Download (2026): NUR 2048 Chest Tubes and more Quizzes Medicine in PDF only on Docsity!
What is a the purpose of chest tubes? Restore negative pressure
Where is a chest tube placed for air? 2-3 intercostal space
Where is a chest tube placed for fluid? 8-9 intercostal space
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
What are the signs/symptoms of a pneumothorax? (6) - SOB
- Decreased O
- Tachypnea/tachycardia
- Diminished/absent breath sounds
- Chest pain
- Anxiety/restlessness
What are risk factors for a pneumothorax? (7) - Thoracentesis/subclavian CL placement
- Trauma
- Fractured ribs
- Chest surgery
- Lung biopsy
- Ruptured bleb (COPD)
- Spontaneous
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 pleural effusion? Excess fluid in pleural space
What causes pleural effusion? (4) - Usually recurrent
What is hemothorax? Blood in the pleural space
What causes hemothorax? (2) - Trauma
What is empyema? Collection of pus in pleural space
What causes empyema? Infections
What is the 1st compartment of a chest tube? (3) - Drainage collection chamber
- Do not tip
- Do not put above patient
How many mL does the 1st compartment of a chest tube hold?
2000 mL
What is the 2nd compartment of a chest tube? - Water seal chamber
- Tidaling/oscillation (fluctuation)
What does intermittent bubbling mean in the water seal chamber?
Air leak
What is the 3rd compartment of a chest tube? (2) Suction control chamber; - 20 cm
What is a normal finding for water suction? Gentle, continuous bubbling in the water suction chamber (3rd compartment)
Do you want to see fluctuations in the water seal chamber?
Yes, this is a normal finding
What does it mean when there's no fluctuation in the water seal chamber?
Possible air leak
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
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 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
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 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'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.
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.
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.
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 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.
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 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
