376 Burns disaster chest tube Test 3

If its connected to the wall suction -

1 -1/2 inches from pt when it falls over ****

3) A nursing student KICKS OVER THE DRAINAGE SYSTEM . What should you do first 1) Ask patient to exhale fully and cough 2) Reconnect the tube to collection chamber port 3) Clamp the chest tube near insertion site 4) Disinfect the end of chest tube 4) What next? 1) Clamp the tube 2) Reconnect the chest tube to the collection chamber port Disinfect

1) -this action will help rid the pleural cavity of any remaining air and will retain negative intrapleural pressure while you atend the chest tube 1) 1-just for a moment as long as you see no signs of air leak such as continuous bubbling gin water seal chamber. If there is an air leak, immerse the end of chest tube in 1 inch steril fluid to restablish the water seal .

9) REMOVAL OF CHEST TUBE 1. Reinforce instruction to breathe deep while being removed 2. Cover site with occlusive dressing after removal 3. Clamp chest tube near insertion just before removal 4. Raise the drainage system to level of chest tube insertion 5) Have client perform the valvasa maneuvers as chest tube is pulled out

1) 2 and 5 Take a deep breathe and bear down(valvasa) quickly withdrawn and an airtight( occlusive dressing placed) hold breathe while tube removed must be LOWER

10) Intervention for chest tube 1. Pin tubing to bed linen 2. Be sure all connecting upright 3. All connections are taped and secure 4. Monitor for tubing kinked 5. Empty drainage from drange collection chamber daily

1) 234 Closed system never pinned to bed and not opened and emptied bc closed system if open air pressure causes air to rush in and lung collapse acan occur

JP DRAIN CARE 1) If plug touched- clean with alc swab 2) Squeeze bulb __ and put back 3) Measure the amount 8) JP REMOVAL 1) Amount of fluid that drains will decrease as wound heals 2) Removed when less than ____ is collected in 24 hours Discharged with still in

7) JP DRAIN CARE 1) If plug touched- clean with alc swab 2) Squeeze bulb flat and put back 3) Measure the amount 8) JP REMOVAL 1) Amount of fluid that drains will decrease as wound heals 2) Removed when less than 30ml is collected in 24 hours Discharged with still in

7) The nurse is assisting with monitering chest tube who just returned from surgery? What to find? 1. Excess bubbling in water chamber 2. Vigorous bubbling in suction controlled chamber 3. 50ml drainage in drainage collection 4. Drainage system below chest 5. Occlusive dressing is in lace over chest tube insertion 6. Fluctuation of water ini the tube of the of the water seal chamber during inhilation and exhalation

7) The nurse is assisting with monitering chest tube who just returned from surgery? What to find? 1. Excess bubbling in water chamber 2. Vigorous bubbling in suction controlled chamber 3. 50ml drainage in drainage collection 4. Drainage system below chest 5. Occlusive dressing is in lace over chest tube insertion 6. Fluctuation of water ini the tube of the of the water seal chamber during inhilation and exhalation a. 3456 1) -no , no The nurse notes fluctia

Z) Closed chest drainage system has ceased . When you inspect YOU OBSERVE CONTINOUS BUBBLING 1) Assess all connections between patient and drainage system 2) Continous bubbling 3) Loose connection= common air leak THEN

=water seal chamber= air leak somewhere btwn pt and water seal. First, tighten any loose connection then recheck for continuous bubbling Cross clamp the chest tube close to the pt chest. If the bubbling in thewater seal chamber stops, the air leak is at the insertion site or within the pt throax. IF it stipped youd release the CROSS CLAMP reineforce chest dressing , and notify physician . Leaving chest tube clamped can cause tension pneumothroax and a mediastinal shift.

14. The chest tube may be removed when: a. the patient says it's okay b. there is less than 100 ml of drainage in 24 hours and no air leak in the water seal chamber c. there is 100 ml or more of drainage per hour

b

A nurse is caring for a client who has a chest tube. While turning the client in bed, the tube is accidentally removed. Which of the following should be the nurse's first response? • Place the tip of the catheter near the opening and secure it • Tell the client to stay still while you go to retrieve an occlussive dressing to cover the site • Place a gloved hand over the site • Turn the client so that the affected side is up

"Place a gloved hand over the site" is correct. If a client's chest tube becomes dislodged and is pulled out, the nurse should immediately cover the site with an occlusive dressing and tape. If these supplies are not immediately available, the nurse should cover the site with a gloved hand, stay with the client and call for help. Occluding the site with dressing or manually acts as a one-way valve to prevent development of a tension pneumothorax until the condition can be treated by the provider. Tell the client to stay still while you go to retrieve an occlusive dressing to cover the site" is incorrect because not covering the site immediately could result in a tension pneumothorax. The nurse should cover the site with a gloved hand or occlusive dressing to prevent air from entering the pleural space. The nurse should also remain with the client. "Place the tip of the catheter near the opening and secure it" is incorrect. The catheter is of no use once it has been removed. A new, sterile tube may need to be placed by the provider. "Turn the client so that the affected side is up" is incorrect, because this would not be helpful to the client. The client's chest tube site must be occluded right away.

JACKSON PRATT STEPS 1) After emptying the drain the bulb should be ______ to establish ____ 2) Examine the tube and container 3) Open the plug on the _____ 4) Measure the drianage in a calibrated container 5) Clean the drianage spout with antisepctic swab 6) _____ the resoruvour to establish ____

1) After emptying the drain the bulb should be compressed to establish suction 2) Examine the tube and container 3) Open the plug on the resrouvr 4) Measure the drianage in a calibrated container 5) Clean the drianage spout with antisepctic swab 6) Compress the resoruvour to establish suction

1) Jackson Pratt drain reservour expanded and half full of blood 2) You empty Jackson Pratt - to reactivate the jackson pratt you?

