Page 133 - Critical Care Notes

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■ Patient may need chest tube or thoracostomy needle aspiration.
■ Provide routine nursing care related to chest tubes (refer to section on
Chest Tubes). Avoid connecting chest tube to wall suction. Chest tube is
connected to gravity drainage only.
■ Assess for signs and symptoms: neck vein distention, ↑ HR, ↑ RR, dyspnea,
trachea displaced to one side.
■ Note that remaining lung needs 2–4 days to adjust to increased blood flow.
■ Monitor fluid and electrolyte balance to prevent fluid overload (e.g., crack-
les, increased HR, increased BP, dyspnea). Administer IV fluids with caution
to prevent fluid overload and pulmonary edema.
■ Provide O 2 therapy. Mechanical ventilation may be needed; monitor level of
oxygenation. Administer pulmonary function tests, such as forced expiratory
volume (volume of air patient can forcibly exhale after a full inspiration).
Monitor respiratory and oxygenation status.
■ Encourage coughing, deep breathing, and splinting.
■ Elevate head of bed 30°–45°.
■ Administer analgesia as needed.
■ Monitor ECG to detect cardiac arrhythmias, especially atrial arrhythmias.
■ Monitor vital signs to detect hypotension.
■ Monitor for pulmonary edema and subcutaneous emphysema.
Complications of Pneumonectomy
■ Atelectasis, pneumonia, tension pneumothorax, empyema, bronchopleural
fistula (increased temperature, cough, increased WBC, anorexia, purulent
sputum)
■ Excessive blood loss, hemorrhage
■ Respiratory distress and pulmonary edema
■ Cardiac dysrhythmias and hypotension
Chest Tubes
A chest tube is inserted into the pleural space to reestablish negative intrapleural
pressure or to remove air, fluid, or blood. It is inserted after cardiac surgery, if
needed, and to treat pneumothorax, hemothorax, empyema, or pleural effusion.
It may also be used for intrapleural administration of chemotherapeutic agents or
a mechanical agent (talc slurry).
A mediastinal tube is inserted into the mediastinal space to provide fluid and
bloody drainage after cardiac surgery to prevent tamponade. It is managed the
same as a chest tube.
A three-chamber water system or dry suction (waterless) is generally used.
■ Three-chamber system has water seal, drainage, and suction chambers.
■ Dry suction has only water seal and drainage chambers. Can provide higher
levels of suction, easier to set up and manage, quiet, and absence of water
evaporation.
RESP