Discussion Board Expectations : consist of three (3) paragraphs using at least two (2) sources, using APA 7th ed.
Case study: Mr. T was involved in a motor vehicle crash in which he was the driver. He was wearing a seatbelt. His compact car collided head-on with a full-size pickup truck. There was no evidence of alcohol or drug involvement, and the only history that can be obtained is that he has a chronic lung problem. Assessment reveals absent breath sounds on the right side with minimal chest movement. Vital signs are BP, 110/68; HR, 100; RR, 10; and shallow, T. 98°F.
The physician inserted a chest tube, intubated Mr. T. and initiated positive pressure ventilation. Mr. T. also sustained a significant head injury that has left him unconscious and in need of ventilator support. Several days later, he starts to regain consciousness and becomes extremely restless. When the nurse suctions his artificial airway, the nurse observes blood-tinged sputum. Mr. T has a low-grade fever and is tachycardic.
Discuss: 1) Indications for a chest tube. 2) Possible reasons for frothy sputum. 2) Top two nursing diagnoses 3) Other potential complications that the nurse caring for Mr T should anticipate.
Expert Solution Preview
Introduction:
The case study involves Mr. T who was involved in a car crash and sustained multiple injuries. The critical care team has started him on mechanical ventilation and inserted a chest tube. This assignment will discuss the indications for chest tube insertion, possible reasons for frothy sputum, the top two nursing diagnoses, and potential complications that the nurse caring for Mr. T should anticipate.
1) Indications for a chest tube:
The indication for a chest tube in Mr. T’s case is due to absent breath sounds on the right side with minimal chest movement. These symptoms suggest a pneumothorax, which is the accumulation of air in the pleural cavity. The chest tube’s primary purpose is to drain the pleural space and re-expand the collapsed lung. The insertion of a chest tube in Mr. T’s case is critical as a large pneumothorax can lead to impaired oxygenation, cardiac arrhythmias, and even cardiac arrest.
2) Possible reasons for frothy sputum:
Frothy sputum is a cause for concern as it suggests pulmonary edema, which is the accumulation of fluid in the lungs. Several factors can cause pulmonary edema, such as left-sided heart failure, pulmonary hypertension, or trauma to the lung tissue as in Mr. T’s case. Pulmonary edema can have severe consequences, such as the inability to breathe properly, reduced oxygenation, and even heart failure. In Mr. T’s case, pulmonary edema is likely due to the mechanical ventilation and positive pressure ventilation, which can increase the pressure in the lungs and cause fluid accumulation.
3) Top two nursing diagnoses:
The top two nursing diagnoses for Mr. T would be impaired gas exchange and ineffective breathing pattern. Impaired gas exchange relates to the difficulty in exchanging oxygen and carbon dioxide through the lungs. This would place Mr. T at risk for hypoxia, which can have severe consequences. Ineffective breathing pattern relates to the alteration in the pattern and depth of breathing due to the ventilator support. Mr. T may also be at risk for ineffective airway clearance, which relates to the suctioning of blood-tinged sputum described in the case study.
4) Other potential complications that the nurse caring for Mr. T should anticipate:
The nurse caring for Mr. T should anticipate potential complications such as infections, pressure ulcers, and deep vein thrombosis. Mr. T is at risk for infections due to the prolonged intubation and the insertion of the chest tube. He is also at risk for pressure ulcers due to a prolonged period of immobility. Finally, deep vein thrombosis is a potential complication due to immobility, causing blood clots to form in the deep veins of the legs, which can lead to pulmonary embolism. The nurse should implement measures to prevent these complications through frequent turning, use of alternating pressure mattresses, and administering prophylactic anticoagulant therapy.