1) Empty the reservoir- Jackson pratt incorporates flexible BULB that aspirates drainage from the found by self suction. When 1/2 full= suction is demisted so empty it 2)2) You empty Jackson Pratt - to reactivate the jackson pratt you? 1) Collapse the drainage bulb fully and secure the seal. Each time you empty the jackson pratt drain u must reestablish its connection to suction. = squeeze bulb to let out air hwen fully collapsed-seal the drainage spout to allow for negative pressure within the device to continue to draw drainage from the wound

1) INDICATIONS FOR CHEST TUBE REMOVAL 1) _____ has decreased to little or none 1b) - Guidelines: less than ______ in 24 hours or less than _______ in 8 hours ( use _______ in 24 hours) 2) Air leak has _____ 3) - Pt ______ 4) ______ in water chamberh ave stopped 5) Chest x-ray shows________with no ___ or ___ *B4 removal ______ 6) Take deep breathe exhale and bear down ( ____ maneuver) or take a deep breathe and hold it (^ ntrathoracic pressure and reduces risk of ____ during chest removal ) 1) Trachial deviatin AWAY FROM SITE

1) INDICATIONS - Drainage has decreased to little or none - Guidelines: less than 300 in 24 hours or less than 100ml in 8 hours ( use 100ml in 24 hours) - Air leak has disappeared - Pt breathing normally without sign of resp - Fluctions in water chamber ave stopped - Chest x-ray shows lung reexpansion with no residual air or fluid in pleural space - B4 removal give pain meds - Take deep breathe exhale and bear down ( valsalva maneuver) or take a deep breathe and hold it (^ ntrathoracic pressure and reduces risk of air emboli during chest removal ) 1) Trachial deviatin AWAY FROM SITE

C) Removal of chest tube

1) Lie on left side 2) Use incentive spirometer 3) Cough at reg intervals Perform the valsalva maneuver

Clamping has no effect what do you do next?

1) Move the clamps down the drainage tube- using 2 clamps gradually move them one a ttime down the drinage tubing away from pt and toward drianage chamber. When bubblng stops youll known that the leak is in the section of tubing distal to the clamp. You can then replace the tubing or secure the connection & release the clamp

1) ______ in pleural space from infection ____ and ___ 2) Damage to pleural space and membrane 3) ____ around the dressing site to check for ____- air in tissues under that produce_______sensation on palpation 4) Cause 1) P 2) Tb 3) Lung abscess 5) SIGNS 1) C 2) Sob 3) Chest pain ( deep breathe) 4) Fever and chills 6) TX 1) Placement of ____ 2) ____ ( tap) 3) ABX

1) Purulent drainage in pleural space from infection like pneumonia or lung abscess 2) Damage to pleural space and membrane 3) Palpare around the dressing site to check for sub q emphysema- air in tissues under that produce CRACKLING sensation on palpation 4) Cause 1) Pneumonia 2) Tb 3) Lung abscess 5) SIGNS 1) Cough 2) Sob 3) Chest pain ( deep breathe) 4) Fever and chills 6) TX 1) Placement of CT 2) Throacentessis ( tap) 3) ABX

VAC 1) _______wound therapy ( NPWT) 2) Removal blood serous fluid/exudate from wound or operative site 3) Area covered with _______ secreted to the healthy skin around wound 4) Exposed end of drain tube is___________, fluid drawn out from wound thru foam into a r_______ 5) Plastic membrane - ________ reducing 6) The application of_______ removes edema fluid from wound thru suction 7) USE + BENEFITS i. _____ wound ii. _____ wound healing iii. Decrease in dressing iv. Reduces the need for materials and qualified personall

1) VAC 1) Neg pressure wound therapy ( NPWT) 2) Removal blood serous fluid/exudate from wound or operative site 3) Area covered with transparent adhesive secreted to the healthy skin around wound 4) Exposed end of drain tube is connected to a vacuum source, fluid drawn out from wound thru foam into a resourvour/device 5) Plastic membrane - prevents the ingress of air + allows partial vaccum to form within wound= reducing volume and removing fluid 6) The application of NEG pressure in vac removes edema fluid from wound thru suction 7) USE + BENEFITS i. Chronic wound ii. Faster wound healing iii. Decrease in dressing iv. Reduces the need for materials and qualified personall

HEMOPNUEMOTHROAX 1) __ and ___ in pleural space 2) requires insertion of ____ 3) they are placed 1-____

1) blood and air 2) insertion of 2 chest tubes 3) CT 1-apex 2nd intercostal 4) ct 2- at base of lung

Open Pnuemo 1) ___ & ____are penetrated 2) air enteres pleral space CAUSE 3) penetrating trauma 4) surgery

1) chest wall and pleural space are penetrated

benefits of vac

1) chronic wounds 2) faster wound healing 3) decrease in freq of wound procedures

SUCTION CHAMBER: CHEST TUBE ASSESS 1) h20 is at level 2) connected to wall suction and its turned to _ 3)__ hg

1) connected to wall suction and turned on to continous 2) 10-20 hg

Spontaneous pneumothroax A) CAUSE 1) excess ___ 2) smoking 3) tall thin men 4) copd 5) ruptured pnl THERAPY 1) high flow 02 2) ____ 3) high fowler

1) coughing 2) chest tube

If the chest tube becomes expelled 1) do not___ 2) cover the opening with ______ and keep ____

1) do not leave patient 2) ccover with sterile 4-4 gauze

contra for cupping and postural drainage

1) head injuries 2) copd 3) history of cardiac

Deep breathing technique 1) position 2) place hands palms ____, with ___ fingers touching along the rib cage 3) ask pt to ____ slowly thru nose , feeling __ fingers seperate and hold breathe for 3-4 seconds 4) have pt exhale slowly thru mouth 5) repeat ___ Controlled coughing 1) if ___ breath sounds or sputum. Have pt take a deep breathe and _____ for 3 seconds and cough 2-3 times 2) stand at patients side 3) if pt has abdominal or chest incision during cough, hold pillow over inciscion which is called ____ 4) 2-3 hour post op

