what are the focus assessments for Gill
- neuro
- resp
- circulatory
what is a pneumothorax
build up of air in the pleural space causing a partial or complete collapse of lungs
what is the difference of open and closed pneumothorax
open: open wound so air can go in and out due to open injury like stabbing or gunshot wound
closed: no open wound air enters from inside the body like blunt trauma, spontaneous collapse, or broken rib puncturing lung
what are the risk factors for pneumothorax
- genetics
- previous hx of pneumothorax could put u at risk for another one
- smoking causes damage to the lungs
what are the s/s of pneumothorax
- chest pain
- SOB
- absent breath sounds on one side
- low SPO2
- tachypnea
what are complications of pneumothorax
tension pneumothorax air enters pleural space but can’t leave increasing pressure
NI
- needle decompression
- chest tube
air leak constant bubbling in the water seal chamber
NI
- site to source from patient to, drainage unit, to wall
resp failure due to poor O2 levels
NI
- O2 therapy
- medical ventilation
how is a pneumothorax diagnosed
- chest x-ray shows the lungs and the placement of air within the pleural space
- CT scan to get a more detailed picture
- physical assessment absent breath sounds on one side of the chest when auscultating
how often is a chest tube dressing changed
- Q3D / 72 hours
or before if needed
what is the LPN role in chest tubes
- LPN’s can only monitor and reinforce dressings
what is inside a chest tube safety kit
- gloves
- sterile water
- 2 smooth edged forceps
- 2 sterile 4x4 gauze
- occlusive dressing
what are the nursing considerations for chest tube
- ensure it is below chest level
- site to source
- ax site for bruising or SC emphysema (air under the skin)
- ax for resps
what is the difference of blunt trauma and penetrating trauma
blunt trauma: injury caused by forceful impact without breaking the skin like a fall or fight
penetrating trauma: something breaks through the skin like knife or bullet
what is hepatitis C
viral infection of the liver that causes inflammation leads to liver damage, scaring (fibrosis), and cirrhosis
how is hepatitis C contracted
coming into contact with a affected persons blood, blood to blood
- sharing needles
- needle stick injures at work
- mother to fetus during birth/pregnancy
what are the s/s for hepatitis C
- flu like symptoms
- fatigue
- asymptomatic (followed by the chronic stage)
- jaundice
- abdominal pain
- bruising and bleeding easily
what are the diagnostic tests for hepatitis C
- liver biopsy to see if it the virus or smt else
- magnetic resonance elastography imaging of the liver to assess for stiffness, stiff liver means scaring
- liver function tests, elevated ALT, AST shows damaged liver
- HCV antibody: assesses for hepatitis antibodies
- PCR detects active hepatitis in the body
what are the tx for hep C
- vaccination for hep A and B they can worsen symptoms
- antiviral medication clears body of infection goal is within 12 weeks (direct acting antiviral)
- liver transplant
what are the nursing considerations for hepatitis C
- wear correct PPE if coming into contact with blood like gloves, gown and mask/face shield
- be extra cautious when dealing with needles or blood contact of a hep C patient
- educate patient on not sharing needles or personal belongings to prevent spreading the virus
- monitor liver function tests (AST, ALT, bilirubin) elevates signs indicate liver damage
- monitor for liver dysfunction
abdominal pain
jaundice
elevated liver enzymes
confusion
how does hepatitis relate to alcoholism
both conditions cause damage to the liver over time It increases inflammation, scaring which leads to low blood flow to liver, cirrhosis and liver failure.
How do you assess that your patient is drinking well?
- check the fluid in’s and out sheet
- moist mucous membranes
- patient tolerates fluids well (no N/V)
- good urine output
when can a chest tube be removed
- lung has fully re-expanded
- minimal to no drainage
- no air leaks
- improved respirations
During your assessment your client reports SOB. You hear decreased air entry to his left lung. What do you think is happening? What are your nursing interventions
- tension pneumothorax
NI
- ABC’s
- ax for tension pneumothorax (tracheal shift, cyanosis, chest pain, hypotension)
- put patient in high fowlers and administer O2
- get vitals and monitor SPO2, BP
- notify physician
what medications would Gill be on
direct acting antiviral medication to prevent the growth of the virus
- ledipasvir
- sofosbuvir
low dose of acetaminophen
- no NSAID’s if liver function is poor
purpose of IV fluids
to deliver medication, fluids, nutrients, directly into bloodstream giving rapid effect
