![]() If the patient has been shot, ask the paramedics for ballistic information, including the caliber of the weapon and the range at which the person was shot. Assessment HistoryĮstablish a history of the injury. In areas of civil and political strife and war, ballistic injuries and stab wounds to the chest also cause hemothorax. According to the World Health Organization, falls from heights of less than 5 meters are the leading cause of injury globally, but estimates are that only a small percentage of those are related to thoracic trauma. Specifically with respect to thoracic trauma, MVCs are the leading cause of injury and they occur most commonly in males 14 to 30 years of age. Some experts define a hemothorax only when the hematocrit is greater than 50%, as compared to a bloody pleural effusion, but most do not differentiate between the two conditions. Complications of hemothorax include hypovolemic shock, exsanguination, organ failure, cardiopulmonary arrest, and death. ![]() Low pulmonary pressures and thromboplastin in the lungs may aid in spontaneously tamponading parenchymal lacerations. The hemorrhage can occur from pulmonary parenchymal lacerations, intercostal artery lacerations, or disruptions of the pulmonary or bronchial vasculature. Pneumothorax, or air in the pleural cavity, often accompanies hemothorax. Hemodynamic instability occurs as bleeding increases in the pleural space and vascular volume is depleted. Ventilation is likewise impaired as the accumulating blood takes the place of gas in the lungs. Oxygenation is affected because the accumulation of blood exerts pressure on pulmonary structures, leading to alveolar collapse, a decreased surface area for gas exchange, and impaired diffusion of oxygen from the alveolus to the blood. This would cause the test taker to eliminate options "3" and "4." If the test taker thinks about bubbling, he or she should know it has to do with suctioning.Hemothorax, an accumulation of blood in the pleural space, affects oxygenation, ventilation, and hemodynamic stability. TEST-TAKING HINT: The test taker should always think about assessing the client if there is a problem and the client is not in immediate danger. Encouraging the client to cough force fully will help dislodge a blood clot that may be blocking the chest tube, causing no fluctuation (tidaling) in the water-seal compartment. The chest tube is never stripped, which creates a negative air pressure and would suck lung tissue into the chest tube. The tube is milked to help dislodge a blood clot that may be blocking the chest tube causing no fluctuation (tidaling) in the water- seal compartment. No fluctuation (tidaling) would cause the nurse to assess the tubing for a blood clot. Checking to see if someone has increased the suction rate is the simplest action for the nurse to implement if it is not on high, then the nurse must check to see if the problem is with the client or the system. Monitoring (option "4") is also assess- ing, but the test taker should not check a diagnostic test result before caring for the client. The first step in the nursing process is assessment and "check" (option "3") is a word that can be used synonymously for assess. TEST-TAKING HINT: The test taker should apply the nursing process to answer the question correctly. The stem does not state that the client is in respiratory distress, and a pulse oximeter read- ing detects hypoxemia but does not address any fluctuation in the water-seal compartment. Usually the client is lying on the tube, it is kinked, or there is a dependent loop. The key to the answer is "2 hours." The air from the pleural space is not able to get to the water-seal compartment, and the nurse should try to determine why. Increasing the amount of wall suction does not address why there is no fluctuation in the water-seal compartment. ![]() A STAT chest x-ray would not be needed to determine why there is no fluctuation in the water-seal compartment.
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