Week 4 Lab Skills Flashcards

Questions and Answers

What assessment finding would cause suspicion of an air leak?

Water in the water-seal chamber falling with inspiration and rising with expiration

All the air being immediately evacuated with a chest tube in place

Continuous bubbling in the water-seal chamber (correct)

Water in the water-seal chamber rising with inspiration and falling with expiration

What action should be taken before transporting a patient with a chest tube to the radiology department?

Strip or milk the tube aggressively to ensure the patency of the tube until the patient returns to the unit.

Place the collection drainage system in the bed with the patient to ensure that the chest tube is not dislodged.

Clamp the chest tube and secure it to the bed during transport.

Ensure that the chest tube drainage system is below the patient's chest. (correct)

What is most likely the reason for the decrease in chest tube output during assessment?

The PEEP level is too high on the ventilator.

Drainage has decreased, which is an early sign of dehydration.

Drainage has decreased, indicating an obstruction in the tubing. (correct)

The drainage system may need to be changed.

What is the best approach by the nurse when assisting a patient with a chest tube to change positions in bed?

Ensure that the chest tube is securely taped to the patient's chest or abdomen to prevent dislodgement. Signup and view all the answers

What should the nurse conclude when assessing a patient with a chest tube and notes fluctuation in the water-seal chamber with spontaneous respiration?

This is a normal process. Signup and view all the answers

What is the most appropriate response by the nurse when a family member asks if they can hold a patient with a chest tube?

Yes, as long as the closed system is kept below the level of the chest. Signup and view all the answers

What approach by the practitioner should the nurse anticipate when preparing for chest tube insertion to treat a hemothorax?

A thoracostomy tube placed posteriorly and inferiorly. Signup and view all the answers

What is the best response by the nurse when a family member asks why an intubated patient's neck looks swollen and a popping sensation is felt?

Some air may leak out of the pleural space and will dissipate over time. Signup and view all the answers

What is the best way for the nurse to assess for an air leak when there is continuous bubbling in the water-seal compartment?

Clamp the tubing between the chest tube and the closed system. Signup and view all the answers

What should the nurse consider when preparing to change out a closed drainage system?

Suction should be turned on after the tubing has been connected to the chest tube. Signup and view all the answers

What is the physiologic goal of chest tube insertion?

Restore negative pressure in the pleural space. Signup and view all the answers

What should the nurse suspect based on assessment findings of absent breath sounds, decreased oxygen saturation, and neck vein distention in a 6-year-old patient?

Tension pneumothorax. Signup and view all the answers

How should the nurse position a patient being prepared for chest tube placement for a hemothorax?

Semi-Fowler. Signup and view all the answers

What should the nurse do when they notice that the drainage has stopped 6 hours after chest tube placement?

Look for kinks in the chest tube and connecting tubing. Signup and view all the answers

Where should the nurse secure the chest tube to avoid dislodgement?

Patient's chest. Signup and view all the answers

Which complication should the nurse suspect in a 3-year-old patient after a motor vehicle crash, showing increased work of breathing and unequal chest rise?

Tension pneumothorax. Signup and view all the answers

What is the correct statement regarding chest tube size and intended use?

Chest tube size is based on the weight of the patient: Smaller chest tubes are inserted to evacuate air. Signup and view all the answers

What should the nurse know about chest tube placement when a patient is in respiratory distress?

There are no absolute contraindications for chest tube placement when we need the lung reexpanded. Signup and view all the answers

What should the nurse do after inserting a chest tube into a patient?

Turn on the ordered suction. Signup and view all the answers

What is the physiological reason for using chest tubes?

To restore negative pressure in the pleural space. Signup and view all the answers

Study Notes

Chest Tube Assessment and Air Leaks

Continuous bubbling in the water-seal chamber suggests an air leak from the chest cavity.
Intermittent bubbling indicates normal air drainage in pneumothorax patients.
Tidaling in the water-seal chamber is typical with breathing; it reverses in mechanically ventilated patients.

Drainage System Management

Maintain the chest tube drainage system below the patient's chest for gravity flow.
Clamping should only occur to assess air leaks, not during patient transportation due to risk of tension pneumothorax.
Avoid aggressive milking of the pleural tube, as it may dislodge or occlude the tube.

Monitoring Chest Tube Output

A sudden decrease in drainage may signal an obstruction in the tubing.
Assess for kinks in the tubing if drainage stops after chest tube placement.
Collecting system fullness should be checked to ensure continued drainage.

Patient Positioning

Secure the chest tube to the patient’s chest or abdomen to prevent dislodgment during repositioning.
The semi-Fowler position is ideal for patients with hemothorax, while the lateral supine position is suitable for pneumothorax.

Risk Indicators

Symptoms of tension pneumothorax include absent breath sounds on one side, decreased oxygen saturation, and neck vein distention.
Subcutaneous emphysema is detectable by crackling sensation on palpation around the chest tube insertion site, indicating air leakage.

Equipment and Procedure Guidelines

Suction should be activated only after the chest tube is affixed to the drainage system.
Chest tube size is determined by the patient's weight, with smaller tubes used for air evacuation and larger ones for blood drainage.
No absolute contraindications exist for chest tube placement in respiratory distress cases if lung reexpansion is required.

Communication with Family

Educate family members on signs of complications and the rationale behind tube management to alleviate concerns.
Clarify that while special conditions like bleeding disorders warrant caution, they don't constitute absolute contraindications for chest tube placement.

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Description

Test your knowledge on lab skills related to continuous bubbling in water-seal chambers. Understand the implications of bubbling patterns in patients with pneumothorax or those on mechanical ventilation. This quiz will help reinforce essential concepts for clinical practice.