Page 91 - Critical Care Nursing Demystified

76 CRITICAL CARE NURSING DeMYSTIFIED

e. Observing that the water seal has no bubbling if there is no pneumothorax.
Bubbling in the water seal when there is no pneumothorax could indicate
a leak in the system or in the patient.
f. Checking and maintaining the depth of the water if a suction control cham-
ber is included with the unit. Some systems have dry suction where a suction
control chamber is absent.
g. Keeping a petroleum gauze dressing and shodded clamps at the bedside
in case of accidental disconnection and troubleshooting.

Lung Cancer/Surgery

What Went Wrong?
Lung cancer is one of the most malignant and lethal of all cancers. Cancer
patients with this condition may be admitted to the intensive care unit on a
ventilator due to ARF or after lung surgeries. Lung surgery is also done to
remove diseased portions of a lung (wedge resection, segmental resection) or
the entire lung (pneumonectomy) (see Table 2–10). Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.

Prognosis
Prognosis is good if lung cancers are found early, but many times, since alveoli
have no pain receptors, cancers can become very advanced before the patient
exhibits symptoms.

TABLE 2–10 Types of Lung Surgeries
Laser surgery A palliative measure used to shrink a tumor that is press-
ing on a vital structure or that is not operable.
Wedge resection Small area near the lung surface removed using stapling
devices. Generally well tolerated as it is usually a small area.
Segmental One or more segments of the lungs are removed (a bron-
resection chiole and its alveoli). Remaining lung tissue expands and
fills this potential space.
Lobectomy Entire lobe of the lung is removed through a thoracotomy.
Pneumonectomy Removal of the entire lung. Chest tube not usually pres-
ent. No lung to reexpand. Empty side to fill in with exu-
date so tracheal shift will not occur. Balloons or implants
can be used to prevent shifting.