1) high fowler 2) facing down, middle fingers touching 3) inhale thru nose, feeling middle fingers seperate 4) 3-5x Controlled: 1) adventicious breath sounds, hold for 3 seconds 3) splinting

Incentive spirometer steps 1) position? 2) determine volume to set goal based on calculated ________ a) seal lips tightly aorund mouthpiece b) ___ slowly and deeply thru mouth, hold for 2-4 seconds c) observe for progress d) exhale slowly around mouthpiece normally e) ___ times every ___

1) high fowler 2) lung volumes b) inhale d) 5-10 times every 2 hours

Inspiration 1) involuntary 2) air moves in and out due to changes in __ 3) ___ stimulated (contracts and _____) 4) external intercostal- move the ribcage up and down 5) chest wall and parietal pleura- move ____ puling visceral pluera and lung with it 6) volume thoracic cavity ______ (increases/decrease) - the pressure in the lungs ___ 7) intrapulmonary pressure is now ____ than atmospheric pressure thru air flows out into lungs.

1) involuntary 2) air moves in and out due to changes in LUNG 3) DIAPHRAGM stimulated (contracts and DOWNWARD) 4) external intercostal- move the ribcage up and down 5) chest wall and parietal pleura- move RIBCAGE puling visceral pluera and lung with it 6) volume thoracic cavity INCREASES (increases/decrease) - the pressure in the lungs DECREASE 7) intrapulmonary pressure is now LOWER than atmospheric pressure thru air flows out into lungs.

Assess status of chest tube 1) tubing remains at ___ of patient and no ____ tubes are present 2) no visible clots 3) gently "__" compress with fingers BUT NEVER ___

1) level of pt and no dependent tubes are present 3) "milk" NEVER STRIP

Clinical need for chest tube 1) ___ pressure in pleural cavity is disrupted and there is ___ compromise Purpose of chest tube 2) evaculate air or fluid from ____ and reestablish negative intrathoracic pressure 3) chest tube placement faciliates ________

1) negatie and there is pulm compromise 2) chest cavity 3) chest tube placement faciliate expansion of lung

SYSTEM FALLS OVER 1) If to wall suction: set up_______, clamp chest tube ________ inches from pt, place a second clamp _______ distal to first, remove the old system , connect new, record drainage 2) GRAVITY DRAINAGE: set up new drainage system, disconnect and connect **** NEVER CLAMP A CHEST TUBE FOR MORE THAN 1 MINUTE AND ONLY CLAMP IT TO CHANGE DRAINAGE UNITS****

1) new system 1-21/2 inches from pt then second clamp 1 inch distal

EXPIRATION 1) Diaphragm retunrs to _____ state 2) intercostal muscles- __ as the chest wall moves in 3) lungs- _____ 4) intrapulmonic pressure now ___ than atmostpheric

1) normal relaxed state 2) relax chest wall moves in 3) lungs - elastic recoil pulls inward and air flows out fo lungs 4) GREATEr

Closed pneumothorax 1) penetration of pleural space BUT CHEST WALL ______ 2) air enters ___ from within ___ CAUSE 1) C 2) cf 3) lung disorder

1) remains intact 2) air enters from pleural space from within lung 3) cancer

Goals for Deep breathing 1) faciliate ___ 2) increase __ 3) and prevent A_____ 4) encouorage exporation of mucus and secretion that accumulates after ___ and ___

1) resp functoning 2) increase lung expansion 3) alveolar collapse 4) airways after general anastehsia and immobility

ASSESSING DRAINAGE COLLECTION CHEST TUBE 1) keep ___ 2) 3 things to loo kfor 3) mark the amount 4) keep ___ chest level 5) measure and record every ___

1) upright 2) amount color characteristic 4) below 5) 8 hours

Incentive spirometer goal 1) incentive is ____ cues 2) increase ___ ventilation and oxygenation 3) loosens ____ 4) prevents ____ by _______

1) visual cues 2) pulmonary 3) loosens secretion 4) prevents atelectasis by expanding collapsed alveoli

TENSION PNEUMOTHORAX 1) __ leaks into ___ thru ___ in the ___ and it has no way to espace 2) each breathe air accumulates in the ____ increasing the ___ pressure which compressess the lungs adn shifts the _______ to the ______ side of the chest 3) venous return and __ decrease 4) lung ___ then pressure moves to -___ side 5) life threatening and emergency S+S 1) Rapd ___ 2) tach 3) C+++ 4) hypoxic dyspnea 5) H____ with distended neck vein 6) sudden chest pain that extends to ___ ****__________** SIGN

1)air leaks into pleural space thru tear in lungs 2) in pleural space and increases pos pressure comrpesses lungs and shifts to the medianistum to the unnaffested side 3) and co2 rdecreased 4) lung collapses then pressure moves to unaffected sid 1) rapid breathing 3) cyanosis 5) hypotension 6) unaffected side ***deviation of trach away from the tension shift in the mediastinum

1) Peak Flow is point of __________ 2) better control for pts with ___ by quicly detecting ___ in airway ___ so that preventative measures can be instilled 3) ____ data to acccess resp STEPS 1) position __and put indicator at ___? 2) tell pt to ______ then place the meter in his mouth. The pt should close his lips around mouthpiece ( do not put tongue) 3) tell pt to _____ with __ attempts 4) repeat steps ____ and record __ 5) Green= 6) yellow 7) red- 8) TWICE a day PEAK FLOW before ____

1)highest flow maxial exhalation 2) asthma, subtle changes in airway diametere so that preventative measures can be instilled 3) objective data to assess resp 1) stand, base 2) take deep breathe then place meter in mouth 3) exhale fast and hard 3 attempts 4) repeat twice more and record highest 5) green-80-100 6) yellow -50=80 7) red- below 50 8 ) 2x a day b4 BRONCHODILATOR THERAPY

