NUR 2048 Chest Tubes

Who can perform chest tube removal? (3)

- NP/PA/MD - Have client Valsalva (hold breath) with removal - Place occlusive dressing over site

What are the signs/symptoms of a pneumothorax? (6)

- SOB - Decreased O2 - Tachypnea/tachycardia - Diminished/absent breath sounds - Chest pain - Anxiety/restlessness

What causes hemothorax? (2)

- Trauma - Surgery

What does intermittent bubbling mean in the water seal chamber?

Air leak

What is empyema?

Collection of pus in pleural space

What is pleural effusion?

Excess fluid in pleural space

What is a normal finding for water suction?

Gentle, continuous bubbling in the water suction chamber (3rd compartment)

What causes empyema?

Infections

What is a the purpose of chest tubes?

Restore negative pressure

What are nursing interventions for a chest tube? (5)

- Assess VS, lung sounds, dressing, drainage, s/s of infection - Assess CDU/suction - Pain control - Turn, cough, deep breathe - Education

What are nursing interventions for no fluctuation in the water seal chamber? (3)

- Assess for air leak by clamping briefly at the chest tube - Continue to clamp every few inches until bubbling stops - When you clamp and bubbling stops, the leak is located between the last clamping and current clamping

The nurse is developing a plan of care for a client who had a chest tube removed. To promote respiratory exchange, what should the nurse add to the plan of care? A. Coughing and deep breathing every hour B. Careful monitoring for crepitus Bed rest with range-of-motion exercises Covering the chest tube site with a sterile dressing

A. Coughing and deep breathing every hour Prevents atelectasis and collection of secretions and promotes respiratory exchange.

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? A. Take the client's vital signs. B. Inform the health care provider. C. Turn the client to the unaffected side. D. Check the tube to ensure that it is not kinked.

D. Check the tube to ensure that it is not kinked.

What is the 3rd compartment of a chest tube? (2)

Suction control chamber; - 20 cm

What is the 1st compartment of a chest tube? (3)

- Drainage collection chamber - Do not tip - Do not put above patient

When do you notify HCP about drainage? (3)

- Order from HCP, unclamp if resp. distress and notify HCP - When changing out CDU clamp for a few seconds - Assessing for an air leak in the system for a few seconds only

What clinical indicators should the nurse expect to identify when assessing an individual with a spontaneous pneumothorax? Select all that apply. A. Shortness of breath B. Mediastinal shift toward the involved side C. Unilateral chest pain D. Hematemesis E. Increased thoracic motion

A. Shortness of breath C. 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? A. Decreased filling of the right heart B. Infection of the subpleural lining C. Rupture of the pericardium D. Increased volume of the unaffected lung

A. Decreased filling of the right heart Pressure within the pleural cavity causes a shift of the heart and great vessels to the unaffected side.

What is hemothorax?

Blood in the pleural space

Do you want to see fluctuations in the water seal chamber?

Yes, this is a normal finding

What is a tension pneumothorax?

air continues to enter the pleural space and can't escape, completely collapses the affected lung and puts pressure on unaffected lung. Collapse so severe that the pressure pushes everything to the opposite side (mediastinal shift), trachea deviates to unaffected side

What is a pneumothorax?

air in the pleural space that causes a loss of negative pressure in the chest cavity and lung collapse. Can be open (pleural cavity exposed to outside air) or closed pneumothorax

A nurse is caring for a client with a pneumothorax who has a chest tube in place. What should the nurse do when caring for this client? A. Empty and measure the drainage in the collection chamber each shift. B. Encourage range of motion to the client's arm on the affected side. C. Apply clamps below the insertion site when getting the client out of bed. D. Administer the prescribed cough suppressant at the prescribed times.

B. Encourage range of motion to the client's arm on the affected side. Promotes maintenance of functions in the arm and shoulder.

A client tells the nurse that the client's chest tube is scheduled to be removed soon. Before it is removed, what is the nurse aware of? A. An arterial blood gas will be obtained to determine oxygenation status. B. The client will be sedated 30 minutes before the procedure. C. A chest x-ray will be performed to determine the lung re-expansion. D. The drainage system will be disconnected from the chest tube.

C. A chest x-ray will be performed to determine the lung re-expansion.

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. Apply a petroleum gauze dressing over the site Prevent air from being sucked into pleural space, causing a pneumothorax.

What do you do if chest tube is inadvertently removed? (2)

- Place an occlusive dressing over site and tape on 3 sides. This allows air/fluid to escape but prevents air from entering into the opening - Notify HCP immediately

What do you do if chest tube becomes disconnected? (3

- Recreate the negative pressure by creating a new water seal or reattach system - Get a new CDU - Have client deep breath and cough in case any air entered the pleural space 0the

What type of documentation should be done with a chest tube? (7)

- Sterile dressing change - Drainage amount & characteristics - Site assessment - SubQ air - Lung sounds - Presence/absence of air - Suction amount

What are risk factors for a pneumothorax? (7)

- Thoracentesis/subclavian CL placement - Trauma - Fractured ribs - Chest surgery - Lung biopsy - Ruptured bleb (COPD) - Spontaneous

What causes pleural effusion? (4)

- Usually recurrent - CHF - Liver failure - Cancer

What is the 2nd compartment of a chest tube?

- Water seal chamber - Tidaling/oscillation (fluctuation)

Where is a chest tube placed for air?

2-3 intercostal space

How many mL does the 1st compartment of a chest tube hold?

2000 mL

Where is a chest tube placed for fluid?

8-9 intercostal space

After thoracic surgery a client has a chest tube connected to a water-seal drainage system that is attached to suction. When excessive bubbling is observed in the water-seal chamber, the nurse should: A. Strip the chest tube catheter B. Check the system for air leaks C. Decrease the amount of suction pressure D. Recognize that the system is functioning correctly

B. Check the system for air leaks

A client who had a thoracic surgery is admitted to the post anesthesia care unit. What should the nurse do after the chest tube is attached to a disposable plastic water-seal drainage system? A. Check that the fluid level in the water-seal compartment increases with expiration. B. Empty the drainage container and measure and record the amount once a day. C. Ensure the security of the connections from the client to the drainage unit. D. Verify there is vigorous bubbling in the wet suction control compartment.

C. Ensure the security of the connections from the client to the drainage unit.

A spontaneous pneumothorax is suspected in a client with a history of emphysema. In adding to calling the healthcare provider, which action should the nurse take? A. Administer 60% oxygen via a Venturi maks B. Prepare for intravenous (IV) administration of electrolytes C. Give oxygen at 2 L per minute via nasal cannula D. Place the client on the unaffected side

C. Give oxygen at 2 L per minute via nasal cannula (prevent anoxia)

A client with a chest tube is to be transported via a stretcher. When transporting the client, what should the nurse do? A. Keep chest tube end covered with sterile gauze pads taped to the client B. Keep collection device attached to mechanical suction C. Keep collection device below the level of the client's chest D. Keep chest tube clamped distal to the water-seal chamber

C. Keep collection device below the level of the client's chest (Prevent back flow)

When assessing a client with a pleural effusion, what does the nurse expect to identify? A. Moist crackles at the posterior of the lungs. B. Increased resonance with percussion of the involved area. C. Deviation of the trachea toward the involved side. D. Reduced or absent breath sounds at the base of the lung.

D. Reduced or absent breath sounds at the base of the lung. Compression of the lung by fluid that accumulates at the base of the lungs reduces lung expansions and air exchange.

What does it mean when there's no fluctuation in the water seal chamber?

Possible air leak