6.10 Learning Activities
Exercises
(Answers to the exercises are located in the Answer Key at the back of the book).
1. A client is recovering from a thoracotomy and has a right pleural chest tube to drainage. Highlight or place an “X” next to the best indicators showing the client’s condition is resolving and ready for chest tube removal.
| Indicators | |
|---|---|
| Improved respiratory status | |
| Asymmetrical rise and fall of the chest | |
| Diminished breath sounds over right lower lobe | |
| Decreased chest tube drainage | |
| Absence of bubbling in the water seal chamber during expiration | |
| Improved chest X-ray findings |
2. Managing chest tubes and drainage systems is essential for client safety. Place an “X” next to each nursing action to indicate whether it is likely to be effective in improving the client’s condition being treated with a chest tube or if it is ineffective.
| Nursing Action | Effective | Ineffective |
|---|---|---|
| Promote oxygenation by encouraging frequent position changes, mobilization, and deep breathing and coughing exercises. | ||
| Coil the drainage system tubing and secure it to the edge of the client’s bed. | ||
| Place the drainage system unit on the client’s waist during transport. | ||
| Immediately apply pressure to the chest tube insertion site and apply a sterile petroleum gauze dressing if the tube dislodges. | ||
| Perform routine stripping of the chest tube to prevent blood clots from forming. | ||
| Assess the amount, color, and consistency of drainage in the drainage tubing and in the collection chamber at regular intervals. |
3. The nurse is assessing a patient with a chest tube placed two days ago for a pneumothorax. The system is connected to suction. Which of the following findings indicate that there may be a problem with the chest tube drainage unit?
a. There is sanguineous drainage in the collection chamber.
b. There is continuous bubbling in the water seal chamber.
c. There is vigorous bubbling in the suction chamber.
d. The water level fluctuates in the water seal chamber with respirations.
Case Study #1
Scott, a 70-year-old male, arrived in the ED with increased shortness of breath and left-sided sharp chest pain. Upon arrival, he is hypertensive, tachycardic, tachypneic, and has an O2 sat of 76%. Lung sounds are absent on the left side. Scott’s wife Sarah is concerned. “I’ve never seen him like this. What is going on?” Scott rates his pain 7/10 but has difficulty speaking.
Scott has a history of COPD and a 50-year history of smoking two packs a day; he has had two exacerbations of COPD in the past year. Rapid COVID-19 test is negative.
The following stat orders are given by the ED provider:
- Attach ECG monitoring
- Obtain a portable chest X-ray STAT
- Provide client education about chest tube insertion
- Ensure informed consent for chest tube insertion
- Insert chest tube and chest tube drainage system
1. What client education should be provided regarding the chest tube?
2. What are the maintenance care priorities for care of the chest tube?
3. Are there any specific concerns related to Scott’s need for a chest tube that should be monitored or addressed?
4. What will you consider as you prepare for placement of the chest tube?
5. What is the purpose of the chest tube? What do you hypothesize is Scott’s primary diagnosis?
6. How often should a chest tube be assessed?
7. What cues would indicate further assessment of the chest tube and the client are needed?