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ADN 126 CT Drainage

Study Guide, Brunners 667-72, Castillo 157-9, and Seminar

QuestionAnswer
Differentiate the Visceral and Parietal Pleura. -The Visceral covers the lungs (inside lungs) -The Parietal lines the thorax (outside lungs)
List Substances that can accumulate in the pleural space. -fibrin or clotted blood -liquids (serous fluids, blood, pus, chyle) -Gases (air from the lung, tracheobronchial tree, or esophagus)
Name specific conditions in which chest tubes are used. -open or closed pneumothorax -pleural effusion -empyema -Hemothorax -Thoracic Surgery
-pneumothorax characterized by increasing positive pressure in the plueral space with each breath -This is an emergency situation and the positive pressure needs to be decompressed or released immediately Tension Pnuemothorax
List important signs and symptoms of tension Pnuemothorax -Sudden respiratory distress -decreased B/P -Increased JVD -decreased breath sounds -asymmetry -tracheal deviation (ominous)
Explain the 1)function of the Collection Chamber and 2)any nursing observations/care. 1)collects drainage 2)replace system when chamber is full
Explain the 1)function of the Water Seal Chamber and 2)any nursing observations/care. 1)-to allow air to leave pleural space -to prevent air from re-entering pleural space 2)-2cm of water -determine presence of air leak (bubbling in this area)
Explain the 1)function of the Suction control Chamber and 2)any nursing observations/care. 1)-regulates suction to pleural space -drain lungs w/out damaging tissue 2)-suction determined by amt of H2O in chamber -wall suction-enough to create a gentle bubbling -dry suction uses valves -dry-wall suction 80mmHG -if no suction,tubing must be
Discuss normal findings that a nurse may detect in a client with a chest tube. -start w/client(RR, effort, symmetry, skin color, Lung sounds, ABGs, and Pulse O2) -Dressing - Tubing(no dependent loops) -Drainage Unit(below chest) -Chambers(Drainage:amt & char. H2O Seal: Tidaling.Suction Control: Gentle Bubbling/dry is per HCP)
Discuss abnormal findings that a nurse may detect in a client with a chest tube. -Start w/ct -dressing (subcutaneous emphysema - crackling in skin) -Drainage (more than 100mL/ especially if bloody) -H2O seal- bubbling/wet, alarm/dry = air leak -Suction control- wet/ bubbling too fast or not at all, dry/ set to HCP ordered
Describe Nurse's role in assisting with chest tube insertion and removal at the bedside. -informed consent -Analgesia/sedation -Activity restriction -Teaching -Emotional support -Prepare drainage system -assist with positioning (upright over bedside/lateral supine) -assessment -Clean-up
Explain Problem solving steps that can be taken when drainage slow or stops. -Assess ct. -Assess Drainage system -If above 2 are normal, there may just be no fluids to remove from Pleural Space. -If client or drainage system is abnormal, assess further and contact HCP if necessary
Explain Problem solving steps that can be taken when the collection chamber is full. -Replace drainage unit with a new drainage unit
Explain Problem solving steps that can be taken when tubing comes dislodged. -notify HCP for reinsertion -Place end of tube connected to client in bottle of sterile water.
Explain Problem solving steps that can be taken when the client is transported. -Disconnect from suction -Keep below chest level. -DO NOT clamp -Keep unit upright at all times
Explain Problem solving steps that can be taken when the chest tube is pulled out. -cover with dry, sterile dressing. Be sure to tape 2-3 sides only -contact HCP -CXR
You are observing your client's chest tube and you notice that the fluid is no longer fluctuating in the tubing. Discuss 3 possible reasons and the nursing actions required.
Created by: queline76
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