Case Study-MRS. Richards
Mrs Richards daughter is a second year student nurse. She tells you she doesn’t understand the pathophysiology of a pneumothorax and why they can develop into a tension pneumothorax without UWSD(Under water seal drain) insertion. Please explain to her the pathophysiology of a pneumothorax and the UWSD and how it affects the cardiac & respiratory system using the correct medical and nursing terminology. the Assessment criteria below must be met in regards to this.
1. We are to give a detailed explanation of the pathophysiology of the illness/disease of the case patient, MRS Richards.
2. Explanation of 2 signs/symptoms the case patient presented with and why they manifested as part of the illness/disease. The two sign and symptom Mrs Richards had presented were chest tightness and shortness of breath.
3. Critical thinking and rationale – The patient, Mrs. Richards, is on some Antibiotics (Metronidazole and Cephalothin). Link these medication, A&P, pathophysiology, context and theory together and give detail description as to why the medication is being given to Mrs Richards, in regards to her pneumothorax, chest drain (UWSD).
Lastly linking pharmacology to multiple parts of practice such as; infection control, safety, Nursing consideration.
Pneumothorax Case Study
Pneumothorax is a medical condition where the pleural cavity gets filled of air, which impairs ventilation and oxygenation. This health complication occurs when air leaks in the pleural cavity (space between lungs and chest walls) which creates an external force outside (destroys negative pressure) the lungs making them to collapse. It can be caused by chest injury or medical health disorders. This medical complication may occur in various clinical settings and in any person of any age (Tamburrini, Sellitri, Tacconi, Brancati & Mineo, 2015). This paper explores the disease pathophysiology and ways it with the disease clinical manifestation. The paper also critically analyses the medication to give detailed information on the rationale behind the administration of specific medication. The concepts of pharmacology will be linked to nursing practice such as patient safety and infection control.
Causes and risk factors
Pneumothorax is caused by many factors. To start with, the patient may experience chest injuries (blunt or penetrating) that occur during physical accidents or physical assaults. Others causes include pleural lacerations caused during the medical procedures such as inserting aspiration needles in the patient chest. Damaged lung tissues are likely to cause air leakages into the pleural cavity. Lung disorders can be caused by many underlying diseases such as pneumonia, cyctic fibrosis or chronic pulmonary diseases. In some cases, small air blisters (blebs) can develop in the lungs, which could burst, causing air to leak into the spaces surrounding the lungs. There incidences when pneumothorax occur in patients with breathing difficulty and who require mechanical assistance. The mechanical ventilation used can cause imbalance of air pressure and could cause the lungs to collapse (Tamburrini, Sellitri, Tacconi, Brancati & Mineo, 2015).
The main risk factors associated with pneumothorax includes gender, where men are more likely to suffer from pneumothorax as compared to women. The risk of pneumothorax increases with poor lifestyles such as smoking. Pneumothorax caused by ruptured air blisters is common in people between the ages of 20 years and 40 years, and common in tall and underweight people. Genetics also plays a huge role as it mainly appears in families with a history of pneumothorax. Other risk factor includes lung disorders and mechanical ventilation (Ling, Wu, Ming, Cai & Chen, 2015).
Pathophysiology and clinical manifestation
The pathophysiology of pneumothorax is described according to the causes. Traumatic pneumothorax occurs due to penetrative injuries such as impaled object, gunshot wound, and stab wound which are associated with traumatic open pneumothorax, closed pneumothorax or heamo-thorax of the pneumothorax. Traumatic open pneumothorax occurs when the pleura gets lacerated and allows accumulation of atmospheric air in the pleural cavity. It mainly cause by a penetrating chest trauma. Air in the pleural cavity interrupts normal negative pressure which makes the lungs not remain inflated. The traumatic closed pneumothorax occurs when laceration of the pleura is caused by a blunt trauma, causing air to enter the pleural cavity (Tamburrini, Sellitri, Tacconi, Brancati & Mineo, 2015).
Latrogenic traumatic pneumothorax occurs when the pleura laceration is caused by therapeutic and diagnostic procedures such as needle biopsy, mechanical ventilation, central line insertion, and aspirations. Air trapped in pleural cavity interrupts normal negative pressure which makes the lungs not remain inflated. Spontaneous pneumothorax is an example of closed type. This is common in geriatric patients diagnosed with chronic pulmonary diseases but can also occur in adults. The main cause of pleura rapture is mainly underlying respiratory disorders such as asthma, pneumonia, chronic air flow limitation (CAL), tuberculosis, disorders of the connective tissues, Cystic fibrosis and Marfan’s syndrome.
