Advanced Skills: Chest Tubes
When a client suffers a complete pneumothorax, there is danger of a mediastinal shift. If such shift occurs, what potential effect is a cause for concern?
Decreased filling of the right heart
The nurse is taking a report on a patient who had pneumonectomy 4 days ago. Which question is the best to ask during shift report?
Does the surgeon want the patient placed on the nonoperative side?
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 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
A client has a pneumothorax, and a closed-chest drainage system is inserted to allow the lung to reinflate. Identify the chamber in the figure below that provides the water seal
C
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 is not kinked
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
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 the client?
Observe for fluid fluctuations in the water seal chamber
A client has chest tubes attached to a chest tube drainage system. What should the nurse do when caring for the client?
Palpate the surrounding area for crepitus
A client is shot in the chest during a holdup and in 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 the 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 spontaneous pneumothorax shold the nurse's response take into consideration?
Rupture of a subpleural bleb
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
The physician's prescription indicate an increase in the suction to -20 cm for a patient with a chest tube. To implement this, the nurse performs which interventions?
Stops the suction, adds sterile water to level of -20 cm to the water seal chamber, and resumes the wall suction
A client who was involved in a motor vehicle collision sustained multiple internal injuries, and thoracic surgery was performed. After surgery the client has two chest tubes attached to closed chest drainage systems. Place an X on the image on the right where the nurse should palpate to identify where the complication of subcutaneous emphysema most likely may occur
The nurse should palpate the area around a chest tube insertion site for the presence of crackling sensation felt beneath the fingertips (crepitus), indicating that air is trapped in the tissues. Also, the chest tube insertion site should be assessed for an adequate seal
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-breathing exercises 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 vigorous bubbling in the water seal chamber