Respiratory System Procedures

Respiratory System ProceduresCarol Bailey, MSN, RNIntroduction Task Process Evaluation Conclusion attributeIntroductionYou are a harbour working in a PCU. Your clinical unit specializes in the deal of uncomplainings who are undergoing treatment for pulmonary disease. You very much provide care and diligent teaching for unhurrieds having tests and procedures for pulmonary conditions.Your assignment today includes providing care and education support for 2 long-sufferings.You have a student nurse observing in your unit today. As you teach, please be sure to include rationales and answer the students questions.The Task forbearing 1Mr. capital of Minnesota Monary, a 58 year old farmer, was admitted to your unit with complaint of progressive hoarseness, difficulty in swallowing, and loss of appetite over the past 3 months.The medical exam plan of care involves chemotherapy and radiation therapy. He will need a tracheostomy prior to beginning therapies.Objective dataHe smok es 1 bundle up of cigarettes per day.His weight has decreased from 200 pounds to 180 pounds over the past 3 months.The results of a CT scan and MRI reveal that this patient has throat cancer. inbred dataThe doctor said I would have a tracheostomy, but I usurpt really know what that means for me. I dont know how I am going to manage my farm if I have to have surgery.The nursing diagnosis you must address is association deficit related to lack of information regarding care of a tracheostomy as evidenced by patients verbal response. patient of 2Ms. Flora Vack, a 25 year old female, is a bull rider in the Riding Stars Rodeo that is currently performing at the Civic Center. She was impel from a bull in last nights performance and received repeated kicks to her left posterior government agency. She was seen in the emergency room and admitted for line up care.Her bosom X-ray reveals a large pleura effusion on the left. You are assigned to prepare the patient for a thoracentesis.Outc ome You assist with the thoracentesis. 1,500 ml of pink tinged pleural fluid is removed. The patient experiences a pneumothorax following the procedure and a chest electron tube is inserted and connected to an atrium ocean chest tube drain.You are assigned to prepare the patient for chest tube creation and to manage the chest tubes after the procedure.The ProcessTo accomplish the task, you will review information from the connect provided for each patient to fill in the birth control pillle below.Patient 1 Linkshttp//www.youtube.com/ put on?v=DoSTehS7iq8http//www.youtube.com/watch?v=Lo74zm3ULykTracheostomy regular manual of arms approachhttp//www.youtube.com/watch?v=6TVOSb6sqL8feature=relatedTracheostomy percutaneous insertionhttp//www.youtube.com/watch?v=SloXwGG2n-QTracheostomy percutaneous view from inside the tracheahttp//www.youtube.com/watch?v=PhasybkUrzkfeature=relatedLaryngoscopy (this mavin was just cool)http//www.youtube.com/watch?v=iYpDwhpILkQfeature=relatedeffects of locoweedhttp//www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_ skunk/ effects all organs of the corpsehttp//www.tobaccofreekids.org/research/factsheets/pdf/0264.pdfimmediate effectshttp//www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Smoking_effects_on_your_bodyhttp//www.quitsmoking.com/content/how-smoking-affects-your-bodytrach carehttp//www.youtube.com/watch?v=Wimw7bz0fLofeature=relatedsuctioning trachhttp//www.youtube.com/watch?v=UVuPzhOWxRsfeature=relatedcleaning intercannula and trach dresshttp//www.youtube.com/watch?v=ivUKHnnTKb4feature=relatedfenestrated trach tubehttp//www.youtube.com/watch?v=RzYPp5h_vx8feature=relatedpassey-muir speaking valvehttp//www.hopkinsmedicine.org/tracheostomy/living/passey-muir_valve.htmlhttp//www.passy-muir.com/video_pageBottom of FormClick on Videos at the top of the stand page.CEUs Videos News and Events FAQs Contact Us InternationalThen under Passy-Muir Animations There is a play list with 6 vi deos. View all videos except for the one on mechanical ventilation.Patient 2 Linksthoracentesis demo on real patienthttp//www.youtube.com/watch?v=noDxydboLrAfeature=relatedchest tube insertionhttp//www.youtube.com/watch?v=424M8L5Z_EQhttp//www.youtube.com/watch?v=A_0K8o98SPwhttp//www.atriummed.com/EN/chest_ drainage/education.aspReview Managing chest drainage ppt presentation for nursing educators (note this ppt includes nursing sound judgment)Under the Product support tab Along the left column under Traditional flowage click on Ocean Under education resources click on Set up and Operation video. Next click on Oasis, then pneumostat section. The videos on ocean, oasis, and pneumostat are interesting and helpful to understand the dish and sagacity of a chest tube drainage systemhttp//www.atriumu.com/ Click on the Learning tabChest drainage 101 chapter 1 4 and Managing chest drainage incision 1-6 are excellent resources of education developed by Atrium a common brand of chest drainage systemaking chest tube out / closing with a suturehttp//www.youtube.com/watch?v=4GTecWv5h6cfeature=relatedNursing Assessment of the patient with a chest tube.Patient 1 Mr. capital of Minnesota MonaryNANDA Knowledge deficit r/t lack of information regarding care