Respiratory System Procedures

Patient 1: Mr. Paul Monary

NANDA: Knowledge deficit r/t lack of information regarding care of a tracheostomy AEB by patient’s verbal response.

Client outcomes: Patient will

• Describe what a tracheostomy is and why it is necessary
• Describe the purpose of suctioning
• Demonstrate clearning of the innercannula and trach dressing
• Identify the effects on cigarette smoking on his current state of health
• List safety precautions in the use of the Passey-Muir valve

Note: Respond to the patient’s questions using terminology the patient can understand. Respond to the Student nurse’s questions using professional terminology.

Patient teaching: explain to this patient what a tracheostomy is and why it is necessary for him while having radiation therapy

Patient 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 oxygenation

Patient 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

Answering the student nurse’s questions: how does the percutaneous insertion of the trach differ from the regular manual insertion?

Answering the student nurse’s questions: How is a fenestrated trach tube different from a regular tube? Is there any potential complications with the fenestrated tube?

List 3 additional Nursing Diagnosis (in 3 part format) appropriate for Mr. Monary:

1.

2.

3.

Note: must list actual nursing diagnosis in 3 part format – not “at risk for”

Patient 2

Ms. Flora Vack

Respond to the patient’s questions (using terminology the patient can understand)

Respond to the Student nurse’s 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 tissue that surrounds your lungs and lines your chest cavity (Lewis, 2014). We do this to take samples to perform some diagnostic testing, remove excess 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 nurse’s questions: How do you position 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 Fluid at Harborview”). Their feet should be supported and you can place a pillow across their abdomen 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 properly 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 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 nurse’s 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 nurse’s 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 nurse’s 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 nurse’s 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 nurse’s 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.

Learning Objectives

Beginning

1 point

Developing

2 points

Accomplished

3 points

Score

Describes the purpose of a tracheostomy including the difference between a regular tube and a fenestrated tube

Response reflects limited knowledge of this objective

Limited explanation

Effectively explains the purpose of a tracheostomy and the fenestrated tube

Explains the purpose and steps of trach suctioning and cleaning of the inner cannula

Response reflects limited knowledge of this objective

Limited explanation

Effectively explains trach suctioning and cleaning of the inner cannula using terms appropriate for patient education

Identifies the effects of smoking on the respiratory system

Response reflects limited knowledge of this objective

Identifies 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

Response reflects limited knowledge of this objective

Identifies only 3 smoking risks to the body

Explains 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 objective

Limited explanation

Effectively explains purpose of a passey-muir valve and how it works using terms appropriate for patient education

Identifies safety precautions for use of a passey-muir valve.

Response reflects limited knowledge of this objective

Identifies only 3 safety precautions

Explains safety precautions effectively to the patient.

Critiques the difference between the surgical insertion and the percutaneous insertion of the tracheostomy tube

Response reflects limited knowledge of this objective

Limited explanation

Clearly 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 objective

Nursing diagnoses do not include pertinent diagnoses or format is not followed

Identifies 3 actual nursing diagnosis pertinent to this patient in proper format

Describes the procedure, performing a thoracentesis

Response reflects limited knowledge of this objective

Limited

Explains the procedure effectively including patient positioning

Recognizes normal versus abnormal function of the chest tube system

Response reflects limited knowledge of this objective

Limited explanation

Recognizes which chambers bubbling may occur and what that means

Describes the function of the 3 bottle chest tube system

Response reflects limited knowledge of this objective

Limited explanation

Fully explains the function of each of the 3 bottles

Demonstrates knowledge in the care of the patient with a chest tube drain and chest tube removal.

Response reflects limited knowledge of this objective

Limited explanation

Explains effectively to the student nurse, how to care for a chest tube drain, including assessment of the patient