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Questions and Answers
What is the primary purpose of inserting a chest tube?
What is the primary purpose of inserting a chest tube?
Which chamber of a disposable three-chamber drainage system is responsible for drainage collection?
Which chamber of a disposable three-chamber drainage system is responsible for drainage collection?
What does cessation of tidaling in the water seal chamber indicate?
What does cessation of tidaling in the water seal chamber indicate?
How should the water seal chamber be maintained during use?
How should the water seal chamber be maintained during use?
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What typically determines the amount of suction transmitted to the pleural space in a wet suction system?
What typically determines the amount of suction transmitted to the pleural space in a wet suction system?
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What does continuous bubbling in the water seal chamber indicate?
What does continuous bubbling in the water seal chamber indicate?
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When using a dry suction control device, how is the suction level determined?
When using a dry suction control device, how is the suction level determined?
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What is expected in the water seal chamber during spontaneous respirations?
What is expected in the water seal chamber during spontaneous respirations?
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Which condition is characterized by an accumulation of air in the pleural space leading to lung collapse?
Which condition is characterized by an accumulation of air in the pleural space leading to lung collapse?
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What physical manifestation might suggest the presence of a hemothorax during an examination?
What physical manifestation might suggest the presence of a hemothorax during an examination?
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Which of the following symptoms is a common presentation for a patient with pulmonary empyema?
Which of the following symptoms is a common presentation for a patient with pulmonary empyema?
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What type of chest tube drainage indication most commonly follows major cardiac procedures such as thoracotomy?
What type of chest tube drainage indication most commonly follows major cardiac procedures such as thoracotomy?
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Which of the following is NOT a typical client presentation for someone with a pneumothorax?
Which of the following is NOT a typical client presentation for someone with a pneumothorax?
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What is the purpose of placing the chest tube drainage system below the client’s chest level?
What is the purpose of placing the chest tube drainage system below the client’s chest level?
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Which position should the client be in when preparing for chest tube insertion?
Which position should the client be in when preparing for chest tube insertion?
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What should be done to the insertion site before placing the chest tube?
What should be done to the insertion site before placing the chest tube?
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What is essential to monitor during the intraprocedure phase of chest tube insertion?
What is essential to monitor during the intraprocedure phase of chest tube insertion?
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When inserting a chest tube to remove air, where should the tip of the tube be positioned?
When inserting a chest tube to remove air, where should the tip of the tube be positioned?
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How often should vital signs and respiratory effort be assessed after a chest tube procedure?
How often should vital signs and respiratory effort be assessed after a chest tube procedure?
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What is the primary purpose of encouraging coughing and deep breathing every 2 hours post-procedure?
What is the primary purpose of encouraging coughing and deep breathing every 2 hours post-procedure?
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What should be done if the client's drainage exceeds 70 mL/hr?
What should be done if the client's drainage exceeds 70 mL/hr?
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What action should NOT be performed regarding chest tube tubing unless prescribed?
What action should NOT be performed regarding chest tube tubing unless prescribed?
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Why is it critical to tape all connections between the chest tube and the drainage system?
Why is it critical to tape all connections between the chest tube and the drainage system?
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What indicated a potential problem if the eyelets of the chest tube become visible?
What indicated a potential problem if the eyelets of the chest tube become visible?
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What should be included in routine monitoring related to the chest tube insertion site?
What should be included in routine monitoring related to the chest tube insertion site?
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What is the recommended client position for optimal lung expansion after chest tube placement?
What is the recommended client position for optimal lung expansion after chest tube placement?
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What is a nursing action to perform if an air leak is detected in the chest tube system?
What is a nursing action to perform if an air leak is detected in the chest tube system?
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Which action should be taken if the chest tube becomes accidentally disconnected?
Which action should be taken if the chest tube becomes accidentally disconnected?
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What should the nurse do if continuous bubbling is observed in the water seal chamber?
What should the nurse do if continuous bubbling is observed in the water seal chamber?
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What is the appropriate initial response if a chest tube is accidentally removed?
What is the appropriate initial response if a chest tube is accidentally removed?
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When applying a padded clamp to assess an air leak, what is a critical nursing action following the assessment?
When applying a padded clamp to assess an air leak, what is a critical nursing action following the assessment?
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Which assessment finding is commonly associated with tension pneumothorax?
Which assessment finding is commonly associated with tension pneumothorax?
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What is the recommended maneuver for a client during chest tube removal to reduce the risk of air emboli?
What is the recommended maneuver for a client during chest tube removal to reduce the risk of air emboli?
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What dressing should be applied after chest tube removal?
What dressing should be applied after chest tube removal?
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Which of the following is NOT an initial assessment finding of tension pneumothorax?
Which of the following is NOT an initial assessment finding of tension pneumothorax?
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Which action should be taken if a chest x-ray indicates the persistence of a pneumothorax after treatment?
Which action should be taken if a chest x-ray indicates the persistence of a pneumothorax after treatment?
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Study Notes
Chest Tube Insertion and Management
- Chest tubes drain fluid, blood, or air from the pleural space, restoring negative pressure for lung expansion and intrapleural pressure.
- Insertion can occur in the emergency department, at the bedside, or in the operating room (thoracotomy incision).
- Tubes are removed when lung re-expansion is complete or when fluid drainage ceases.
Chest Tube Systems
- Disposable three-chamber drainage systems are commonly used.
- First chamber: Collects drainage.
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Second chamber: Creates a water seal.
- Sterile fluid is added to the 2 cm line.
- Maintains negative pressure; air exits during exhalation, prevents entry during inhalation.
- Maintain upright and below insertion site. Monitor and add fluid as needed to maintain manufacturer's water seal level.
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Third chamber: Controls suction (wet or dry).
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Wet suction: Fluid in this chamber determines suction pressure (typically -20 cm H2O).
- Connect to a suction source; initiate suction until gentle bubbling occurs.
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Dry suction: Suction level is prescribed by the provider (typically -20 cm H2O).
- Connect to wall suction, regulator set to manufacturer's recommendation.
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Wet suction: Fluid in this chamber determines suction pressure (typically -20 cm H2O).
Monitoring Chest Tubes
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Tidaling: Fluid level movement with respiration.
- Spontaneous breathing: rises with inspiration, falls with expiration.
- Positive-pressure ventilation: rises with expiration, falls with inspiration.
- Cessation of tidaling signals lung re-expansion or system obstruction.
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Bubbling in water seal:
- Continuous bubbling: air leak in the system.
- Intermittent bubbling (during exhalation, coughing, or sneezing): normal during air removal. -Bubbling cessation indicates all air has been removed.
- Mediastinal tubes (e.g., post-open heart surgery): No tidaling or bubbling expected; pulsations may occur.
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Description
This quiz covers the essential principles of chest tube insertion and management, including the purpose of chest tubes, their insertion sites, and the components of chest tube drainage systems. Understand how to maintain a water seal and manage suction to ensure patient safety and effective lung expansion.