Q) Education who has a chest tube in place attached to a closed chest drainage system following surgery for lung cancer. Which of the following should the nurse emphasize to pt when he is ready to AMBULATE FREELY 1) Keep collection device upright at all times 2) Disconnect when showering 3) Keep collection device at chest level at all times 4) Allow tubing to hang in dependent loop when ambulating

1- Up right at all times to ensure that the tubing drains optimamy and system functions correctly 2- No, NOT DISCONNECT 3- No-BELOW NO- when cannot avoid them- nurse should lift tubing every 15 to allow its content to drain

1. What are three things that indicate a chest tube is properly functioning?

1. What are three things that indicate a chest tube is properly functioning? a. Gentle bubbling in suction control if wet suction is used. b. Tidaling in water seal c. Consistency in drainage

1. What is the purpose of incentive spirometry?

1. What is the purpose of incentive spirometry? Promotes deep breathing with good inspiratory effort to minimize risk of atelectasis and potential development of pulmonary infections such as pneumonia.

Why is coughing and deep breathing useful for clients?

1. Why is coughing and deep breathing useful for clients? Promotes better exchange of oxygen and carbon dioxide, decreases risk of atelectasis and risk for pneumonia. It is the BEST way to clear the airways.

R) A nurse is preparing to care for a client following chest tube placement which items should be in the romo 1) Oxygen 2) Sterile water 3) Enclosed hemostat clamps 4) Indwelling urinary cath Occlusive dressing

1235

D) A nurse is planning care for a client following the insertion of a chest tube and drainage system which of the following 1) Encourage the linet to cough every 2 hours 2) Check for continuous bubbling in the suction chamber 3) Strip drianage tubing every 4 hour 4) Clamp tube once a day Obtain a chest xray

125

A) The chest tube was accidently removed which should be FIRST 1) Chest x-ray 2) Apply sterile gauz 3) Place tape around insertion site Assess resp

2

COLLECTION CHAMBER 1) Fluid blood drains there 2) Checked ___ initially 3) Prescriber if there is >___ML 4) EVERY ASSESSMENT***- document C , C, At of drainage( mark ) 5) May be milked without an order to remove clots 6) CD tubing should NEVER be stripped without an order

2) 1 hour 3) >100 4) color consistenty amount

TUBE FALLS OUT (CHEST TUBE)NI 1) Immediately _______ 2) - If pt has known air leak prior to tube out , ________ NOTIFY PROVIDER IMMEDIATELY

2) TUBE FALLS OUT - Immediately cover site with vaseline gauze to prevent air from entering chest - If pt has known air leak prior to tube out , cover with dry sterile dressing and tape NOTIFY PROVIDER IMMEDIATELY

WATER SEAL CHAMBER 1) Air ____ on ____but air CANNOT ____ 2) No bubbling only on insertion 3) Gentle tidaling 4) Keep ______ 5) Tidaling i. Fluid will +_____ on Inspiration(increase in neg pressure) and _____ during expiration ii. Water fluctuates with inspiration and expiration iii. Fluctiatin n fluid level indicates ________________ iv. Fluctuation diminishes as r________. If TIDALING STOPS THEN LUNG HAS _______******** 6) Bubbling i. Intermitted bubbling- small air leak ii. Large amount- large air leak iii. Unexpected absence of bubbling- obstrution kink, dependent loop, clott

2) WATER SEAL CHAMBER 1) Air EXITS on EXHALATION but air CANNOT ENTER 2) No bubbling only on insertion 3) Gentle tidaling 4) Keep upright 5) Tidaling i. Fluid will RISE on Inspiration(increase in neg pressure) and fall during expiration ii. Water fluctuates with inspiration and expiration iii. Fluctiatin n fluid level indicates pressure changes in pleural iv. Fluctuation diminishes as lung re expands and fills pleural space. If TIDALING STOPS THEN LUNG HAS REEXPANDED 6) Bubbling i. Intermitted bubbling- small air leak ii. Large amount- large air leak iii. Unexpected absence of bubbling- obstrution kink, dependent loop, clott

2. What are the four main causes for lack of tidaling in a chest tube drainage unit?

2. What are the four main causes for lack of tidaling in a chest tube drainage unit? a. Lung has re-expanded b. Tubing is kinked c. Tubing has loop resting below the rest of tubing or resting on floor d. Tubing occluded with clots

CHEST TUBE DISCONNECTs FROM COLLECToR

3) CHEST TUBE DISCONNECTS FROM COLLECTOR*** - Immediately imrese the chest tube into bottle of NS or sterile water NOTIFY PROVIDER

What are the adverse effects of shallow breathing or an ineffective cough?

3. pneumonia, 4. atelectasis, decreased oxygen/carbon dioxide exchange

Q) On auscultation you cannot hear any air movement around the entire lung field on Right side his 02 is 84% 1) Assess dressing over chest insertion 2) Verify the function of the closed chest drainage system' 3) Prepare for another chest tube insertion 4) Inspect the tubing for any kinks or occlusion R) Aftr he recovers you tell him to use the INCENTIVE SPIROMETER 1) Admin pain 2) Assess pain 3) High fowlers Teach him how to use incentive

4, 2

Red -_ yellow_ green_ black_ 1)expectant 2) non urgent 3) urgent ( second highest) 4) emergent ( first priority)

4, 3, 2-greeen non urgent , 4 -black expectant

Q) 6 hour post op and chest tube attached to a closed chest water seal drainage system. The nurse should observice for which of the following PROBLEMS WITH DRIANAGE SYSTEM 1) Constant bubbling in suction control chamber 2) Fluctuations in fluid levein in water seal chamber 3) Occasional ebubbling in water seal Continuous bubbling in water seal

