MS -7-Ricardo Mendoza - assignment PDF

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Simulation Admission Ticket

Session: NUR 201 Scenario: Lung Cancer/Postoperative Pain and Hypoxia MS-7-Ricardo Mendoza-Lung Cancer/Postoperative Pain and Hypoxia OBJECTIVES:  

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Date:

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Instructor:

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Admission Ticket Grade: Medication Card Grade: Average:

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Discuss current nursing research and its relationship to clinical practice with individual’s experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems (SLO- 2) Recognize and respect the individual’s and family’s cultural beliefs when providing nursing care. (SLO 3, 6) Apply knowledge from the health sciences and humanities in the care of adults experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems. (SLO – 1,2,) Demonstrate effective communication skills with individuals, families, peers, and other health care providers. (SLO – 3, 6) Develop, implement, and evaluate individualized teaching plans for individuals in acute and community based settings. (SLO -4, 5, 6) Collaborate with individuals, families, and other health care providers in planning and implementing nursing care. (SLO - 6 ) Identify legal and ethical issues having impact on the care of individuals experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems. (SLO - 7 ) Demonstrate responsibility and accountability in the provision of nursing care. (SLO -7, 8)

Please review the following PRIOR to your simulation experience: How to perform a complete physical assessment, including a focused respiratory assessment How to identify abnormal findings and discusses implications How to correct, change, and troubleshoot a chest tube system How to therapeutically communicate with a cancer patient How to use an incentive spirometer Medications: Morphine, Ketorolac

Answer these questions prior to Simulation Session (Attach answers to this ticket for admission to simulation session. Without this ticket and completed questions you will not be allowed to participate in the scheduled scenarios). 1. 2. 3. 4. 5. 6.

Why is clamping off the chest tube during transport or when the tube is accidentally disconnected no longer advocated? List and describe all possible problems that can go wrong with a chest tube drainage system. How would you determine if these problems existed? What do you do if a chest tube becomes disconnected from the drainage system, or from the patient? What is a Pneumothorax, Hemothorax? Where would the chest tube be inserted for each of these and why: What breath sounds would you expect to hear with a chest tube in place? Why is pain medicine so important for a patient with a chest tube in place?

Simulation Admission Ticket 1. Why is clamping off the chest tube during transport or when the tube is accidentally disconnected no longer advocated? Clamping off of the Chest tube is so important during transport or whenever no longer advocated, to avoid complications, such as accidental removal, recurrent pneumothoraxes, broken collection chambers, Parenchymal injuries and infection. 2. List and describe all possible problems that can go wrong with a chest tube drainage system, how would you determine if there problems existed? Possible complications of chest tube placement include improper positioning and empyema. Unusual complications include organ rupture and problems arising after removal, such as recurrent pneumothorax and tension pneumothorax. Quick treatment of a pneumothorax due to significant chest trauma is critical. The symptoms are often severe, and they could contribute to potentially fatal complications such as cardiac arrest, respiratory failure, shock, and death. Assessing for an air leak: Clamp off suction for one minute. An air leak is present if there is constant bubbling in the waterseal chamber. An air leak alerts the nurse that he or she must assess for the location of the leak by checking the connections from the chest drainage unit to the insertion site. 3. What do you do if a chest tube becomes disconnected from the drainage system, or from the patient? When a chest tube becomes disconnected from the drainage system or from the patient is an emergency, immediately clamp the tube and place the end of chest tube in sterile water or NS. The two ends will need to be swabbed with alcohol and reconnected. Bleeding may occur after insertion of the chest tube. 4. What is a Pneumothorax, Hemothorax? Where would the chest tube be inserted for each of these and why? Pneumothorax – air escaping into the pleural space, either from a disruption in the lung tissue or from an opening in the chest wall, resulting in a collapsed lung. Appropriate insertion sites include the fourth, fifth or sixth intercoastal spaces in the anterior axillary line. If pneumothorax is under tension or reaccumulates following needle aspiration, the insertion of a chest tube will be necessary. Hemothorax – occurs when excess blood builds up in the chest cavity, usually due to an injury, tumor, or bleeding disorder, bleeding into the pleural space, which prevents the lungs from inflating fully and can lead to collapse. A straight tube is placed posterior and toward apex and a right angled tube can be placed at the base of lung and diaphragm. 5. What breath sounds would you expect to hear with a chest tube in place?

Simulation Admission Ticket Breath sounds you would expect to hear would be crackles heard when collapsed or stiff alveoli snap open, as in pulmonary fibrosis. Wheezes are commonly associated with asthma and diminished breath sounds with neuromuscular disease. Breath sounds will be decreased or absent over the area of a pneumothorax. 6. Why is pain medicine so important for a patient with a chest tube in place? Pain medication during insertion and after placement of chest tube so important since it helps to ease anxiety, although pain during insertion and mild discomfort after placement are common, healthcare provider helps minimize these effects with pain medicines....