Nursing of the adult with a chest tube
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| Define pneumothorax. | show 🗑
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| What are some potential causes of pneumothorax? | show 🗑
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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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| show | lung abscess or pneumonia
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| show | anteriorly through the second intercostal space – usually on the anterior aspect of the midclavicular line, second or third intercostal space
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| show | posteriorly through the 8th or 9th intercostals space midaxillary line
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| Why do some clinicians use the 4th and 5th anterior or midaxillary intercostal space for chest tube insertion? How does this work for fluid or air removal? | show 🗑
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| show | to collect drainage from the patient’s pleural space, allow for visual inspection of the nature of drainage, and measure output
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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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| What is the function of the suction chamber of a chest drainage unit? | show 🗑
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| show | no
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| What education should the RN provide to assistive personnel regarding care of the client with a chest tube? (P,BBCCEDSV) | show 🗑
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| What will the nurse check during assessment of the patient with a chest tube?(BCDDubILPSSTkdcV) | show 🗑
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| show | asymmetrical chest movements, cyanosis, decreased breath sounds, hypotension, subcutaneous emphysema at insertion site/neck, tachycardia
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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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| show | dressing is intact, no air or fluid leaking, area around site is free of drainage or skin irritation
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| show | increases patient’s risk for infection, atelectasis, and tension pneumothorax
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| show | Usually not, only with physicians order (usually to assess patient’s readiness for chest tube removal) or very briefly to assess air leak, or to empty/change disposable drainage system (requires special training).
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| What do we use for clamps on a chest tube if the doctor orders clamping? | show 🗑
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| What would be a sign of leaking at the insertion site, connection between tube and drainage, or within the drainage device? | show 🗑
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| How do we find the location of a leak? | show 🗑
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| show | between 100 and 300mL in the first 2 hours, 500 -1000ml in the first 24hours, bloody for first several hours changing to serous
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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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| Name 4 disposable water seal drainage systems. | show 🗑
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| show | collection, water-seal, suction control
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| What is the collection chamber for? | show 🗑
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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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| show | means the unit is functioning normally (fluid falls with inspiration/rises with exhalation if patient is on a ventilator)
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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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| What is the usual amount of suction ordered? | show 🗑
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| Where and when would an open thoracotomy take place? Closed thoracotomy? | show 🗑
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| show | sitting or lying with the affected side up
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| Describe the incision procedure for a thoracotomy tube under normal and emergency circumstances. | show 🗑
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| What happens immediately after the tube is placed? | show 🗑
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| How are the connections and insertion site handled? | show 🗑
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| Discuss the use of Chest X-ray for the client with a chest tube. | show 🗑
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| show | abnormal chest movements;anxiety, bilateral breath sounds > q 2hours; cyanosis; quality of respirations;VS > q 4hr;
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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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| show | diminished or absent breath sounds, dyspnea, cyanosis
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| show | hourly
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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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| show | Report to MD
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| show | Ineffective breathing pattern; Impaired gas exchange rt decreased lung expansion; anxiety r/t perceived risk of CT dislodgement, system disruption, inability to breathe
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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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| What is the nurse’s responsibility if the system breaks? | show 🗑
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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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| What is the nurse’s responsibility if the CT is accidently removed? | show 🗑
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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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| Give several signs that a patient is ready for chest tube removal (CCFA). | show 🗑
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| show | provide medication 30 minutes before procedure, patient is instructed to bear down and cough while tube is quickly removed, Vaseline gauze and sterile dressing placed over site, monitor for respiratory distress after; usually takes about a week to heal
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