Monday, October 12, 2009

For what cause of tension pneumothorax should a nurse check?

A. Infection of the lung
B. Kinked or obstructed chest tube
C. Excessive water in thewater-seal chamber
D. Excessive chest tube drainage
Tension Pneumothorax may be caused by any of the resons mentined by you. But more often it is because of INFECTION OF LUNG only. a check up by a nurse is not sufficiant and you should consult a specialist and have full treatment. Tension Pneumothorax is a series thing and should not be neglected. In medicine (pulmonology), a pneumothorax or collapsed lung is a medical emergency caused by the collapse of the lung within the pleural cavity.It can result from:
A penetrating chest wound
Barotrauma to the lungs
Spontaneously (most commonly in tall, slim young males)
Chronic lung pathologies including emphysema, asthma
Acute infections
Chronic infections, such as tuberculosis
Catamenial pneumothorax (due to endometriosis in the chest cavity) Pneumothoraces are divided into TENSION and non-tension PNEUMATHORACES. A tension pneumathorax is a medical emergency as air accumulates in the pleural space with each breath. The remorseless increase in intrathoracic pressure results in massive shifts of the mediastinum away from the affected lung compressing intrathoracic vessels. A non-tension pneumothorax by contrast is a less severe pathology because the air in the pneumothorax is able to escape.The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the problem, creating a pneumohemothorax.
tension pneumothorax is the complete colapse of the lung where air fills the chest cavity with every breath. it could be caused by any of the above choices if it's not from trauma (knife wound).
Looks like a test Q to me..
The best answer is
B. Kinked/obstructed chest tube.If the chest tube is not working, then that thoracostomy that the chest tube goes through makes a perfect one-way valve for air to go into the pleural space and not come out.On a side note, the most common cause of tension pneumothorax is a penetrating injury to the chest. What are you doing when you put in a chest tube? You're making a penetrating injury to the chest.The other answers aren't so good.
A. Infection
I guess this could conceivably result in a tension pneumo, but is extremely unlikely. It also wouldn't be something a nurse would be checking for on the floor. If it were to happen, it would be diagnosed when the patient was brought into the emergency room.C. Excessive water in the water-seal chamber
I'm not an expert on chest tubes. I guess if there was excessive water in the water-seal chamber, it would make it more difficult for air to bubble through (not sure--need to sit down and tinker with a PleuroVac one of these days). Chest tube collectors nowadays all have positive pressure vents though, so I don't think it's possible for that to be a problem.D. Excessive chest tube drainage
As long as it's draining, I don't think there should be a problem. The whole reason for putting the chest tube there is to evacuate the pleural space. If there is "excessive" drainage, what exactly are you going to do differently? Nothing--you're going to leave the chest tube there until it stops draining.
B is the right answer. the last person said infection is what causes a tension pneumo and that is wrong. Tension pneumos happen most often because of trauma. Air leaks out from the damaged lung into the pleural space and begins to take up space in the chest cavity, leaving less room for the lung to expand. The air is trapped and can't escape, and building pressure inside the chest constricts blood vessles and the heart. Clinically you will find it harder to ventilate the patient (harder to bag or increased peak pressures on the vent, decreased tidal volumes), decreased O2 sats, increased heart rate (to try to compensate for the fact that the heart can't pump as much blood, it pumps faster), and a narrowing pulse pressure (systolic and diastolic are similar numbers). The air needs to escape from the chest to fix these things or the patient will die, so you'd better make sure your chest tube is not kinked off or obstructed! By the way, nurses (and medics) are able to identify and fix tension pneumos. We are not idiots. We may not be able to put in chest tubes, but we can needle a chest in an emergency situation when doctors are not available. Ask any nurse who'se taken Trauma Nursing Core Course, or any nurse anesthetist, flight nurse, or medic and they'll tell you all about it.

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