Clinical case: Nursing care of an inmate with thoracic window.

OBJECTIVE: To make a comprehensive assessment of a pacient who has a thoracoscopy or thoracic window that needs wound care. Through the functional patterns of Marjory Gordon and the NANDA taxonomy (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification). As well as helping the healing and closing time of the wound to be shorter, reducing the risk of infection and improving the quality of life of the patient. CASE PRESENTATION: The clinical case of the patient with thoracic window is described. The real and potential diagnoses were established, some objectives or NOC were set and the necessary activities or NIC were carried out to reach them. RESULTS: On a Likert scale (1 to 5), a wound healing was obtained, from 1 to 3, a level of anxiety, from 3 to 4, a problem coping, from 3 to 4, a level of self-care, from 2 to 4, the promotion of health, from 2 to 4, and the therapeutic regimen, from 2 to 4, after one year of follow-up. CONCLUSIONS: The comprehensive approach that should be performed to the patient, not focused only on the reason for the consultation, but assessing the different functional patterns to know which are altered and take into account the evolution of the process and better care and quality improvement of the patient's life.

Caso clínico: cuidados de enfermería en un interno con ventana torácica / Clinical case: nursing care of an inmate with thoracic window

Objetivos: hacer una valoración integral de un paciente que presenta una toracostomía o ventana torácica, que precisa de cuidados de la herida a través de los patrones funcionales de Marjory Gordon y la taxonomía NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) y NOC (Nursing Outcomes Classification), así como ayudar a que el tiempo de cicatrización y cierre de la herida sea más corto, reduciendo el riesgo de infección y mejorando la calidad de vida del paciente. Presentación del caso: se describe el caso clínico del paciente con ventana torácica. Se establecieron los diagnósticos reales y potenciales, se fijaron unos objetivos (NOC) y se realizaron las actividades necesarias (NIC) para alcanzarlos. Resultados: en una escala de tipo Likert, con rangos de medición del 1 al 5, se obtuvo una curación de la herida del 1 al 3, un nivel de ansiedad del 3 al 4, un afrontamiento de problemas del 3 al 4, un nivel de autocuidado del 2 al 4, el fomento de la salud del 2 al 4, y el régimen terapéutico del 2 al 4, tras un año de seguimiento. Conclusiones: el abordaje integral que se debe realizar al paciente no debe centrarse solo en el motivo de la consulta, sino que es necesario también valorar los distintos patrones funcionales, para saber cuáles están alterados y tener en cuenta la evolución del proceso, la mejor atención y la mejora de la calidad de vida del paciente

Objective: to make a comprehensive assessment of a pacient who has a thoracoscopy or thoracic window that needs wound care. Through the functional patterns of Marjory Gordon and the NANDA taxonomy (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification). As well as helping the healing and closing time of the wound to be shorter, reducing the risk of infection and improving the quality of life of the patient. Case presentation: the clinical case of the patient with thoracic window is described. The real and potential diagnoses were established, some objectives or NOC were set and the necessary activities or NIC were carried out to reach them. Results: on a Likert scale (1 to 5), a wound healing was obtained, from 1 to 3, a level of anxiety, from 3 to 4, a problem coping, from 3 to 4, a level of self-care, from 2 to 4, the promotion of health, from 2 to 4, and the therapeutic regimen, from 2 to 4, after one year of follow-up. Conclusions: the comprehensive approach that should be performed to the patient, not focused only on the reason for the consultation, but assessing the different functional patterns to know which are altered and take into account the evolution of the process and better care and quality improvement of the patient's life

Thoracostomy Tube Removal: Implementation of a Multidisciplinary Procedural Pain Management Guideline.

OBJECTIVE: Thoracostomy tubes are placed following cardiothoracic surgery for the repair or palliation of congenital heart defects. The aim of this project was to develop and implement a clinical practice guideline for the provision of optimal analgesia during removal of thoracostomy tubes in pediatric postoperative cardiothoracic surgery patients. METHODS: Methods used include a nonexperimental design utilizing chart audits to determine baseline documentation as well as procedure note evaluation to determine both baseline documentation and compliance with the new guideline. A convenience sample of unit-based nurses completed a knowledge test and a post-implementation survey. RESULTS: There was a significant increase in nursing knowledge related to the clinical practice guideline education and implementation. Documentation compliance was observed. Nursing satisfaction and feasibility of the new guideline was demonstrated. DISCUSSION: This project was successful in increasing nursing knowledge of available resources for optimal procedural pain management in pediatric patients requiring thoracostomy tube removal on one in-patient acute care unit.

Chest tubes in the critically ill patient.

This article is meant as a review for critical care nurses caring for patients with chest tubes. The types of chest tubes, equipment needed, types of chest drainage systems, chest tube placement and setup, nursing care, chest tube removal, and complications will be discussed.