of a tracheostomy AEB by patients verbal response.Client outcomes Patient willDescribe what a tracheostomy is and why it is neededDescribe the excogitation of suctioningDemonstrate c breeding of the innercannula and trach dressingIdentify the effects on cigarette smoking on his current state of healthList safety precautions in the use of the Passey-Muir valveNote Respond to the patients questions using terminology the patient can understand. Respond to the pupil nurses questions using professional terminology.Patient teaching justify to this patient what a tracheostomy is and why it is necessary for him while having radiation therapyPatient teaching explain to this patient the purpose of suctioning the trach and how it is accomplished. (explain the in-hospital sterile procedure in your own works as if you were telling the patient all the steps you are taking and why)Patient teaching explain to this patient how the nurse will clean the innercannula and why it is done (in-hospital sterile procedure)Patient teaching explain to this patient, the effect of smoking on the lungs and on oxygenationPatient teaching explain to this patient, the effect of smoking on the body.Patient teaching explain to this patient how the passey-muir valve works and list safety precautions respond the student nurses questions how does the percutaneous insertion of the trach differ from the regular manual insertion? state the student nurses questions How is a fenestrated trach tube different from a regular tube? Is there whatever potential complications with the fenestrated tube?List 3 additional Nursing Diagnosis (in 3 pop format) appropriate for Mr. Monary1. 2.3.Note must list actual nursing diagnosis in 3 part format not at risk forPatient 2Ms. Flora VackRespond to the patients questions (using terminology the patient can understand)Respond to the Student nurses questions (using professional terminology.Patient question What is a thoracentesis?A thoracentesis is when a needle is inserted through your chest wall and then into the pleural dummy (Lewis, 2014). The pleural space is the thin, but large lining of tissue that surrounds your lungs and lines your chest cavity (Lewis, 2014). We do this to take samples to perform some diagnostic testing, remove profusion fluid or air and give medications directly to the pleural space (Lewis, 2014). In your situation we are using a thoracentesis to drain the fluid buildup from your lungs by inserting the large needle and letting it drain out (Thoracentesis to remove 1200cc of pleural Fluid at Harborview).Answering the student nurses questions How do you ready the patient for a thoracentesis?What do I do to assist the doctor during this procedure ?You need to position the patient with their elbows on over the bedside adjustable table, sit in the upright position (Thoracentesis to remove 1200cc of Pleural Fluid at Harborview). Their feet should be supported and you can place a pillow across their paunch for additional support (Thoracentesis to remove 1200cc of Pleural Fluid at Harborview).During a thoracentesis the nurse will assist the doctor by supporting the patient throughout the procedure and answering any questions she may have (Thoracentesis to remove 1200cc of Pleural Fluid at Harborview). Throughout the procedure you will need to ask assessment questions to determine how the patient is tolerating the procedure and to facilitate any alterations in body position, such as resting their head during the procedure if they feel light headed (Thoracentesis to remove 1200cc of Pleural Fluid at Harborview). You will also monitor vital signs throughout the procedure (Lewis, 2014). Also, make sure you ensure the patient is pr operly oxygenated by administering any supplemental oxygen that may be necessary (Lewis, 2014). After the procedure you will need to make sure you apply a sterile dressing to the puncture site (Lewis, 2014)Patient question What is the purpose of a chest tube and drainage system?The purpose of a chest tube and drainage system is to drain the air or gas that has built up in the area around your lungs due to your pneumothorax (Chest thermionic vacuum tube Insertion part 1/2). The space around your lungs is known as the pleural space (Chest Tube Insertion part 1/2). This is the lining of tissue that surrounds your lungs and lines your chest cavity (Chest Tube Insertion part 1/2). This reestablishes negative pressure in your lungs which allows your lungs to expand properly (Lewis, 2014).Answering the student nurses questions What is the underwater seal of a chest drainage system and how does it work?The underwater seal of a chest drainage system is what allows the air or fluid to leave the pleural space but also prevents the backflow of air or fluid back into the pleural cavity (Chest Tube Insertion part 2/2). The behavior the underwater seal works is that is contains about 2 cm of water and when the air or gas enters up, or bubbles, through the water it acts as a one way valve (Lewis, 2014).Answering the student nurses questions When do I expect to see bubbles in the underwater seal section of the chest tube drainage system? (what circumstances will cause bubbling in this chamber)Answering the