4- Continous bubbling in water seal chammber- indicates air leak in drainage system= nurse should use rubber tipped clamps to try to LOCATE the leak by CLAMPING momentarily along its length 1- Expected 2- Expected-reflects pressure changes in pleural space during respiration. STOPPPED- when lung expanded or obstructed - a dependent loop handgs below tubing or the suction source is not functioning 3- Occasiional bubbling in water seal chamber indicates removal of air from pleural space

5) Blood tinged watery yellow drainage from jackson pratt

5) Blood tinged watery yellow drainage from jackson pratt 1) Serosangineous 1- Purulent= thick yellow green brown Serous- pale yellow watery plasma

JP DRAIN 1) Empty ____ when_______- 8-12 hours 2) Graduated container/cup to measure 3) ____ GLOVES 4) Remove plug from the bulb 5) Pour fluid into measuring cup without touching cup or plug stopper

6) JP DRAIN 1) Empty bulb when 1.2 full - 8-12 hours 2) Graduated container/cup to measure 3) CLEAN GLOVES 4) Remove plug from the bulb 5) Pour fluid into measuring cup without touching cup or plug stopper

What is the purpose of peak flow measurements?

6. What is the purpose of peak flow measurements? 1) Provides baseline best maximal expiration to evaluate airway diameter. 2) Determines best effort after bronchodilator therapy. 3) Provides information to patient with reactive airway disease (i.e., asthma, COPD) to determine when to use rescue bronchodilator such as albuterol, failure to respond to treatments and when to seek medical/emergency interventions for bronchospasm.

B) Chest tube and drainage system in place which of the following are expected 1) Continuous bubbling in water seal chamber 2) Gentle constant bubbling in the suction control chamber 3) Rise and fall in level of water seal with inspiration and exporation 4) Exposed suture without dressing Drainage system upright at chest level

A) 2, 3 1- No continous bubbling in the water means air leak 2- Yes gentle bubble is expected 3- Yes rise and fall 4- No 5- Upright BELOW level of chest

Q) A nurse is preparing to transport a radiology pt who has a chest tube and a closed chest wet suction drainage. The provider allows disconnecting the drinage tube from the suction source during transportation. Which of the following must the nurse do when DETATCHING THE SUCTION SOURCE 1) Clamp chest tube 2) Attach mobile drianage device 3) Make sure air vent open Empty the collection chamber

A) = make sure the air vent is open. Some contain suction device vent from the h20 chamber. This allows the drianage unit to remain vented without suction. Make sure the exit vent is open when disconnecting the suction source. Other systems allow air to exit thru suction control tubes- nurse should keep suction control tubing uncapped and free from occlusion to prevent buildup of air from inside the pleural cavity 1-NEVER CLAMP A CHEST TUBE during transportation = ^ tension pneumothorax . Acceptable to clamp briefly when replacing drainage system or air leak But not for the length of time this patient wil be away from suction source 2-unecessary and not cost effective 4-closed chesst wet suction drainage are not DISPOSABLE. When colelction is nearly full then it should be REPLACED not attempt to EMPTY IT

REASONS TO USE WOUND DRAINAGE SYSTEM 1) ____incidisons 2) Decubiti 3) B____ 4) Types of drains= depends on type of srugery 5) Tpe of drainage needed and how much expected Surgeon pref

A) REASONS TO USE WOUND DRAINAGE SYSTEM 1) Post op incidisons 2) Decubiti 3) Burns 4) Types of drains= depends on type of srugery 5) Tpe of drainage needed and how much expected Surgeon pref

CC) A nurse is caring for a pt who has a CHEST TUBE in place attached to a CLOSED_CHEST_WATER SEAL DRAINAGE SYSTEM following thoracic surgery. Which of the following strategies should the nurse use to hep promoto comfort 1) Have pt SPLINT the AFFECTED side during COUGHING 2) Perform PROM 3) Position pt SUPINE with minimal elevation Encourage AMBULATION

A- 1 have pt splint - essential for chest tube to COUGH = prevent post op comp, drain pleural space, expand lungs. Splinting AFFECTED side minimize pain . Also admin ANALGESIA To help reduce pain 2-although PROM on affected sdie can help painful admin analgesic 30 min before activity 3-no UPRIGHT position of pt allow optimal lung expansion the nurse should elevate 30 degree or higher Administer analgesic 30 mn b4 ambulation

Q) Chest tube water seal drainage. Which of the following observation shoulld be reported If found 5 hour after insertion 1) A total of 400ml since insertion 2) A gush of fluid when repositioning the pt 3) About 150ml/hr over the past 2 hour 4) A sig decrease in drainage over the past 3 hours

A- 3- about 150ml/hr over the past 2 hour. The nurse should report anything above 70ml/hr . Pt who lose 100ml of blood every 15 minutes require autotransfusion within 6 hours 1-total of 400mL since insertion- nurse should expect 100-300 ml of fluid during first 3 hours after pleural insertion of tube. 2hr after-within expected range 2-gush- often retained blood not active bleeding 4-100-300 ml of fluid during first 3 hours of insertion it decliens after about 2 hr so this is expected

Q) Nurse acdcidnetly DISCONNECTS THE CHEST TUBE FROM DRAINAGE . Which of the following should the nurse to do PREVENT A SERIOUS COMPLICATION while preparigng to reconnect the system ? 1) Clamp the chest tube close to pt chest 2) Submerge end of chest in 1 inch sterile water 3) Gently milk the chest tube in proximal - distal direction Tape gauz around open end of chest tube

A-2 submerge the end of the chest tube in 1 inch of sterile water - this creates water seal and prevents air from entering the pleural space thru the open end of the chest utbe when the patient 1-clamping puts risk for tension pneumothorax 3-gently milking involved intermit compressing it in the area of the clot for 1-2 seconds. Could increase neg pressure within system to a lvevl that could dmaage pleural tissue 4-no

Q) Immediate thoractomy and chest tube insertion and anticipates the need for max suction pressure. The appropraite type of closed tube chest drainage system is ? 1) Pneumostat 2) Water seal 3) Heimlich 4) Dry suction control system

