chest tubes

The OR nurse is setting up a water-seal chest drainage system for a patient who has just had a thoracotomy. The nurse knows that the amount of suction in the system is determined by the water level. At what suction level should the nurse set the system? A)20 cm H2O B)15 cm H2O C)10 cm H2O D)5 cm H2O

A)20 cm H2O

open pneumothorax

An open or penetrating chest wall wound through which air passes during inspiration and expiration, creating a sucking sound; also referred to as a sucking chest wound.

While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patients closed chest-drainage system. What should the nurse conclude? A)The system is functioning normally. B)The patient has a pneumothorax. C)The system has an air leak. D)The chest tube is obstructed.

C)The system has an air leak.

The nurse is assessing a patient who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the patients respirations. How should the nurse best respond to this assessment finding? A)Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. B)Inform the physician promptly that there is in imminent leak in the drainage system. C)Encourage the patient to do deep breathing and coughing exercises. D)Document that the chest drainage system is operating as it is intended.

D)Document that the chest drainage system is operating as it is intended.

A nurse is educating a patient in anticipation of a procedure that will require a water-sealed chest drainage system. What should the nurse tell the patient and the family that this drainage system is used for? A)Maintaining positive chest-wall pressure B)Monitoring pleural fluid osmolarity C)Providing positive intrathoracic pressure D)Removing excess air and fluid

D)Removing excess air and fluid

NI of pneumothorax

HOB: high fowlers monitor breath sounds

3 chambers of water seal system

a collection chamber, a water seal chamber, and a wet suction control chamber

tension pneumothorax

a type of pneumothorax in which air that enters the chest cavity is prevented from escaping tracheal, heart shift to unaffected side increased RR, HR, decreased BP

closed pneumothorax

air leaks into pleural space without an outside wound cause: rib fracture, spontaneous: pul. bleb

hemothorax

blood in the pleural cavity

what should be present in the wet suction chamber?

bubbling

monitoring patient with a chest tube

check lung sounds, check for subq crepitus, dyspnea, rate, insertion site, rate cough, deep breathing, reposition

what if the water doesn't fluctuate?

check to see if a kink in the tubing is present lung may have re-expanded

S/S of pneumothorax - collapsed

chest pain - cyanosis overt tachycardia and tachypnea low BP low O2 absent breath sounds on affected side subq emphysema (crepitus), sucking sound expansion of chest is uneven dyspnea

pneumothorax

collapsing of a lung due to air accumulating in the pleural space diagnostic: chest xray, CT, US

dry suction one-war valve system

collection chamber with one way mechanical valve and a dry suction chamber the valve permits air and fluid to leave the chest but prevents their movement back into pleural space good for emergent situations

what do you do if the chest tube becomes dislodged?

cover with sterile dressing notify physician

how should you handle an open pneumothorax

cover with sterile gauze x3 corners with the 4th corner open

air leak monitoring

excessive bubbling, air leak

pleural effusion

fluid in pleural space alters pressure causing lung collapse

what should be noted on a water seal system?

increase in the water level with inspiration and return to baseline during expiration: tidaling intermittent bubbling in the water seal chamber is normal continuous bubbling indicates an air leak

nurses role with chest tubes

keep drainage system below patients chest make sure there are no kinks in the tubing check q1 and doc output and beginning and end of shift

empyema

pus in the pleural cavity

what does the amount of bubbling in the wet suction chamber indicate?

the amount of bubbling indicates the strength of the suction

wet suction

the amount of suction is determined by the amount of water instilled in the suction chamber

what does the suction control chamber do?

the suction control chamber regulates the amount of negative pressure applied to the chest usually set at 20cm H20 adding more fluid increases the amount of suction

what is the water seal chamber used for with wet suction?

the water seal chamber is used to prevent air from moving back into the chest on inspiration

dry systems

use a one-way valve and may have a suction control dial in place of the water

what does a rise in water level indicate?

water level in the water seal chamber reflects the negative pressure present in the intrathoracic cavity a rise in the water level indicates negative pressure 2 cm mark is expected

dry suction water seal

water seal chamber is filled with water to the 2 cm level. bubbling indicates an air leak