student nurses questions The atrium pleura drain uses the same concepts at the 3 bottle system of chest tube bottles. What is the main function of each of the bottles?Bottle 1 =Bottle 2 =Bottle 3 =Answering the student nurses questions What should I include in the assessment and care of a patient who has a chest tube? (include assessment of the patient as well as the drainage system)Answering the student nurses questions Describe to the student nurse how the chest tube wil l be removed, how the nurse will assist, and observation and care of the site.EvaluationYour grade for this exercise will be 2% of your grade for this course. Grading will use the burnish below. Maximum points = 36. This webquest is due to be submitted by 100 PM, October 17, 2014.Learning ObjectivesBeginning1 pointDeveloping2 pointsAccomplished3 pointsScoreDescribes the purpose of a tracheostomy including the difference in the midst of a regular tube and a fenestrated tubeResponse reflects restrain companionship of this objectiveLimited reportEffectively explains the purpose of a tracheostomy and the fenestrated tubeExplains the purpose and steps of trach suctioning and cleaning of the inner cannulaResponse reflects limited friendship of this objectiveLimited expositionEffectively explains trach suctioning and cleaning of the inner cannula using terms appropriate for patient educationIdentifies the effects of smoking on the respiratory systemResponse reflects limited knowledg e of this objectiveIdentifies only 3 smoking risks on the respiratory system (lungs)Explains effectively to the patient the effect smoking has on their lungs.Identifies the effects of smoking on the bodyResponse reflects limited knowledge of this objectiveIdentifies only 3 smoking risks to the bodyExplains effectively to the patient the effect smoking has on their body.Explains the purpose of the passey-muir valve and how it works.Response reflects limited knowledge of this objectiveLimited explanationEffectively explains purpose of a passey-muir valve and how it works using terms appropriate for patient educationIdentifies safety precautions for use of a passey-muir valve.Response reflects limited knowledge of this objectiveIdentifies only 3 safety precautionsExplains safety precautions effectively to the patient.Critiques the difference between the surgical insertion and the percutaneous insertion of the tracheostomy tubeResponse reflects limited knowledge of this objectiveLimited explanationClearly critiques the difference in the 2 insertion techniques for tracheostomy insertion.Identifies 3 actual nursing diagnosis using the 3 part format (diagnosis / related to / AEB)Response reflects limited knowledge of this objectiveNursing diagnoses do not include pertinent diagnoses or format is not followedIdentifies 3 actual nursing diagnosis pertinent to this patient in proper formatDescribes the procedure, performing a thoracentesisResponse reflects limited knowledge of this objectiveLimitedExplains the procedure effectively including patient positioningRecognizes rule versus abnormal function of the chest tube systemResponse reflects limited knowledge of this objectiveLimited explanationRecognizes which chambers bubbling may amount and what that meansDescribes the function of the 3 bottle chest tube systemResponse reflects limited knowledge of this objectiveLimited explanationFully explains the function of each of the 3 bottlesDemonstrates knowledge in the car e of the patient with a chest tube drain and chest tube removal.Response reflects limited knowledge of this objectiveLimited explanationExplains effectively to the student nurse, how to care for a chest tube drain, including assessment of the patientConclusionThis WebQuest will support learning and application of materials covered in Lewis, Chapters 26, 27, and 28. I hope you found the exercise to be a fun, interesting way to learn.In addition to Web links, you may use your NANDA and Lewis books as needed to support your answers.You must cite references for your answers using APA format. Credits ReferencesAckley, B. J. Ladwig, G. B. (2008). Nursing diagnosis handbook A guide to planning care (8th ed.). St. Louis, MO Mosby-ElsevierAtrium Chest Drainage Education. www.atriummed.com/Products/Chest_Drains/education.aspChest Tube Insertion part 1/2. (2012, July 13). Retrieved March 11, 2015, from https//www.youtube.com/watch?v=424M8L5Z_EQChest Tube Insertion part 2/2. (2012, July 13). Retrieved March 11, 2015, from https//www.youtube.com/watch?v=424M8L5Z_EQLewis, S.M., Heitkemper, M.M., Dirksen, S.R., OBrien, P.G., Giddens, J.F, Bucher, L. (2007). Medical-surgical nursing Assessment and management of clinical problems (8th ed.). St.Louis Mosby-Elsevier.Lewis, S. M., Dirksen, S. R. (2014). Medical-surgical nursing assessment and management of clinical problems (Ninth ed.). St. Louis Elsevier.Ocean Drain Education Video. (n.d.). Retrieved March 11, 2015, from http//www.atriummed.com/EN/chest_drainage/edu-files/ocean-video1.aspThoracentesis to remove 1200cc of Pleural Fluid at Harborview. (2007, November 2). Retrieved March 11, 2015, from https//www.youtube.com/watch?v=noDxydboLrAfeature=relatedBased on a pathfinder from The WebQuest Page