Chest Tube Lab

A patient injured in a motor vehicle crash is transported to an emergency department. The provider determines the need for immediate thoracotomy and chest-tube insertion and anticipates the need for maximal suction pressure. The appropriate type of closed-chest drainage system for this patient is a

A. Pneumostat
B. Water-seal System
C. Heimligh valve
D. Dry suction- control system

Dry suction-control system — Rationale: Systems that use dry suction control allow for higher suction pressures by adjusting a dial on the front surface of the system to deliver suction pressure up to -40cm of water. Some patients need high suction pressure due to a massive air leakfrom the lung surface, emphysema or viscous pleural effusion, or a reduction in pulmonary compliance.
A nurse is caring for a patient who has a chest tube in place attached to water-seal drainage. Which of the following observations about the drainage should be reported if found 5 hr after insertion?

A. Total of 400mL since insertion
B. gush of fluid when repositioning pt
C. About 150 mL/hour over the past 2 hours
D. A significant decrease over past 3 hours

About 150 mL/hour over the past 2 hours — Rationale: after the first few hours, the nurse should report drainage that exceeds 70mL/hr. Patients who lose as much as 100 mL of blood every 15 minmight require autotransfusion within 6 hr
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A nurse is caring for a patient who is 6 hour postoperative and has a chest tube in place attached to a closed-chest water-seal drainage system. The nurse should observe for which of the following indications of a problem in the drainage system?

A. constant bubbling in suction-control chamber
B. fluctuations in fluid level in water-seal chamber
C. occasional bubbling in water-seal chamber
D. continuous bubbling in water-seal chamber

Continuous bubbling in the water-seal chamber — Rationale: excessive and continuous bubbling in the water-seal chamber indicates an air leak in the drainage system. The nurse should use rubber-tipped clamps to try to locate the leak by clamping the tube momentarily at various points along its length.
A nurse is caring for a patient 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 help promote comfort for this patient?

A. Have the patient splint the affected side during coughing.
B. Perform passive ROM exercises
C. Position pt supine w/ minimal elevation
D. Encourage ambulation

Have the patient splint the affected side during coughing. — Rationale:it is essential for a patient with a chest tube to cough, not only to prevent post op complications, but also to help drain the pleural space and expand the lungs. Splinting the affected side, such as with a pillow, can help minimize the pain of coughing. The nurse should administer analgesia to help reduce the pain of coughing and other activities.
A nurse is planning education for a patient 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 the patient when he is ready to ambulate freely?

A. Keep the collection device upright at all times.
B. Disconnect system when showering
C. Keep collection device at chest level at all times
D. Allow tubing to hang in dependent loop when ambulating

Keep the collection device upright at all times. — Rationale: closed-chest drainage system must be upright at all times to ensure that the tubing drains optimally and the system functions correctly.
While providing care for a patient who has a chest tube in place attached to a closed-chest drainage system, the nurse accidentally disconnects the chest tube from the system. Which of the following should the nurse do to prevent serious complication while preparing to reconnect the system?

A. clamp chest tube close to pt’s chest
B. Submerge the end of the chest tube in 1 inch sterile water
C. Gently milk chest tube in a proximal to distal direction
D. tape sterile gauze around open end of chest tube

Submerge the end of the chest tube in 1 inch sterile water
A nurse is preparing to transport to radiology a patient who has a chest tube and a closed-chest wet-suction drainage system. The provider allow disconnecting the drainage system from the suction source during transportation. Which of the following must the nurse for when detaching the suction source?

A. clamp chest tube
B. attach mobile drainage device
C. make sure air vent open
D. empty collection chamber

Make sure the air vent is open — Rationale: some closed-chest drainage systems and suction devices contain a vent from the water-seal chamber. This allows the drainage unit to remain vented without suction, So, the nurse should make sure this exit vent is open when disconecting the suction source. Other systems allow air to exit through the suction-control tubing. With these systems, the nurse should keep the suction-control tubing uncapped and free from occlusion to prevent a buildup of air inside the pleural cavity.
A nurse is assessing a patient who has a chest tube in place attached to a closed-chest water-seal drainage system. When the nurse palpates the area around the chest-tube insertion site, she is checking for

A. lung re-expansion
B. Subcutaneous emphysema
C. chest-tube obstruction
D. increasing drainage

subcutaneous emphysema — Rationale: palpating the area around the insertion site helps identify crepitus, a dry, crackling, or grating sound. This is a classic manifestation of sucutaneous emphysema, which indicates that air is leaking into the sucutaneous tissue surrounding the chest tube insertion site.
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