Tension pneumothorax is caused by either traumatic of spontaneous pneumothorax. The pleura get raptured allowing air into the pleura cavity but do not allow it to escape. This creates tension and pressure in the intrapleural space, which makes the affected lung to collapse, squeezing the mediastinal contents to the unaffected lung. Air in the pleural cavity interrupts normal negative pressure which makes the lungs not remain inflated (Corsini, Pratesi & Dani, 2013).
The main clinical signs of pneumothorax are the sudden sharp pain around the chest, which is normally exacerbated by chest movements such as coughing and breathing. The asymmetrical chest movement causes the lungs to collapse. These results to cyanosis and shortness of breath associated with hypoxia. Other clinical manifestations include decreased vocal fremitus and respiratory distress, which are associated with collapsing of the lungs. When auscultation is done, the breath sounds on the side affected lung are absent as the lung has collapsed (Chiu, Chen, Wang, Tsai & Wong, 2014).
Chest rigidity on the affected side may occur due to tachycardia and hypoxia. Palpation of the affected side normally reveals crackling sound just beneath the skin, which is normally due to leaking of air into the tissues. Research indicates that Tension Pneumothorax has the most severe clinical manifestation which includes hypotension, reduced cardiac output, tachypnea and compensatory tachypnea. The disease diagnosis is normally done using X-rays, which is normally reveals air in the pleural space. Arterial blood analysis normally can be used to reveal hypoxemia (Lee et al., 2014).
Medical management and patient education
The main medical management is done by cutting through the chest (thoracotomy) is required. This is done by inserting of a chest tube in the 5th and 6th intercostal space located under the patient’s arm. The tube is then attached to a water-seal drainage system, which drains all the air in the pleural cavity. The chest tube is normally a long hollow tube which is inserted as described above. This is normally done under local anaesthesia (Gale et al., 2015).
The pleural space refers to the space between the visceral and parietal layers that line has inside the lungs and chest cavity. Normally, the two layers are held together by negative pressure or vacuum, which ensures that the lungs remain inflated. The pleural space is normally empty except the small amount of fluid that helps reduce friction between the cavities. In special cases, air or fluid may accumulate causing pneumonia, chest trauma or other intraabdominal conditions. Pneumothorax could also occur. This results to chest tightness and breathing difficulty (Baird & Gandhi, 2014).
The chest drains are done so long as air remains in the pleural cavity. This must be done because without UWSD, pneumothorax can result into tension pneumothorax. This is because the air trapped in the pleural cavity prohibits air outflow. Consequently, the volume of the air in the pleural cavity increases with every inspiration causing the pressure in the pleural cavity to increase causing lungs to collapse. Further increase of pressure in the pleural cavity makes the mediastinum shift towards the contralateral side of the lungs, which obstructs the venous return to the heart. This causes circulatory instability and could result into a traumatic arrest. This is indicated by cardiovascular diseases, reduced oxygen and low blood pressure. The patient needs to have regular chest X-rays and to monitor the disease progress (Curfman, Robitsek, Sammett & Schubl, 2015).
This intensive care is associated with potential risks and complications even when performed by experienced staff. The main common health complications are pain and infection. For example, drains inserted into the body increases the risks of infection. Therefore, the patients and patient relatives must not touch the drain, tubes and the dressings that cover the site of insertion. Good hygiene practices such as washing hands before and after contacting patient also helps minimize patient’s risks of infection. Some degree of pain, infection control and patient safety must be discussed by the healthcare providers (AL Saif, Hammodi, Al-Azem & Al-Hubail, 2015).
The treatment of pneumothorax mainly depends on the size of the pneumothorax. Small pneumothorax normally resolves by its self. The aim of the treatment is to get rid of the accumulated air in the pleural space. Once the lungs are filled with air, the patient is able to breath with ease. The patient is given Metronidazole and Cephalothin antibiotics in order to treat and prevent bacterial infection during UWSD procedures. The patient should also be given pain medication such as Tylenol. The pain prescription is done to decrease patient’s pain. The pain medication should be done as directed. Sedative medication are given to make the patient remain calm and relaxed when performing needle aspirations and chest tubes (Dixit, Meena & Patil, 2015).
