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KNOWLEDGE COMPETENCIES
Identify various radiologic and pulmonary anatomic features relevant to interpretation of chest x-rays.
Describe different systems and principles of management for chest tubes.
Describe the etiology, pathophysiology, clinical presentation, patient needs, and principles of management of acute respiratory failure (ARF).
Compare and contrast the pathophysiology, clinical presentation, patient needs, and management approaches for common diseases leading to ARF:
Acute respiratory distress syndrome (ARDS)
Acute respiratory failure
Chronic obstructive pulmonary disease (COPD) exacerbation
COVID-19 (SARS-CoV-2)
Acute severe asthma
Interstitial lung disease (ILD)
Pulmonary hypertension (PH)
Pneumonia
Pulmonary embolism (PE)
Venous thromboembolism (VTE)
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SPECIAL ASSESSMENT TECHNIQUES, DIAGNOSTIC TESTS, AND MONITORING SYSTEMS
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Chest radiography is an important tool in respiratory assessment, providing visualization of the heart and lungs. Chest x-rays are a complement to bedside assessment. Progressive care nurses need to know basic radiographic concepts and how to optimize portable chest x-ray technique, as well as how to systematically view a chest x-ray image.
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Chest x-rays are obtained as part of routine screening procedures, when respiratory disease or an acute change is suspected, to evaluate the status of respiratory abnormalities (eg, pneumothorax, pleural effusion, tumors), to confirm proper invasive tube placement (ie, endotracheal, tracheostomy, or chest tubes, and central line catheters), or following traumatic chest injury.
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An x-ray is a form of electromagnetic radiation used by imaging machines to create a radiographic image. Only a few rays are absorbed by air whereas all rays are absorbed by solid substances such as metal or bone. When nothing but air lies between the film cassette and the x-ray source, the radiographic image is blackness or radiolucency. If density increases, more beams are absorbed between the film cassette or detector and the x-ray source, and the radiographic image is whiteness or radiopacity. As the x-ray beam passes through the patient, the denser tissues absorb more of the beam, and the less dense tissues absorb less of the beam. There are four distinct radiographic densities: white, light gray, darker gray, and black. Many institutions have replaced traditional x-ray film with detectors that convert the x-ray energy to a digital radiograph. These can then be stored and distributed in a digital format.
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The lungs are primarily sacs of air or gas, so normal lungs look mostly black on chest films. Conversely, the skeletal thorax appears white, because bone is very dense and absorbs the most x-rays (Table 10-1). The heart and mediastinum appear gray because those structures are made up of mostly water and muscle or tissue. Breast tissue is made up of mostly fat and it appears whitish-gray. Structures of the thorax are made radiographically visible if they are surrounded by air. Conversely, they are obscured if adjacent to consolidation or fluid.
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