Advanced Skills Chest Tubes

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply.

-Shortness of breath -Unilateral chest pain

When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such a shift occurs, what potential effect is a cause for concern?

Decreased filling of the right heart

A client is diagnosed with a spontaneous pneumothorax. Which physiologic effect of a spontaneous pneumothorax should the nurse include in a teaching plan for the client?

Air will move from the lung into the pleural space

During the first 36 hours after the insertion of chest tubes, when assessing the function of a three-chamber, closed chest drainage system, the nurse identifies that the water in the underwater seal tube is not fluctuating. What initial action should the nurse take?

Check the tube to ensure that it is not kinked

The nurse is supervising a nursing student who is providing care for a thoracotomy patient with a chest tube. What finding would the nurse clearly instruct the nursing student to report immediately?

Continuous bubbling in the water seal chamber

A patient has a chest tube in place. What does the water in the water seal chamber do when the system is functioning correctly?

Fluctuates with the patient's respirations

The nurse is caring for a patient with a chest tube in place. Over the past hour in the drainage from the tube was 110 mL. What is the nurse's best action?

Notify the surgeon immediately

A chest tube is inserted into a client who was stabbed in the chest and is attached to a closed-drainage system. Which is an important nursing intervention when caring for this client?

Observe for fluid fluctuations in the water seal chamber

How should the nurse monitor for the complication of subcutaneous emphysema after the insertion of chest tubes?

Palpate around the tube insertion sites for crepitus

A client has chest tubes attached to a chest tube drainage system. What should the nurse do when caring for this client?

Palpate the surround area for crepitus

A client is shot in the chest during a holdup and is transported to the hospital via ambulance. In the emergency department chest tubes are inserted, one in the second intercostal space and one at the base of the lung. What does the nurse expect the tube in the second intercostal space to accomplish?

Remove air that is present in the intrapleural space

A client with emphysema experiences a sudden episode of shortness of breath and is diagnosed with a spontaneous pneumothorax. The client asks, "How could this have happened?" What likely cause of the spontaneous pneumothorax should the nurse's response take into consideration?

Rupture of a subpleural bleb

The physician's prescriptions indicate an increase in the suction to -20cm for this patient with a chest tube. To implement this, the nurse performs which interventions?

Stops the suction, adds sterile water to the level of -20cm in the water seal chamber, and resumes the wall suction

The nurse is caring for a patient with a chest tube. What is the correct nursing intervention for this patient?

The patient is encouraged to cough and do deep-bathing exercising frequently

Upon observation of a chest tube setup, the nurse reports to the physician that there is a leak in the chest tube and system. How has the nurse identified this problem?

There was onset of continuous vigorous bubbling in the water seal chamber.