Chapter 6
- 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 | |
|---|---|
| X | Improved respiratory status |
| Asymmetrical rise and fall of the chest | |
| Diminished breath sounds over right lower lobe | |
| X | Decreased chest tube drainage |
| X | Absence of bubbling in the water seal chamber during expiration |
| X | 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. | X | |
| Coil the drainage system tubing and secure it to the edge of the client’s bed. | X | |
| Place the drainage system unit on the client’s waist during transport. | X | |
| Immediately apply pressure to the chest tube insertion site and apply a sterile petroleum gauze dressing if the tube dislodges. | X | |
| Perform routine stripping of the chest tube to prevent blood clots from forming. | X | |
| Assess the amount, color, and consistency of drainage in the drainage tubing and in the collection chamber at regular intervals. | X |
3. B
Case Study # 1
1. For client education regarding the chest tube, the following information can be provided:
- Explain that the purpose of the chest tube is to remove excess air, fluid, or blood that may have accumulated in the pleural cavity (the space between the lung and the chest wall) in order to relieve pressure and improve breathing.
- Discuss the procedure and any potential risks, such as infection, bleeding, and pain.
- Emphasize the importance of keeping the chest tube site clean and avoiding physical activities that may cause trauma to the site.
2. Maintenance care priorities for the chest tube include the following:
- Keeping the chest tube site and surrounding area clean and dry.
- Making sure the chest tube is secured in place and not kinked or obstructed.
- Monitoring the chest tube drainage for any changes (amount, color, consistency).
- Assessing the client’s vital signs, lung sounds, and breathing patterns regularly.
- Administering pain medication as prescribed.
3. Specific concerns related to Scott’s need for a chest tube that should be monitored or addressed are as follows:
- Pain management, especially around the chest tube site.
- Prevention of infection at the chest tube site.
- Potential complications such as re-accumulation of fluid or air in the pleural cavity, displacement of the chest tube, and injury to surrounding structures.
- Proper functioning of the chest tube and chest tube drainage system.
4. When preparing for placement of the chest tube, the following should be considered:
- Obtaining informed consent from the client or their representative.
- Assess the client’s airway, breathing, and circulation (ABCs) to ensure that they are stable.
- Checking for allergies or adverse reactions to medications, including local anesthetics.
- Administering pain control measures, such as local anesthesia, as indicated.
- Properly positioning the client to facilitate chest tube placement and minimize discomfort.
- Making sure the necessary equipment and supplies are readily available, such as sterile gloves, gowns, drapes, chest tube insertion tray, sterile solution, dressing materials, and suture materials.
5. Purpose of chest tube:
- The purpose of a chest tube is to relieve pressure in the chest caused by fluid or air buildup and to help re-expand collapsed lungs.
- Scott’s primary diagnosis is likely a pneumothorax or pleural effusion, based on his history of COPD and smoking, as well as his presentation of increased shortness of breath and left-sided chest pain.
6. The chest tube should be assessed every hour after initial placement and with each client assessment, minimally every four hours or more frequently based on client condition.
7. Further assessment for the chest tube would be indicated further by the following:
- Sudden changes in the amount or color of the drainage from the chest tube.
- Increased pain or discomfort at the chest tube site.
- Signs of infection, such as redness, swelling, or discharge.
- Changes in the client’s breathing pattern or oxygen saturation level.
All of the answers to the interactive element are found within the element.