
wispy white streaks are seen as vascular markings. Blood vessels can also
appear gray. However, grayness in the lung fields usually suggests pleural
effusion. Light white areas indicate fluid, blood, or exudate.