Nursing Management in Pneumothorax by zer90731

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									PNEUMOTHORAX
CARE PATHWAY: PNEUMOTHORAX                                                     CP No. 91


ADMISSION DAY (SEE BTS GUIDELINES ON THE MANAGEMENT OF PNEUMOTHORAX)

MEDICAL
Take history/examination/check TPR + BP
Determine Pre-disposing factors
Bloods FBC, U/Es
Order Chest X-ray,
Check blood gases/pulse oximetry
ECG / insert IVI
Direct Pleural Aspiration
Insert Chest Drain
Prescribe all medication/ O2 therapy......................%
Repeat chest X-ray if necessary
Review chest drain if inserted
Advise on whether to mobilise patient Y/N
NURSING
Nursing assessment
Reassure patient/support family
Explain procedures
Introduce to named nurse
TPR + BP TDS *Alert doctor if BP drops suddenly*
O2 therapy ...............%
Assist with medical procedure
Assist with hygiene needs
Assist with eliminate needs
Diet and fluids as able
Mobilize as able
Care for venflon site/IVI
Refer to Physiotherapis/Respiratory Nurse Specialist for advice if necessary
Refer to Occupational Therapist
Refer to Social Worker
Check chest drain insertion site
Care of chest drain if any - check for bubbling and oscillation and drainage
OUTCOMES

 1. Relief of shortness of breath at rest
 2. Relief of pain or discomfort
 3. Chest drain oscillating/bubbling/draining
 4. Patient demonstrates understanding of plan of care


PAS/ce/carepath/pneumo91
CARE PATHWAY: PNEUMOTHORAX                                                        CP No. 91



ACUTE PHASE
MEDICAL
Review patient by consultant
Review available results
Check TPR + BP
Review medication
Consider discharge home if no chest drain
Arrange subsequent CXR if needed
Review chest drain, check for bubbling/oscillation/drainage
If suction to chest drain required contact Respiratory Nurse bleep 3224
Review chest X-Ray
Advise on whether to mobilize patient
NURSING
Explore anxieties/give reassurance
Explain plan of care - involve relatives
Monitor chest drain observe for bubbling oscillation/check insertion site
O2 Therapy..............%
TPR + BP TDS/BD
Assist with hygiene needs
Assist with elimination needs
Give prescribed medication including analgesia as needed
Review effectiveness of pain control
Mobilize as able
? Remove venflon
Follow up any referrals
OUTCOMES
1. Patient demonstrates understanding of plan of care
2. Shortness of breath is relieved
3. Pain is controlled
4. Chest drain oscillating
IF ALLOWED HOME
Patient demonstrates understanding of discharge plan and understands he may return to the ward
if any problems arise



PAS/ce/carepath/pneumo91
CARE PATHWAY: PNEUMOTHORAX                                CP No.91



INTERMEDIATE PHASE

MEDICAL
Review patient
Check results
Check TPR + BP
Review chest drain, observe for bubbling
Review medication
Remove drain (give analgesia prior to removal)
Repeat chest X-Ray

NURSING
Explore anxieties/give reassurance
Explain procedures
TPR + BP - TDS/BD*
Assist medical staff with removal of chest drain Y/N
Give all prescribed medication/analgesia as required
Independent with: hygiene needs
                   elimination needs
                    mobility within normal limitation
OUTCOMES
1. Shortness of breath relieved
2. Pain controlled
3. Chest drain oscillating
4. Patient demonstrates understanding of plan of care
5. Patient demonstrates understanding of discharge plan



PAS/ce/carepath/pneumo91
CARE PATHWAY:           PNEUMOTHORAX                                                CP No. 91




DISCHARGE PHASE
MEDICAL
Review patient
Review blood results
Repeat chest X-Ray and review
Consider discharge date when lung fully inflated
(if yes see discharge plan)
Discharge home
Prescribe TTOs
GP discharge letter
Follow up appointment

NURSING
Explore anxieties/give reassurance
TPR + BP BD
Give all prescribed medicatio/analgesia as required
Independent with: hygiene needs (or back to patients normal)
                     elimination needs (or back to patients normal)
Mobilise independently within own limitations
Start discharge arrangements when lung fully inflated (if yes see discharge plan)
DISCHARGE PLAN
Complete/refer to transfer check list
Ensure patient understands diagnosis and treatment
Transport arranged -- Ambulance for medical reasons only
OUTCOMES
1. Breathing normally
2. Patient demonstrates understanding of plan of care
3. Pain controlled
4. Chest drain removed
5. Discharged home safely or to appropriate place of care




PAS/ce/carepath/pneumo91
REFERENCES



Godden J, Hiley C (1198) Managing the Patient with a chest drain a review Nursing Standard
12,32, and p35-39

Tomlinson MA, Treasure T (1997) Insertion of a chest drain how to do it. British Journal of
Hospital Medicine 58, 6 p 248 - 252

Phipps, Cassmeyer et al (1995) Medical, Surgical Nursing - concepts and clinical practice
Mosby Philadelphia 5th Edition P1116 - 1118

Harriss Dr Graham TR (1991) Management of Intercostal drains. British Journal of Hospital
Medicine 45 p 383 - 386

Hyde J, Sykes T (1997) Reducing morbidity from chest drains: Knowledge of basic principles
and use of appropriate equipment would help. British Medical Journal 314 p 914 - 915

Miller AC, Harvey JE (1993) Guidelines for the Management of Spontaneous Pneumothorax.
British Medical Journal Vol 307 p 114 - 115




PAS/ce/carepath/pneumo91

								
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