References AL Saif, N., Hammodi, A., Al-Azem, M., & Al-Hubail, R. (2015). Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube. Case Reports in Critical Care, 2015, 1-4
Msichana wa Bi Richard ni mwanafunzi wa mwaka wa pili wa uuguzi. "Kama unavyojua, kuna uwezekano wa kuwa na ""pneumothorax ya mvutano"" bila kuingiza UWSD (Underwater Seal Drain)." "Kumbuka kuwa ""pneumothorax"" ni ugonjwa wa moyo na mfumo wa kupumua unaoathiri mfumo wa moyo na mfumo wa kupumua kwa kutumia maneno sahihi ya kitiba na uuguzi." vigezo vya tathmini hapa chini lazima kukidhi kuhusiana na hili. 1. Uwe na mtazamo wa kweli "Kama ilivyoelezwa hapo juu, ""mfano wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa wa ugonjwa.""" 2. Uwezekano wa kupata Maelezo ya dalili mbili za mgonjwa na kwa nini zilionekana kama sehemu ya ugonjwa. Ishara na dalili mbili ambazo Bi. Richards alikuwa amewasilisha zilikuwa mfadhaiko wa kifua na upungufu wa pumzi. 3. Uwe na mtazamo wa kweli Mawazo ya kukosoa na mantiki <unk> Mgonjwa, Bi. Richards, anatumia dawa za kuua viini (Metronidazole na Cephalothin). "Kufanya utafiti wa ""A&P, pathophysiology, context na theory"" pamoja na kutoa maelezo ya kina kwa nini dawa hiyo inapewa Bi Richards, kuhusiana na pneumothorax yake, chest drainage (UWSD)." Mwishowe kuunganisha pharmacology kwa sehemu nyingi za mazoezi kama vile; udhibiti wa maambukizo, usalama, kuzingatia uuguzi. Pneumothorax ni hali ya matibabu ambapo utando wa pleural hujazwa hewa, ambayo huzuia uingizaji hewa na oksijeni. Ugonjwa huu hutokea wakati hewa inapoingia ndani ya utando wa pleura (mahali kati ya mapafu na kuta za kifua) ambayo huunda nguvu ya nje nje (inaangamiza shinikizo hasi) ya mapafu na kuifanya ianguke. Inaweza kusababishwa na jeraha la kifua au matatizo ya afya. Matatizo haya yanaweza kutokea katika mazingira mbalimbali ya kliniki na kwa mtu yeyote wa umri wowote (Tamburini, Sellitri, Tacconi, Brancati & Mineo, 2015). Karatasi hii inachunguza ugonjwa pathophysiology na njia yake na ugonjwa kliniki maonyesho. Karatasi pia inachambua kwa ukali dawa ili kutoa habari ya kina juu ya mantiki nyuma ya utawala wa dawa maalum. Dhana za pharmacology itakuwa kushikamana na mazoezi ya uuguzi kama vile usalama wa mgonjwa na kudhibiti maambukizi. Sababu na mambo ya hatari Pneumothorax husababishwa na mambo mengi. Kwa kuanza, mgonjwa anaweza kupata majeraha ya kifua (kinyume au kupenya) ambayo hutokea wakati wa ajali za kimwili au mashambulizi ya kimwili. Sababu nyingine ni pamoja na lacerations pleural unasababishwa wakati wa taratibu za matibabu kama vile kuingiza sindano aspiration katika kifua mgonjwa. Viungo vya mapafu vilivyoharibiwa huenda vikasababisha uvujaji wa hewa ndani ya shimo la pleura. Matatizo ya mapafu yanaweza kusababishwa na magonjwa mengi ya msingi kama vile nimonia, cystic fibrosis au magonjwa ya mapafu ya muda mrefu. Katika baadhi ya kesi, vidonda vidogo vya hewa vinaweza kutokea kwenye mapafu, ambavyo vinaweza kupasuka, na kusababisha hewa kuvuja katika nafasi zinazozunguka mapafu. Kuna visa vya pneumothorax kutokea kwa wagonjwa wenye ugumu wa kupumua na ambao wanahitaji msaada wa mitambo. Upasuaji wa hewa wa kawaida hufanywa kwa njia ya mashine, ambayo inaweza kusababisha kuanguka kwa mapafu (Tamburini, Tacconi, Brancati, na Mineo, 2015). Vipengele vya hatari vinavyohusishwa na pneumothorax ni pamoja na jinsia, ambapo wanaume wana uwezekano mkubwa wa kuteseka na pneumothorax ikilinganishwa na wanawake. Hatari ya kupatwa na pneumothorax huongezeka kwa sababu ya mtindo mbaya wa maisha kama vile kuvuta sigareti. Pneumothorax ni ugonjwa wa kawaida