Nursing of the adult with a chest tube
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| Define pneumothorax. | show 🗑
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| show | traumatic chest injury, thoracotomy,and spontaneous in tall thin people
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| show | fluid in the pleural space
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| show | impaired lymphatic drainage/malignancy; changes in colloidal osmotic pressure/heart failure
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| show | purulent pleural fluid
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| How might empyema develop? | show 🗑
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| Where does the chest tube go if air is to be removed from the pleural space? | show 🗑
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| Where does the chest tube go if fluid is to be removed? | show 🗑
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| show | To prevent dissection of the pectoral muscles; tube is directed upward for air removal and downward for fluid removal
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| What is the function of the collection chamber in a chest drainage unit? | show 🗑
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| show | The tube in this chamber is submerged to prevent air from flowing back toward the patient. The water acts like a one way valve.
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| show | The water level has to do with the strength of suction to the patient. The more the tube in this chamber is submerged the more suction to the patient.
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| Can the RN delegate chest tube care? | show 🗑
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| show | Proper positioning to facilitate drainage, report changes in vital signs, comfort level, SpO2, excessive bubbling in water-seal chamber, disconnection, change in drainage, bleeding , or bubbles stop
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| show | Breath sounds over affected lung,Chest pain,Dressing,Drainage system – upright and below level of tube insertion,Insertion site LOC,Pain scale,Signs respiratory distress,SpO2,Tubing for kinks, dependent loops, clots; Vital signs,
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| What signs/symptoms would alert the nurse to respiratory distress in the patient with a chest tube?(ACDHST) | show 🗑
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| What signs/symptoms would alert the nurse to the possibility that her patient with a chest tube has developed a pneumothorax? | show 🗑
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| What is the nurse’s responsibility if her patient shows signs of pneumothorax? | show 🗑
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| Why monitor the chest tube patient’s pulse and BP? What might changes in these values mean? (IRP) | show 🗑
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| What is the nurse looking for when she assesses the insertion site of the chest tube patient? | show 🗑
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| show | increases patient’s risk for infection, atelectasis, and tension pneumothorax
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| When would chest tubes be clamped? | show 🗑
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| What do we use for clamps on a chest tube if the doctor orders clamping? | show 🗑
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| show | Continuous bubbling in the water seal chamber
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| show | By progressively moving clamps from the insertion site on down the tube until bubbling stops. When bubbling stops the leak is above the last clamp placed.
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| What are the expected drainage amounts and characteristics after placement of a pleural drainage system? | show 🗑
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| show | Inform the physician, stay with the patient, assess vital signs, O2 sat, and cardiopulmonary status.
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| What size are chest tubes? | show 🗑
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| show | the tube collapses on inspiration and opens on expiration (or when chest pressure exceeds atmospheric pressure)
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| show | Pleur-evac, Medi-evac, Atrium, Thoraseal
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| show | collection, water-seal, suction control
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| show | where drainage from the patient goes; calibrated so that amount of drainage can be assessed
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| show | When first connected (air in system and from patient’s interpleural space), but should stop and become intermittent after a short time. Intermittent bubbling can be seen with exhalation, coughing or sneezing, continuous bubbling indicates a leak
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| What does fluid rising with inhalation and falling with expiration mean if seen in the waterseal chamber? Describe how observations would differ if client is on a ventilator. | show 🗑
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| What does no bubbling in the water seal chamber mean? | show 🗑
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| show | 48-72 hours
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| What might the nurse suspect if there is an abrupt cessation of tidaling in the water seal chamber? | show 🗑
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| show | -20cm H2O
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| show | Open thoracotomy is inserted during time of surgery; Closed thoracotomy at the bedside
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| How is the patient positioned for a thoracotomy? | show 🗑
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| show | after the area is prepped and local anesthesia is injected a small incision is made or in case of emergency a removable trocar (metal guide in the middle of the chest tube) is used
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| show | the tube is connected to the chest drainage system and the MD sutures the tube to the chest wall
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| show | all connection are securely taped to maintain airtight system; occlusive sterile dressing is applied to the insertion site; pneumothorax- petroleum gauze is often used to prevent air from being sucked into the pleural space
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| show | CXR are used to check tube position and whether lung has re-expanded
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| What assessments will the nurse make to gather information about the clients general respiratory status (6)? | show 🗑
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| show | confusion, cynosis, hyperresonance,increased absent breath sounds; increased respiratory distress,restlessness, sudden sharp chest pain, tachycardia,
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| What signs and symptoms would alert the nurse to possible hemothorax (3abcd)? | show 🗑
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| How often do we assess the chest drainage system? | show 🗑
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| show | system below patient’s chest, free of kinks, dependent loops, obstruction; color and amount of drainage; dressing and subcutaneous emphysema; tidaling (ok) or continuous bubbling (bad) in water seal chamber
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| What is the nurse’s responsibility if the drainage changes from dark to bright sanguineous or if the amount of drainage exceeds 200mL/hr for 2 hours | show 🗑
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| What are some applicable nursing diagnoses for the patient with a chest tube (3)? | show 🗑
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| show | ABGs approaching normal;breath sounds equal, clear; even and unlabored; cxr shows lung re-expansion ,RR 16-20/min, symmetrical expansion
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| show | Patient describes necessary precautions, Patient describes what is expected in terms of drainage
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| show | Maintain patent system; retape all connection; monitor/care for CT dressing; no kinks/clogs/dependent loops in tubing; TCDB (splint with pillow); pain management; Milk per protocol/MD; notify MD if no fluctuation
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| show | Place end of tube in sterile H2o or Saline; hold below chest level; immediately replace system; momentary clamping okay if air entering pleural cavity
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| show | Air is trapped and creates pressure that works against lung expansion
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| What change in the trachea would result from a tension pneumothorax? | show 🗑
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| show | cover wound with occlusive dressing (in an emergency a gloved hand will work); tape 3 sides, leave one open to avoid tension pneumothorax
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| What can be done to avoid placing pressure on the chest tube if the client wants to lie on the side of the insertion site? | show 🗑
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| show | CXR confirms full re-expansion, no fluctuation of fluid, cessation bubbling in water seal chamber, adequate gas exchange
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| Discribe how a chest tube is removed (4). How long does it usually take for the incision to heal? | show 🗑
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