A-4 Dry suction control system- allow for high suction pressure by adjusting dial on front surface of the system to deliver pressure up to 40cm of water. Need high =massive air leak from lung surface, emphysema, or viscous pleural effectusoon or reduciton in pulm 1- Pneumostat= mobile chest drain with a 1 way valve that attaches directly to the chest tube to collect fluid. SMALL OR PARTIAL PNEUMOTHROAX not high pressure 2- Water seal- regulates the amount of suction by height of water- 20cm Not highest 3- Heimlech- Mobile chest drain with 1 way flutter valve that allows air to escape but keeps it from reentering chest cavity- small or partial pneumothorax- DOES NOT COLLECT FLUID

Y) As you help pt turn to Left side 2 hour later - sudden gush of drainage in collection chamber. What should you do

Assess resp - often retained blood and not active bleeding however if they are actively bleeding expect to see change in LOC ^ resp as blood fill pleural space , absense of resp distress ^ llikelhood that drainage was retained fluid that escapd during the position change

HEMOVAC 1) Portable wound suction device that is _____ to provide ____ 2) HEMOVAC DRAIN i. Connected to additional suction as needed ii. ___ Suction that pulls drainage from body into collection tank

C) HEMOVAC 1) Portable wound suction device that is compressed to provide gentle suction 2) HEMOVAC DRAIN i. Connected to additional suction as needed ii. Closed Suction that pulls drainage from body into collection tank

D) PENROSE DRAINAGE 1) Open 2) Flexible rubber tube inside site of wound but exits _____ from the incising site or line 3) Small _____ is left in place at ____ of the prenrose on the ____ so it cant slip back into wound 4) Acts like a ________-pulls fluid out of wound and drain the outside of wound 5) Drainage 1) Collects on the ____ ___ pulls it out 2) Removed dressing 4 drainage 3) High risk t________when dressing changed As healing- slowly pulled out , clipped to promote healing in the areas of wound

D) PENROSE DRAINAGE 1) Open 2) Flexible rubber tube inside site of wound but exits AWAY from the incising site or line 3) Small safety pin is left in place at END of the prenrose on the OUTSIDE so it cant slip back into wound 4) Acts like a STRAW-pulls fluid out of wound and drain the outside of wound 5) Drainage 1) Collects on the dressing , gravity work to pull it out 2) Removed dressing 4 drainage 3) High risk to fall out or be pull out when dressing changed As healing- slowly pulled out , clipped to promote healing in the areas of wound

7. The water seal chamber is filled with Normal Saline Solution. 8. The level of suction applied is documented in centimeters. 9. The air vent must be clamped every other day for four hours. 10. The nurse has the responsibility to maintain an intact and patent pleural/chest drainage system.

F 7. The water seal chamber is filled with Normal Saline Solution. (Filled with sterile water.) T 8. The level of suction applied is documented in centimeters. F 9. The air vent must be clamped every other day for four hours. T 10. The nurse has the responsibility to maintain an intact and patent pleural/chest drainage system.

O) CHEST TUBE PLACEMENT 1) Inserted high and anteriorly= Low posterioly

HIGH AIR LOW FLUID

INDICATIONS FOR CHEST TUBE 1) inserted following ______ prevent 2 thingss ___+ ____ 2) inserted as medianistal tubes MT TUBES 3) prevents ___ or ___ from reentering pleural space 4) reestablish the usual intrapleural intralemanl pressure 5) apply ______ can also remove fluid from pleural space

INDICATIONS FOR CHEST TUBE 1) inserted following surgery to prevent acumulation of fluid around the HEART and prevent CARDIAC TOMPANADE 2) prevents air from reentering pleural space 3) resstablish intraplerual intralumenal pressure 4) apply low level suction

11. If the chest tube falls out of the patient who does not have an existing air leak, one would________________________ and call the physician. a. cover with a dry sterile dressing b. leave the site alone c.cover with a petrolatum (Vaseline) gauze

c

How would you position a patient who is going to have a left sided chest tube inserted?

On their right side with left arm up (if possible) and back stretched slightly to expose left midaxillary area

CHEST TUBE COMPLICATIONS 1) B_______: if _______nicked during insertion. 2) INFECTION 3) _______: air leaks from pleural into subq. - Swelling in face, neck, and chest - Rice krispies when palpated 4) ____- insertion

Q) CHEST TUBE COMPLICATIONS 1) Bleeding: if blodo vessel nicked during insertion. 2) INFECTION 3) SUBQ EMPHYSEMA: air leaks from pleural into subq. - Sweling in face, neck, and chest - Rice krispies when palpated TENSION PNEUMTHROAX- insertion

T F 1. The insertion of a chest tube is a sterile procedure. F F 2. A consent for chest tube placement is obtained from the patient after sedation for the procedure. (Consent obtained before sedation.) T F3. When the physician is inserting the chest tube, ensure the patient's back is properly stretched to allow easier access to the intercostal space.

T, F, T

chest tube is in pt hand what is the first thing you do

apply petroleum jelly

rythme-absent rate-none pwave-absent pr interval-indeterminte qrs- absent

aystole

A nurse is caring for a client who has a chest tube after a motor vehicle accident. The provider has ordered low suction for the chest tube. Which interventions would the nurse utilize when managing suction on this chest tube? Select all that apply. • Suction is always at low-intermittent suction with a chest tube, never continuous suction • The nurse should note tidaling when the client breathes • The apparatus should make a sucking sound at the insertion site • The wall suction should be set at > 80 mmHg • The nurse should notify the provider if there is a sudden increase in drainage

The wall suction should be set at > 80 mmHg", "The nurse should note tidaling when the client breathes" and "The nurse should notify the provider if there is a sudden increase in drainage" are correct. When a wet suction control unit is used, the level of water determines the amount of suction inside the chest cavity. The wall suction should be set at >80 mmHg for a suction level of -20 mmHg. Tidaling in the water-seal chamber means that the client is breathing, and is normal. However, intermittent or continuous bubbling in the water-seal chamber means there is an air leak. The leak should be located and fixed immediately, and the provider needs to be notified if the nurse is unable to find the leak. If there is a large increase in the amount of output from the chest tube, the provider must also be notified right away. "The apparatus should make a sucking sound at the insertion site" is incorrect. If there is a sucking sound at the insertion site, this is a medical emergency and must be addressed immediately. "Suction is always at low-intermittent suction with a chest tube, never continuous suction" is incorrect. While low-intermittent suction is most common, it is not the only suction setting used.