kwa watu wenye umri wa kati ya miaka 20 na 40, na kwa watu wa urefu na uzito mdogo. Urithi pia una jukumu kubwa kwa kuwa huonekana hasa katika familia zilizo na historia ya pneumothorax. Vipimo vya hatari vya ugonjwa wa mapafu na uingizaji hewa wa mitambo (Ling, Wu, Ming, Cai & Chen, 2015). Pathophysiology na clinical maonyesho Pathophysiology ya pneumothorax ni ilivyoelezwa kulingana na sababu. Pneumothorax ya kiharusi hutokea kutokana na majeraha ya kupenya kama vile kitu kilichofungwa, jeraha la risasi, na jeraha la kisu ambalo linahusishwa na pneumothorax ya wazi ya kiharusi, pneumothorax iliyofungwa au heamo-thorax ya pneumothorax. Pneumothorax ya wazi ya kiharusi hutokea wakati pleura inapovunjika na kuruhusu mkusanyiko wa hewa ya anga katika shimo la pleural. Hasa husababishwa na jeraha la kifua linaloingia. Hewa katika utando wa pleural huvuruga shinikizo la kawaida la chini ambalo hufanya mapafu yasibaki yamefurika. Pneumothorax ya kufungwa ya kiharusi hutokea wakati laceration ya pleura inasababishwa na majeraha ya blunt, na kusababisha hewa kuingia katika cavity ya pleural (Tamburini, Sellitri, Tacconi, Brancati & Mineo, 2015). Ugonjwa wa pneumothorax ya Latrogenic hutokea wakati laceration ya pleura inasababishwa na taratibu za matibabu na utambuzi kama vile biopsy ya sindano, uingizaji wa hewa wa mitambo, kuingizwa kwa mstari wa kati, na matarajio. Hewa iliyokamatwa katika shimo la pleural huvuruga shinikizo la kawaida la chini ambalo hufanya mapafu yasibaki yamefurika. Pneumothorax ya ghafula ni mfano wa aina iliyofungwa. Hii ni ya kawaida katika wagonjwa wa wazee waliogunduliwa na magonjwa ya mapafu ya muda mrefu lakini inaweza pia kutokea kwa watu wazima. Kifo cha pleura ni sababu ya matatizo ya kupumua kama vile asthma, pneumonia, upungufu wa mtiririko wa hewa (CAL), kifua kikuu, matatizo ya tishu za kuunganisha, cystic fibrosis na Marfan syndrome. Pneumothorax ya mkazo husababishwa na pneumothorax ya kiharusi au ya ghafula. Pleura hupata raptured kuruhusu hewa katika cavity pleura lakini si kuruhusu kutoroka. Hii huunda mvutano na shinikizo katika nafasi ya intrapleural, ambayo hufanya mapafu yaliyoathiriwa kuanguka, ikifinyanisha yaliyomo ya mediastinal kwa mapafu yasiyoathiriwa. Upasuaji wa pleural huathiri kwa kiasi kikubwa hali ya hewa ya kawaida ya mapafu, na kwa hivyo, kwa sababu ya hali ya hewa ya kawaida, mapafu ya pleural yanaweza kuharibika (Corsini, Pratesi na Dani, 2013). Dalili kuu za pneumothorax ni maumivu makali ya ghafla karibu na kifua, ambayo kwa kawaida huongezeka na harakati za kifua kama vile kikohozi na kupumua. Mwendo usio sawa wa kifua husababisha mapafu kuanguka. Matokeo hayo ni cyanosis na upungufu wa pumzi unaohusiana na hypoxia. Maonyesho mengine ya kliniki ni pamoja na kupungua kwa sauti ya sauti na shida ya kupumua, ambayo inahusishwa na kuanguka kwa mapafu. Wakati wa kusikiliza, sauti za pumzi kwenye pua iliyoathiriwa hazipo kwa sababu mapafu yameporomoka (Chiu, Chen, Wang, Tsai & Wong, 2014). Ukaidi wa kifua upande ulioguswa waweza kutokea kwa sababu ya tachycardia na hypoxia. Kwa kawaida, kugundua upande unaohusika huonyesha sauti ya mlipuko chini ya ngozi, ambayo kwa kawaida husababishwa na kuvuja kwa hewa ndani ya tishu. Utafiti unaonyesha kwamba Pneumothorax ya Mfadhaiko ina dalili kali zaidi za kliniki ambazo ni pamoja na hypotension, kupunguzwa kwa pato la moyo, tachypnea na tachypnea ya fidia. Ugonjwa huo huchunguzwa kwa kutumia X-ray, ambayo kwa kawaida huonyesha hewa katika nafasi ya pleural. Uchunguzi wa damu ya mishipa ya damu kwa kawaida inaweza kutumika kufunua hypoxemia (Lee et al., 2014). Usimamizi wa matibabu na elimu ya mgonjwa Usimamizi mkuu wa matibabu unafanywa kwa kukata kupitia kifua (thoracotomy) inahitajika. Hii hufanywa kwa kuingiza bomba la kifua katika nafasi ya 5 na 6 ya intercostal iliyoko chini ya mkono wa mgonjwa. Kisha, bomba hilo huunganishwa na mfumo wa kuondoa maji, ambao huondoa hewa yote katika shimo la pleura. Bomba la kifua kwa kawaida ni bomba refu tupu ambalo huingizwa kama ilivyoelezwa hapo juu. Hii ni kawaida kufanyika chini ya anesthesia ya mahali (Gale et al., 2015). Sehemu ya pleural ni sehemu ya ndani ya tumbo la mwili, ambayo ni sehemu ya ndani ya mapafu na kifua. Kwa kawaida, tabaka hizo mbili huunganishwa pamoja kwa shinikizo la chini au utupu, ambao huhakikisha kwamba mapafu hubaki yamefurika. Kwa kawaida nafasi ya pleura ni tupu isipokuwa kiasi kidogo cha umajimaji ambao husaidia kupunguza msuguano kati ya mashimo. Katika visa maalum, hewa au kioevu inaweza kukusanyika kusababisha nimonia, chest trauma au hali nyingine intraabdominal. Pneumothorax yaweza pia kutokea. Hii inaongoza kwa upungufu wa kifua na ugumu wa kupumua (Baird & Gandhi, 2014). Mtiririko wa kifua hufanywa kwa muda mrefu kadiri hewa inavyobaki katika shimo la pleural. Hii ni muhimu kwa sababu bila UWSD, pneumothorax inaweza kusababisha pneumothorax ya mvutano. Hii ni kwa sababu hewa iliyokamatwa katika shimo la pleural inazuia mtiririko wa hewa. Kwa hivyo, kiasi cha hewa katika utando wa pleural huongezeka na kila pumzi, na kusababisha shinikizo katika utando wa pleural kuongezeka, na kusababisha mapafu kuanguka. Kuongezeka kwa shinikizo katika utando wa pleura hufanya mediastinum kuhamia upande wa kinyume wa mapafu, ambayo huzuia kurudi kwa moyo. Hilo husababisha ukosefu wa utulivu wa mzunguko wa damu na laweza kusababisha mshtuko wa moyo. Hilo huonyeshwa na magonjwa ya moyo na mishipa ya damu, kupungua kwa oksijeni na kushuka kwa shinikizo la damu. Kwa hivyo, kwa kawaida, mgonjwa anapaswa kupima kwa njia ya X-ray ya kifua na kuamua ikiwa anaendelea na ugonjwa wake (Curfman, Robitschek, Sammet na Schubel, 2015). Utunzaji huu wa kina unahusishwa na hatari na matatizo ya uwezekano hata wakati unafanywa na wafanyakazi wenye uzoefu. Matatizo makuu ya afya ni maumivu na maambukizo. Kwa mfano, mifereji ya maji iliyoingizwa ndani ya mwili huongeza hatari ya maambukizo. Kwa hiyo, wagonjwa na jamaa za wagonjwa hawapaswi kugusa mfereji, mirija na vifuniko vinavyofunika mahali pa kuingizwa. Mazoea mazuri ya usafi kama vile kuosha mikono kabla na baada ya kuwasiliana na mgonjwa pia husaidia kupunguza hatari za maambukizi ya mgonjwa. "Hata hivyo, kwa mujibu wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti wa utafiti.""" Matibabu ya pneumothorax hutegemea hasa ukubwa wa pneumothorax. Pneumothorax ndogo kwa kawaida hutoweka yenyewe. Lengo la matibabu ni kuondoa hewa iliyojikusanya katika nafasi ya pleural. Mara mapafu yanapojazwa hewa, mgonjwa anaweza kupumua kwa urahisi. Metronidazole na cephalothione ni dawa za kuzuia na kuzuia maambukizi ya bakteria. Mgonjwa anapaswa pia kupewa dawa za kupunguza maumivu kama vile Tylenol. Dawa ya maumivu hufanywa ili kupunguza maumivu ya mgonjwa. Dawa za kupunguza maumivu zapasa kutumiwa kama inavyoelekezwa. Dawa za kulala zinatolewa ili kumfanya mgonjwa awe na utulivu na kupumzika wakati wa kufanya aspirations na mirija ya kifua (Dixit, Meena na Patil, 2015). Al-Sayyid, N. Hammadi, A. Al-Azem, M. na Al-Hubail, R. Pneumothorax ya mkazo na Emphysema ya chini ya ngozi inayofanya iwe vigumu kuingiza Tube ya Nasogastric. Ripoti za kesi katika Huduma ya Makali, 2015, 1-4