Care of Chest Tubes

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 side of the heart.

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.

The nurse is taking a report on a patient who had a pneumonectomy 4 days ago. Which question is the best to ask during the shift report?

"Does the surgeon want the patient placed on the nonoperative side?"

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.

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 this 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 this client?

Palpate the surrounding are 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 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 the spontaneous pneumothorax should the nurse's response take into consideration?

Rupture of a subpleural bleb.

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

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

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 provider 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 water in the water seal chamber.