Respiratory Case Study
1. A hemothorax is when blood is in the chest's pleural cavity. Mr. Yang's injuries from his fall,
which resulted in bleeding and broken ribs, could be the cause of his hemothorax.
2. A language barrier can cause many difficulties when developing a nurse and patient
relationship. Due to Mr. Yang's cultural background, the nurse should become familiar with his
culture and determine what is appropriate and what is not. For instance, in Mr. Yang's culture,
they do not shake hands or make eye contact. The nurse needs to know this information to
establish respect and a relationship with Mr. Yang. Additionally, the nurse should also bring in
an interpreter to ensure that Mr. Yang has all the information he needs and understands
everything and vice versa for the nurse as well.
3. Medical translators work with written words, and medical interpreters work with spoken
words. Some resources that can be given to the nurse when an interpreter is needed are online
services where an interpreter can be provided, using pictures and symbols to explain the
information. The nurse should document that the patient cannot understand or communicate
during the interaction. The nurse should also document that the patient is not able to repeat the
education given as well.
4. The primary concerns with a hemothorax are the patient's oxygen, respiratory rate, and
rhythm, breath sounds, if any blood loss is present, and pain. The primary concerns involving a
rib fracture are bone healing and pain. The nurse should encourage deep breathing using the
incentive spirometer to prevent complications. Additionally, the patient should be performing a
range of motion exercises to prevent DVT.
5. The first nursing diagnosis is pain due to a hemothorax and rib fracture. The outcome should
include pain management, medication or nonpharmacological interventions, or both. The second
nursing diagnosis is a risk for DVT due to immobility. The outcome is no development of DVT by
including a range of motion in the patient's care plan, monitoring lab values such as PT/INR, and
giving medication if needed. The last nursing diagnosis is impaired gas exchange due to
hemothorax. The outcome is to keep the oxygen levels above 92%.
6. The three chambers include the collection chamber, the water seal chamber, and the suction
control chamber.
7. The nurse sets up the water-seal chamber by ensuring the water level is 2 cm. Most chest tubes
have manual negativity vents that can be held down until the water level is at 2 cm and can also
remove any negative pressure and avoid any tissue damage in the process. The water seal
chamber can prevent air from returning into the chest through the one way valve and water seal.
This occurs when the patient exhales and prevents a pneumothorax from developing. The nurse
has to attach the tube to the suction and then use the dial to set the suction at the level the
doctor ordered. The indicator is an orange device that vacuums the chest tube drainage.
8. The nurse should disconnect the drainage system and place the chest tube in a bottle of sterile
water. This will prevent a pneumothorax from developing by not allowing the air to enter the
pleural cavity.
9. Some nonverbal cues Mr. Yang can portray are guarding his body on the side that hurts,
grimacing, increased vital signs such as blood pressure and heart rate, and shallow breathing and
tenderness during palpation.
10. In Mr. Yang's Hmong culture, using direct eye contact is inappropriate and is considered a
sign of disrespect.
11. In Mr. Yang's culture, complimenting the child is not appropriate or respectful because they
believe that the spirits can hear them and can steal the children's souls. Additionally, touching
the head of anyone that is Hmong is not allowed because that is where the soul resides.
12. The output should be reported as 125 mL for the 8-hour shift. The provider should be called
when more than 100 mL was drained per hour.