V) ChEST TUBE REMOVAL -prepare you admin pain medication. Then what? 1) Ask pt to lie on unaffected side 2) Show pt how t perform valsalva maneuver 3) Apply occlusive dressing

V) ChEST TUBE REMOVAL -prepare you admin pain medication. Then what? 1) Ask pt to lie on unaffected side 2) Show pt how t perform valsalva maneuver 3) Apply occlusive dressing 2-Valsalava's Maneuever- exhaling completely and bearing down. Doing this immediately b4 chest tube removal maintain neg pressure in pleural cavity during removal. = preventing air from entering pleural space.

W) Chest tube on bed- dark blood oozing from insertion site 1) Apply occlusive dressing 2) Prepare for another chest tube 3) Assist in high fowler 4) Assess rate depth and quality of resp X) After preparing the occlusive dressing what next

W) Chest tube on bed- dark blood oozing from insertion site 1)*** Apply occlusive dressing 1) Apply occlusive dressing- risk for air entering pleural cavity as he inhales 2) Apply dry gauze to chest tube insertion while contacting physician 3) Then seal the dressing with occlusive mateiral - 3 sides only 4) 3 sides only- allows air to escape thru the wound but prevents air from entering when pt inhales. 5) Air that cannot escape cause a tension pneumothorax X) After preparing the occlusive dressing what next Assist to high fowler to promote drainage from fluid

2. There will be a large amount of bubbling in the water seal chamber when: a. there is a leak in the system or the patient b. the patient coughs or deep breathes there is an occlusion in the tubing

a

3. Normal, intermittent bubbling occurs in the water seal chamber when: a. it is first connected to suction b. there is an occlusion in the tubing when the collection chamber is overfille

a

9. Encouraging a patient to cough and deep breathe after a chest tube is placed facilitates which of the following? a. emptying of the pleural space so the lung can expand and prevent atelectasis b. clear the airway of secretions maintain proper chest tube placement

a

a. ______ (cupping): striking the chest rhythmically so that vibrations are transmitted to the mucosal laden bronchioles. Facilitates removal of bronchial secretions. b. ____placement of hands on chest wall with rapid vibrations while patient is exhaling. Helps loosen secretions, promote cough to clear them from airways. c. _____ use of gravity to facilitate removal of secretions from various lung segments.

a-percussion b-vibration c-postural drainage

a. involves a mediastinal shift and tracheal deviation b. accumulation of lymphatic fluid into the pleural space caused by tumors or mediastinal surgery c. air enters the pleural space from within the lung; the chest wall is intact d. purulent drainage from an infection such as pneumonia into the pleural space e. both the chest wall and the pleural space are penetrated f. blood in the pleural space g. air enters the pleural space through a rupture in the lung wall caused by trauma or a lung disorder such as ruptured blebs h. excessive fluid in the pleural space i. blood and air in the pleural space

a-tension pneumothorax b-chlyothorax c-closed pneumothorax d-emphema e- open pnuemo f- hemothorax g- spontaneous pneumo h- pleural effucsion i - hemopneumothroax

What are the assessments that are performed pre and post chest tube insertion?

a. Pre Insertion: Obtain VS: T, HR/pulse, RR, B/P, pulse oximetry and pain assessment, auscultation of lungs (before chest tube insertion); if situation allows, administer pain med and reassess pain. Post Insertion: Check Chest tube dressing - occlusive and intact, chest tube is taped securely to collector tubing, check if presence of an air leak in the water seal chamber, check water level of water seal, check that ordered suction is dialed in and system connected to suction, drainage in collector (amount, color, consistency); auscultate lungs. Check for subcutaneous emphysema (crepitus). May feel spongy or like crunching rice krispies.

Tidaling = Bubbling +

a. Tidaling: movement of fluid in the water seal chamber column that fluctuates with normal respiration (up with inspiration; down with expiration). This diminishes as lung re-expands and negative pressure in the pleural space is reestablished. Bubbling: in the water seal chamber; normal intermittent or constant can be noted at the initiation of a chest tube. Can also be present when a patient coughs or forcibly exhales, will continue to be intermittent or constant if the air leak persists and slowly disappears as lung re-expands. A large amount of bubbling in a dry set up indicates a large patient leak but more likely to be a system leak in most patients. Unexpected absence of bubbling can mean a blockage in the tube.

Pneumothorax is ____ in pleural space 1) spontaneous 2) closed 3) open SIGNS 1) tachypnea 2) tachycardia 3) ____ breathe sounds over effected area SYMPTOMS 4) pain is worse on __ 5) dyspnea ccough 6) __ _on affected side

air 3) absent 4) afffected side 5) pain

7. During your assessment of a client with a chest tube the following symptoms are noted: muffled heart sounds, respiratory distress, tracheal deviation and dyspnea. Which of the following do these symptoms indicate? a. spontaneous pneumothorax b. tension pneumothorax c. hemothorax

b

HEMOTHROAX 1) ____ in pleural space CAUSES 2) thoracic injury 3) chest and heart surgery 4) cancer 5) tear in bp from cvs placement

blood

monitor bronchodilator

bp, hr, resp, hr, increase agitation nervousnessresltesness

12. If the patient's chest tube becomes disconnected from the system one would: a. clamp off the tubing and reconnect a new system b. let it hang and reconnect a new system c. immediately place the tube in a bottle of sterile water/at least an inch of sterile water to form a water seal

c

femoral fracture skeletall tracture pt foot is flush with footboard off the bed. principles of traction

center patient on bed

jackson pratt whats the last step

compress the reservour to establish suction

After three defibirllation attempts, a patient continues to be in pulseless ventricular tachycardia. A lidocaine bolus of 100 mg is administered intravenously. The nurse would expect which of the following as a therapeutic response to lidocaine?

