Chest Tubes
A chest tube with an attached closed-drainage system is inserted into a client who was stabbed in the chest. Which is an important nursing intervention when caring for this client? A. Observe for fluid fluctuations in the water-seal chamber B. Obtain a prescription for morphine to minimize agitation C. Apply a thoracic binder to prevent excessive tension on the tube D. Clamp the tubing securely to prevent a rapid decline in pressure
A. Fluctuations occur with inspiration and expiration until the lung is fully expanded. If these fluctuations do not occur, the chest tube may be clogged or kinked; coughing should be encouraged. The client may not be agitated; morphine depresses respirations and usually is avoided. The binder does not prevent tension on the tube; its use is contraindicated because it limits thoracic expansion. The tube should be clamped only if prescribed or if an air leak is suspected.
A client sustains a stab wound to the chest, and a chest tube is inserted. Later the client's chest tube appears to be obstructed. Which is the most appropriate nursing action? A. Instruct the client to cough B. Clamp the tube immediately C. Prepare for chest tube removal D. Arrange for a stat chest x-ray film
A. Usually having the client is sufficient to move blood, fluid, or air that may be obstructing drainage. Clamping the tube is contraindicated unless there is a break in the system. Removal of a chest tube is a medical decision and is not done unless the tube cannot be made patent. A stat x-ray film is not indicated unless symptoms, such as dyspnea, are present.
A nurse is caring for a client with a history of chronic obstructive pulmonary disease (COPD) who develops a pneumothorax and has a chest tube inserted. Which primary purpose of the chest tube will the nurse consider when planning care? A. Lessens the client's chest discomfort B. Restores negative pressure in the pleural space C. Drains accumulated fluid from the pleural cavity D. Prevents subcutaneous emphysema in the chest wall
B. Negative pressure is exerted by gravity drainage or by suction through the closed system. Though the discomfort may be lessened as a result of the insertion of the chest tube, this is not the primary purpose. There is an accumulation of air, not fluid, when a pneumothorax occurs in a client with COPD. Subcutaneous emphysema in the chest wall is associated most commonly with clients receiving air under pressure, such as that received from a ventilator; subcutaneous emphysema can also occur with a chest tube.
A nurse is caring for a client with a pneumothorax who has a chest tube attached to a closed chest drainage system. If the chest tube and closed chest drainage system are effective, what type of pressure will be reestablished? A. Neutral pressure in the pleural space B. Negative pressure in the pleural space C. Atmospheric pressure in the thoracic cavity D. Intrapulmonic pressure in the thoracic cavity
B. Removal of air and fluid from the pleural space reestablishes negative pressure, resulting in lung expansion. Neutral pressure in the pleural space will cause collapse of the lung. Atmospheric pressure in the thoracic cavity will cause collapse of the lung. Intrapulmonic pressure refers to pressure within the lung itself, not the pressure within the thoracic cavity.
A client's chest tube has accidentally dislodged. What is the nursing action of highest priority? A. Place the client in a left side-lying position B. Apply oxygen via nonrebreather mask C. Apply a petroleum gauze dressing over the site D. Prepare to reinsert a new chest tube
C. A petroleum gauze dressing will prevent air from being sucked into the pleural space, causing a pneumothorax. The petroleum gauze dressing should be taped only on three sides to allow for excessive air to escape, preventing a tension pneumothorax. The physician should immediately be notified and the client assessed for signs of respiratory distress. Positioning the client on the left side will not make a difference in outcome. There is no indication that the client is experiencing respiratory distress. Preparing to reinsert a new chest tube is not a priority of the nurse at this moment.
A client with a pneumothorax has a chest tube inserted and attached to a closed chest drainage system. The client asks, "Why is the tube in my chest hooked up to a contraption with water in it?" How does the nurse explain the function of the water? A. Promotes pleural drainage via gravity B. Measures the pressures in the chest wall C. Prevents reflux of air back into the chest D. Ensures bubbling in the water-seal chamber
C. Water acts as a seal, preventing air from entering the pleural space, which will interfere with expansion of the lung. Removal of air (drainage) is promoted by negative pressure, not gravity, in the closed chest drainage system. Water in the system does not facilitate measurement of pressures in the chest wall; this is not the purpose of a water-seal drainage system. Although air exiting the pleural space will cause bubbling in the water-seal chamber, water in the system does not ensure bubbling in the water-seal chamber; this is not the purpose of the water-seal chamber.
A nurse is caring for a client with a chest tube. How will complete lung expansion be determined before removal of the chest tube? A. Return of usual tidal volume B. Decreased adventitious sounds C. Absence of additional drainage D. Comparison of chest radiographs
D. Serial chest x-rays help determine treatment effectiveness. Chest x-ray films or radiographs reveal the degree to which the lung fills the pleural cavity and also the presence or absence of mediastinal shift. Return of usual tidal volume is not specific to expansion of the affected lung. Decreased adventitious sounds are abnormal chest sounds and do not indicate the degree of lung expansion. The chest tube may have minimal drainage and the lung may still not be expanded.