T-Tube Nursing Care NCLEX Review

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Questions and Answers

What's a T-Tube?

It's a t-shaped tube that is placed in the bile duct to help drain excessive bile and can be used for testing to assess the biliary tree and ducts.

Why would a patient have a t-tube?

Cholecystectomy (correct)

Common bile duct exploration (correct)

Liver transplant

None of the above

What is a cholecystectomy?

It's a surgical procedure to remove the gallbladder.

What is cholecystitis?

It is the inflammation and swelling of the gallbladder. Signup and view all the answers

What are gallstones?

These are hardened deposits of digestive fluid that can form in the gallbladder. Signup and view all the answers

What are the two types of cholecystectomy?

Both A and B Signup and view all the answers

Where is the common bile duct located?

The common bile duct is located in the biliary system connecting the liver and the small intestine. Signup and view all the answers

What is a common bile duct exploration?

It is a surgical procedure where an incision is made in the bile duct to assess it. Signup and view all the answers

What is a liver transplant?

It is the replacement of a diseased liver with a healthy liver from another person. Signup and view all the answers

What is the role of a t-tube?

The t-tube serves as a drain to remove excessive bile. Signup and view all the answers

What is a cholangiograph?

It is the imaging of the bile duct by x-rays and an injection of contrast medium. Signup and view all the answers

What does the mnemonic DRAIN stand for when thinking about nursing care of T-tubes?

Drainage bag positioned correctly, Record and empty drainage, Assess color and consistency of drainage, Inspect skin and abdomen frequently, Need physician's order to clamp or flush the t-tube. Signup and view all the answers

What does the D stand for in the mnemonic DRAIN in relation to nursing care of T-tubes? And explain why it's important.

Drainage bag positioned correctly. Signup and view all the answers

What does the R stand for in the mnemonic DRAIN in relation to nursing care of T-tubes? And explain why it's important.

Record and empty drainage per facility's protocol. Signup and view all the answers

What is peritonitis?

It is inflammation of the membrane lining the abdominal wall and covering the abdominal organs. Signup and view all the answers

What does the A stand for in the mnemonic DRAIN in relation to nursing care of T-tubes?

Assess color and consistency of drainage. Signup and view all the answers

What does the I stand for in the mnemonic DRAIN in relation to nursing care of T-tubes?

Inspect skin and abdomen frequently. Signup and view all the answers

What does the N stand for in the mnemonic DRAIN in relation to nursing care of T-tubes?

Need physician's order to clamp or flush the t-tube. Signup and view all the answers

A patient had a cholecystectomy and has a t-tube in place. Where is the t-tube located?

Bile duct Signup and view all the answers

The nurse helps the patient with a t-tube get up from the bed and sit in the bedside chair. Where will the nurse prioritize the position of the tubing and drainage bag?

At or below the waist Signup and view all the answers

Which position is best for a patient with a t-tube?

Semi-Fowler's Signup and view all the answers

A patient is post-op day 4 from a t-tube placement. Which finding below requires you to notify the physician?

Drainage from the t-tube within the past 24 hours is approximately 925 cc. Signup and view all the answers

The physician orders a patient's t-tube to be clamped 1 hour before and 1 hour after meals. While the tube is clamped, which finding requires immediate nursing intervention?

The patient reports nausea and abdominal pain. Signup and view all the answers

You're assessing a patient's t-tube and note that it is not draining bile. The patient is reporting nausea. The nurse will first?

Assess if the tubing from the t-tube is kinked or clamped. Signup and view all the answers

Study Notes

T-Tube Overview

A T-tube is a drainage device placed in the bile duct to facilitate the removal of excess bile and assess the biliary tree.
Common indications for a T-tube include cholecystectomy, common bile duct exploration, and liver transplant.

Cholecystectomy

Cholecystectomy involves the surgical removal of the gallbladder due to inflammation (cholecystitis) or gallstones.
Cholecystitis is characterized by gallbladder inflammation leading to pain and possible complications.

Gallstones

Gallstones are solid deposits formed from digestive fluid in the gallbladder, which disrupt bile flow.

Types of Cholecystectomy

There are two approaches to cholecystectomy: laparoscopic and open surgery.

Common Bile Duct Exploration

This procedure involves making an incision in the bile duct to assess for gallstones or other issues and is often performed alongside cholecystectomy.
A T-tube is used post-operation to facilitate bile drainage during recovery.

Liver Transplant

Involves replacing a diseased liver with a healthy liver from a donor. This is critical for treating end-stage liver disease.

T-Tube Functionality

A T-tube serves as a drain to remove excess bile until the duct has healed. It can also assist in diagnostic testing via cholangiograms.

Cholangiograph

A cholangiograph is an imaging technique to visualize the bile ducts using x-rays and a contrast medium.

Nursing Care with T-Tubes: DRAIN Mnemonic

D: Drainage bag positioning - Ensure bag is below the insertion site to facilitate bile drainage.
R: Record and empty drainage - Document drainage volume and characteristics to monitor for complications.
A: Assess drainage - Evaluate color and consistency; yellowish-green drainage is typical.
I: Inspect skin and abdomen - Monitor for leakage and changes in condition, keeping dressings dry and clean.
N: Need physician’s order for flushing/clamping - Flushing is only done with an order; clamping aids digestion by directing bile flow during meals.

Assessing T-Tube Positioning

T-tube drainage bag should be kept at or below waist level for gravity assistance in bile drainage.
Semi-Fowler’s position (30-45 degrees) is optimal for facilitating drainage.

Potential Complications

Pay attention to signs of peritonitis, including abdominal pain, rigidity, and fever, which may indicate bile leakage.

Critical Nursing Actions

Early intervention is required if a patient experiences nausea and abdominal pain with a non-draining T-tube; assess for kinks first.
A drainage volume exceeding 500 cc in 24 hours necessitates physician notification to avoid complications like bleeding or blockage.

Patient Education

Instruct patients on maintaining T-tube placement, including avoiding tension on the tubing and preventing dislodgment during movement or sleep.

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Description

Enhance your nursing knowledge with this NCLEX review focusing on T-Tube nursing care. Explore important concepts such as the purpose of a T-Tube, indications for its use, and related procedures. Perfect for nursing students preparing for the exam.