conversion to a supraventricular rythme

If airor fluid enters pleural space - it seperates ___ from ____....which disrupts the _____ pressure. = prevents lungs from ____ at the end of exhalation + compresses lungs if small amount of air or fluid- may be reabsorbed if large enough- air compromises and must be evacuated when air enteres the pleural space _____

seperates visceral from parietal pleura disrupting negative pressure prevents lungs from collapsing pneumothrax

episodes of 4 premature ventric PVC in a row

dont call code blue assess orientation and vital sign s

13. If the chest tube drainage system falls over and is hooked up to suction, one would disconnect the tube from the old system and reconnect to a new system. a. True False

f

11. A patient with chest tubes must never breathe deeply or cough. Coughing and deep breathing is encouraged to support lung expansion and re-inflation and present atelectasis.) 12. Hemothorax is the collection of blood in the intrapleural space. 13. Pneumothorax is the collection of pus in the extra-pleural space. (Empyema)

f, t, f

14. The fluid in the water-seal chamber should never fluctuate with patient respiration. (Should fluctuate with patient respiration; water level boes up on inspiration and goes down with expiration.) 15. The prescriber has the option to start a chest drainage system to gravity or to wall suction. F 16. When the suction is discontinued the most important intervention by the nurse is to turn the wall suction off. (Most important interventions are: obtain VS, check for any pain or discomfort, and auscultate lungs. A risk associated with changing from suctioning to gravity is potential for pneumothorax accumulating again.

f, t, f,

10. One knows there is a leak in the chest tube drainage system when the tubing is clamped off by the patient's chest and the bubbling in the water seal chamber stops. a. True False

false

When should you empty a jp train

half full 8-12 hours

chest tube inserted ____ to drain air

high and anterior

A nurse is caring for a patient with a chest tube. He notes that the dressing around the patient's tube insertion site is wet and there is some crepitus with mild palpation. Which actions by the nurse are most appropriate in this situation? Select all that apply. • Keep the tubing below the level of the insertion site • Gently milk the tubing to remove clots, if present • Notify the provider to evaluate the level of suction • Remove the tube and place an occlusive dressing over the site • Prepare for replacement of the tube

keep tubing BELOW level of insertion, prepare for replacement of the tube, and notify provder are correct Subcutaneous emphysema may develop in a patient with a chest tube if air leaks under the skin, causing crepitus and swelling of the face and neck. The nurse should notify the physician right away and prepare to replace the tube. -"Remove the tube and place an occlusive dressing over the site" is incorrect. The nurse should never remove a chest tube without a provider order. Rather, the provider should be notified to confirm placement and evaluate the level of suction. -"Gently milk the tubing to remove clots, if present" is incorrect. Chest tubing should not be stripped or 'milked' unless a provider specifically orders this. Stripping the tubing rapidly changes the pressure in the pleural space. If clots are present, the nurse can pinch the tubing, hand over hand, until the clots move into the chest drainage unit.

after surgery of amputation lower it is bandaged to do what

limit edema

chest tube inserted ____ to drain fluid

low and posterior

the nurse should look at what lab values before cardioversion

mag 1.0- and k 2.9

LEAKS - Clamp tubing by pt chest - If chamber STOPS BUBBLING the leak______ - If the chamber doesn't stop - clamp intermittently along the tubing toward end and if you reach the end and it does not stop bubbling_____

patient in system

3) Prevent disoledgement of the drain you secure jackson pratt to the 4) Checking the dressing- jackson pratt drain is intact and draining that there is a 1/4 size fresh bloody drainage noteiable on dressing. The appropriate action at this time would be to

patient gown- bulb has small hanger to safety pin 4) mark eges apply tape outer perimeter with date adn note

12 ekg lead

recording of the electircal activity of heart

9) RISK OF JP 1) Pain 2) Positioning 3) Leaking 4) Accidental 5) Tube block crack break 6) Infection Scarring

t

Diagnosis for chest tube T) DIAGNOSIS 1) Ineffective breathing patttern 2) Infection 3) Acute pain 4) Impaired gas exchange

t

NURSING ASSESSMENTS FOR ALL DRAIN SYSTEMS 1) Amount 2) Consistency- bloody @ first then serosang, serous 3) Color 4) Odor 5) Temp T or F

t

When pt has chest tube Encourage the patient to cough, deep breathe, and use an incentive spirometer frequently. Provide analgesics as necessary. T or false

t

BEDSIDE CHECKLIST 1) Vaseline gauze 2) One bottle of NS 3) 1 roll of cloth tape 2 pairds padded kelly clamps ( hemostats)

t or false

4. To drain a hemothorax, the chest tube will be inserted between the fifth to sixth intercostal space at the mid-axillary line. 5. The patient will be positioned for chest tube insertion, according to which type of lung collapse is being treated. 6. Hemothorax and pneumothorax are two conditions that may require chest tubes to remove drainage or air from the intrapleural space. T or F

t, t, t

the water seal colum has stopped fluctuating

the lung has fully reeexpanded

palpitation and irregular fast heart beat where would LEAD v5 be placed

top left

rythme-chaotic rate-absent p wave-absent pr interval-absent qrs-absent

ventric fib

synchronized cardioversion WHAT IS NOT TREATED

ventric fib

unresponsive not breathing and without pulse, whether pt requires defib the nurse knows what can be managed by DEFIBRILLATION

ventricular tach without a pulse or ventric fib