Managing a chest tube and drainage system.

Intercostal drainage tubes (ie, chest tubes) are inserted to drain the pleural cavity of air, blood, pus, or lymph. The water-seal container connected to the chest tube allows one-way movement of air and liquid from the pleural cavity. The container should not be changed unless it is full, and the chest tube should not be clamped unnecessarily. After a chest tube is inserted, a nurse trained in chest-tube management is responsible for managing the chest tube and drainage system. This entails monitoring the chest-tube position, controlling fluid evacuation, identifying when to change or empty the containers, and caring for the tube and drainage system during patient transport. This article provides an overview of indications, insertion techniques, and management of chest tubes.

Pigtail catheters used in the treatment of pneumothoraces in the neonate.

Air leak in the neonatal population can be a deadly situation. Neonates have many risk factors that can contribute to air leak. These include, but are not limited to, respiratory distress syndrome; mechanical ventilation; sepsis; pneumonia; aspiration of meconium, blood, or amniotic fluid; and congenital malformations. In the NICU, the staff must be prepared to diagnose and treat pneumothoraces in a timely manner. Pathophysiology of air leaks in the neonate including the anatomy of the chest and diagnosis, indications, and common methods for the treatment of a pneumothorax in an infant is explained in this article. In addition, the latest form of treatment for neonates, known as the modified pigtail catheter, is described. A comprehensive literature review of the evidence behind the use of the pigtail catheter in neonates will be incorporated. Finally, the step-by-step placement of this catheter using the modified Seldinger technique will be illustrated and described in detail.

Cuidados enfermerosdel paciente con ventana torácica / Nursing care of the patient undergoing thoracic window

La toracostomía abierta, también llamada ventana torácica, es una técnicaquirúrgica de baja incidencia indicada como uno de los últimos recursosterapéuticos para la resolución de un empiema pleural o torácico.La atención de los pacientes en esta situación, requiere conocimientosy cuidados enfermeros específicos, tanto en el medio hospitalario comoa nivel domiciliario. Dado que es una alternativa terapéutica poco frecuente,dichos cuidados habitualmente no están contemplados en la formaciónpregrado de Enfermería, así como tampoco suelen ser abordadosen la formación continuada.El objetivo del presente artículo es informar a los profesionales enfermerossobre el cuidado de estos pacientes, haciendo un breve recordatoriode la fisiopatología del empiema, de las opciones terapéuticas, de loscuidados pre y postoperatorios, así como de las recomendaciones al alta (AU)

Open thoracotomy, also called thoracic window, is a low-incidence, surgicaltechnique indicated for pleural or thoracic empyema as a last therapeuticresource.Patient care in this situation requires specific nursing knowledge and care,both in the hospital and in domiciliary care or home setting. Given thatit is an infrequent therapeutic alternative, this type of care is not usuallycovered in undergraduate nursing training nor is it addressed in continuoustraining.The objective of this study is to inform nursing professionals on the careof these patients, with a brief description of empyema physiopathology,therapeutic options, pre- and post operative care and recommendationsat the moment of discharge (AU)

Management of the patient undergoing lung transplantation: an intensive care perspective.

The postoperative management of a patient undergoing lung transplantation involves many components of care. These components include ventilatory and hemodynamic management, immunosuppression, wound care, rehabilitation, infection control and treatment, and early detection of rejection.

Chest drain removal.

This article provides a step-by-step approach to the removal of chest drains and offers a rationale for practice. It also discusses indications for chest drain removal and potential complications associated with the procedure.

Nursing management of patients with a chest drain.

Chest drains incorporate the use of a one-way valve to drain fluid or air from the pleural cavity. The valve prevents back-flow of air and fluid into the pleural cavity. They are indicated for use when collections of fluid or air are present in the pleural space, and by draining the collection they restore efficient gaseous exchange. Little has been written on the nursing management of chest drains and the literature highlights a lack of national standardized guidelines for due to the range of thoracic conditions encountered by clinical staff. Themes such as pain management and mechanism of breathing occur frequently; however, there is a lack of up-to-date literature for the nurse to refer to. This article examines the nursing role in chest drain management from insertion to removal and includes aspects of pain management and features of a functioning chest drain.

The need for nurses to have in service education to provide the best care for clients with chest drains.

Chest drains are a widespread intervention for patients admitted to acute respiratory or cardiothoracic surgery care areas. These are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management and identify and to ascertain how nurses keep informed about the developments related to the care of patients with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a selected group of nurses and a paucity of resources. Nurse managers are encouraged to identify educational needs in this area, improve resources and the delivery of in service and web-based education and to encourage nurses to reflect upon their own knowledge deficits through portfolio use and ongoing professional development.