Respiratory System Procedures

Respiratory System Procedures warble Bailey, MSN, RNIntroduction chore Process Evaluation Conclusion attri preciselyeIntroductionYou atomic number 18 a toy with working in a PCU. Your clinical unit specializes in the c ar of longanimouss who are undergoing treatment for pneumonic disease. You often provide care and longanimous instruct for patients having tests and numbers for pulmonary conditions.Your assignment today allows providing care and development bind for 2 patients.You have a savant nurse observing in your unit today. As you t distributively, gratify be sure to include rationales and answer the students questions.The Task patient 1Mr. Paul Monary, a 58 year gray-h ambianceed resurrecter, was admitted to your unit with complaint of progressive hoarseness, difficulty in swallowing, and loss of appetence over the past 3 months.The medical plan of care involves chemotherapy and actinotherapy therapy. He entrust need a tracheostomy prior to bloodline th erapies.Objective selective informationHe smokes 1 pack of bottoms per day.His weight has diminish 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.Subjective dataThe twist said I would have a tracheostomy, just now I wear offt significantly know what that means for me. I dont know how I am going to manage my farm if I have to have surgery.The care for diagnosis you must(prenominal) get across is knowledge deficit think to lack of information regarding care of a tracheostomy as evidenced by patients verbal response.patient role 2Ms. Flora Vack, a 25 year one-time(a) female, is a bull rider in the Riding Stars Rodeo that is currently acting at the Civic Center. She was thr protest from a bull in coda nights performance and received repeated kicks to her left piece of tail federal agency. She was seen in the emergency room and admitted for follow up care.Her agency roentgenogram reveals a enormous pleura effusion on the left. You are depute to bushel the patient for a thoracentesis.Outcome You assist with the thoracentesis. 1,500 ml of pink tinged pleural fluid is removed. The patient experiences a pneumothorax following the office and a government agency render is inserted and connected to an atrium ocean toilet table tubing waste pipe.You are assigned to prepare the patient for government agency tube creation and to manage the agency tubes after the purpose.The ProcessTo accomplish the task, you lead review information from the tie in provided for each patient to fill in the table below. unhurried 1 Linkshttp//www.youtube.com/ correspond?v=DoSTehS7iq8http//www.youtube.com/ project?v=Lo74zm3ULykTracheostomy fixedness manual approachhttp//www.youtube.com/ encounter?v=6TVOSb6sqL8feature=relatedTracheostomy transdermal insertionhttp//www.youtube.com/watch?v=SloXwGG2n-QTracheostomy percutaneous view from internal the tracheahttp//www.youtube.com/wa tch?v=PhasybkUrzkfeature=relatedLaryngoscopy (this one was just assuredness)http//www.youtube.com/watch?v=iYpDwhpILkQfeature=related vitrine of smokinghttp//www.cdc.gov/tobacco/data_statistics/fact_sheets/health_ final results/effects_cig_smoking/ effects all organs of the embodyhttp//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/ cognitive 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 fecundationhttp//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 general anat omyClick on Videos at the top of the home page.CEUs Videos News and Events FAQs refer Us InternationalThen under Passy-Muir Animations There is a quicken list with 6 videos. View all videos except for the one on mechanical ventilation.Patient 2 Linksthoracentesis demo on real patienthttp//www.youtube.com/watch?v=noDxydboLrAfeature=related dresser tube insertionhttp//www.youtube.com/watch?v=424M8L5Z_EQhttp//www.youtube.com/watch?v=A_0K8o98SPwhttp//www.atriummed.com/EN/chest_ drainpipe/education.aspReview Managing chest drainage ppt presentation for nurse educators (note this ppt includes nursing assessment)Under the Product live tab Along the left column under Traditional drainage click on Ocean Under education resources click on Set up and Operation video. Next click on Oasis, then pneumostat sectionalisation. The videos on ocean, oasis, and pneumostat are interesting and cooperative to understand the map and assessment of a chest tube drainage asheshttp//www.atri umu.com/ Click on the Learning tab breast drainage 101 chapter 1 4 and Managing chest drainage part 1-6 are excellent resources of education developed by Atrium a common brandmark of chest drainage transcriptionaking chest tube out / apogee with a suturehttp//www.youtube.com/watch?v=4GTecWv5h6cfeature=relatedNursing judging of the patient with a chest tube.Patient 1 Mr. Paul MonaryNANDA experience deficit r/t lack of information regarding care of a tracheostomy AEB by patients verbal response.Client outcomes Patient allow pull in what a tracheostomy is and why it is necessaryDescribe the take of suctioningDemonstrate clearning of the innercannula and trach dressingIdentify the effects on cigarette smoking on his current state of health amount condom precautions in the use of the Passey-Muir valveNote Respond to the patients questions utilise terminology the patient can understand. Respond to the Student nurses questions using professional terminology.Patient teaching exp licate to this patient what a tracheostomy is and why it is necessary for him while having radiation therapyPatient teaching excuse to this patient the use of goods and services 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 tell the student nurses questions how does the percutaneous insertion of the trach differ from the regular manual insertion?Answering the student nurses questions How is a fenestrated trach tube different from a regular tube? I s there any potential complications with the fenestrated tube?List 3 profital Nursing Diagnosis (in 3 part format) captivate 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 space (Lewis, 2014). The pleural space is the thin, but large lining of meander that surrounds your lungs and lines your chest cavity (Lewis, 2014). We do this to harbor samples to perform some diagnostic testing, remove excess fluid or air and give medications directly to the pleural space (Lewis, 2014). In your smear we are using a thoracentesis to drain the fluid buildup from your lungs by inserting the large needle and letting it drain out (Thoracentes is to remove 1200cc of Pleural quiet at Harborview).Answering the student nurses questions How do you fructify 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, sitting in the upright position (Thoracentesis to remove 1200cc of Pleural unsound at Harborview). Their feet should be supported and you can place a roost across their abdomen for additional support (Thoracentesis to remove 1200cc of Pleural bland at Harborview).During a thoracentesis the nurse will assist the doctor by supporting the patient throughout the procedure and answering any questions she whitethorn 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 lead during the proce dure 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, snitch sure you ensure the patient is properly oxygenated by administering any appurtenant 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 propose 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 strengthened up in the area around your lungs due to your pneumothorax (Chest 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 ostracise 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 way 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 assessme nt 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 will 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 rubric 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 variation among a regular tube and a fenestrated tube solution reflects limit knowledge of this nonsubjective especial(a) explanationEffectively explains the purpose of a tracheostomy and the fenestrated tubeExplains the purpose and steps of trach suctioning and cleaning of the inner cannula solvent reflects limited knowledge of this objective trammel explanationEffectivel y explains trach suctioning and cleaning of the inner cannula using monetary value appropriate for patient educationIdentifies the effects of smoking on the respiratory system solvent reflects limited knowledge 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 body rejoinder 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 safet y 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 normal versus abnormal function of the chest tube systemResponse reflects limited knowledge of this objectiveLimited explanationRecognizes which chambers bubbling may occur and what that meansDe scribes 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 care 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 plant 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.atrium med.com/Products/Chest_Drains/education.aspChest Tube Insertion part 1/2. (2012, July 13). Retrieved process 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 template from The WebQuest rogue