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Med Surg 1 > ATI: Chapter 18 - Chest Tube Insertion and Monitoring > Flashcards

ATI: Chapter 18 - Chest Tube Insertion and Monitoring Flashcards

1
Q

Chest tubes are inserted into the _____ to drain fluid, blood, or air; reestablish a negative pressure; facilitate lung expansion; and restore normal intrapleural pressure.

A

pleural space

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2
Q

Chest tubes can be inserted in the emergency department, at the bedside or in the operating room through a _______ incision.

A

thoracotomy

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3
Q

A disposable three-chamber drainage system is most often used. First chamber: ________ collection. Second chamber: water seal. Third chamber: ______ control (can be wet or dry)

A

drainage

suction

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4
Q

______ are created by adding sterile fluid to a chamber up to the 2 cm line. While this is the minimum amount required for functioning, recommended amounts can vary by manufacturer. The ____ allows air to exit from the pleural space on exhalation and stops air from entering with inhalation.

A

water seals

water seal

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5
Q

To maintain the water seal, keep the chamber ______ and ______ the chest tube insertion site at all times. Routinely monitor the water level due to the possibility of evaporation. Add fluid as needed to maintain the manufacturer’s recommended water seal level.

A

upright

below

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6
Q

Wet suction: The height of the sterile fluid in the suction control chamber determines the amount of suction transmitted to the pleural space. A suction pressure of ____ cm H20 is commonly prescribed. The prescribed amount of suction is applied by setting the regulator on the chest tube drainage device. The application of suction results in continuous bubbling in the suction chamber. Monitor the _______ and add fluid as needed to maintain the prescribed level of suctioning.

A

-20

fluid level

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7
Q

Dry suction: When a dry suction control device is used, the provider prescribes a level of suction for the device, typically ____ cm H20. When connected to wall suction, the regulator on the chest tube drainage system is set to the manufacturer’s recommendation.

A

-20

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8
Q

_______ (movement of the fluid level with respiration) is expected in the water seal chamber. With spontaneous respiration, the fluid level will rise with inspiration (increase in negative pressure in lung) and will fall with expiration. With positive-pressure mechanical ventilation, the fluid level will rise with expiration and ____ with inspiration.

A

Tidaling

fall

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9
Q

Cessation of tidaling in the water seal chamber signals _______ or an obstruction within the system.

A

lung re-expansion

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10
Q

Continuous bubbling in the water seal chamber indicates and ______ in the system.

A

air leak

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11
Q

Indications for chest tube insertion

A 
pneumothorax
hemothorax
postoperative chest drainage
pleural effusion
pulmonary empyema
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12
Q

______ is a partial to complete collapse of the lung due to accumulation of air in the pleural space.

A

pneumothorax

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13
Q

______ partial to complete collapse of the lung due to accumulation of blood in the pleural space.

A

hemothorax

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14
Q

_______ as a result of thoracotomy or open-heart surgery.

A

postoperative chest drainage

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15
Q

_______ is the abnormal accumulation of fluid in the pleural space.

A

pleural effusion

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16
Q

_______ is the accumulation of pus in the pleural space due to pulmonary infection, lung abscess, or infected pleural effusion.

A

pulmonary empyema

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17
Q

A chest tube is indicated when a client presents with…

A

dyspnea
distended neck veins
hemodynamic instability
pleuritic chest pain
cough
absent or reduced breath sounds on the affected side
hyperresonance on percussion of affected side (pneumothorax)
Dullness or flatness on percussion of the affected side (hemothroax, pleural effusion)
Asymmetrical chest wall motion

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18
Q

Prior to the chest tube verify that the consent form is ____.

A

signed

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19
Q

Reinforce client teaching. ______ will improve when the chest tube is in place.

A

Breathing

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20
Q

Prior to placement of a chest tube, assess for ______ to local anesthetics.

A

allergies

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21
Q

Assist the client into the desired position (_______ or _______) prior to a thoracentesis.

A

supine or semi folwers

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22
Q

Prepare the _______ system prior to the chest tube insertion per the facility’s protocol. (fill the water seal chamber.)

A

chest drainage

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23
Q

Administer pain and ______ mes as prescribed prior to the chest tube insertion.

A

sedation

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24
Q

Prep the insertion site with ______ or other facility-approved agent.

A

povidone-iodine

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25
Q

Assist the provider with insertion of the chest tube, application of a ______ to the insertion site, and set-up of the drainage system.

A

dressing

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26
Q

Place the chest tube drainage system below the client’s chest level with the tubing coiled on the _____. Ensure that the tubing from the bed to the drainage system is straight to promote drainage via _______.

A

bed

gravity

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27
Q

The nurse should continually monitor vital signs and response to the ____.

A

procedures

28
Q

Postprocedure assess vs, breath sounds, SaO2, color and respiratory effort as indicated by the status of the client and at least every ___ hours.

A

4 hours

29
Q

Encourage coughing and deep breathing every ____ hours.

A

2 hours

30
Q

Keep the drainage system below the client’s chest level including during ______.

A

ambulation.

31
Q

Monitor chest tube placement and function check the water seal level every ______ and add fluid as needed. The fluid level should fluctuate with respiratory effort.

A

2 hours,

32
Q

Monitor chest tube placement and function, document the amount and color of drainage hourly for the first 24 hours and then at least every _______ hours.

A

8

33
Q

Monitor chest tube placement and function, mark the date, hour, and ______ level on the container at the end of each shift. Report excessive drainage, greater than ______ or drainage that is cloudy or red to the provider.

A

drainage

70 mL/hr

34
Q

Drainage often ____ with position change or coughing.

A

increases

35
Q

Monitor the fluid in the suction _________, and maintain the prescribed fluid level.

A

control chamber,

36
Q

Ensure the regulator dial on the ____ suction device is at the prescribed fluid level.

A

dry

37
Q

Check for expected findings of tidaling in the water seal chamber and continuous bubbling only in the _____.

A

suction chamber

38
Q

Routinely monitor tubing for kinks, ______, or loose connections.

A

occlusions

39
Q

Monitor the chest tube insertion site for _____, pain, infection, and crepitus (air leakage in subcutaneous tissue.

A

redness

40
Q

Tape all connections between the chest tube and the _______.

A

chest tube drainage system.

41
Q

Position the client in the ______ to _____ position to promote optimal lung expansion and drainage of fluid from the lungs.

A

semi to high fowlers

42
Q

Administer pain medications as prescribed after the placement of a _____.

A

chest tube.

43
Q

Keep two enclosed _____, sterile water, and an occlusive dressing located at the bedside at all times.

A

hemostats

44
Q

Obtain a ______ to verify the chest tube placement.

A

x ray

45
Q

Due to the risk of causing a tension pneumothorax, chest tubes are clamped only when prescribed in specific circumstances, such as in the case of an air leak, during _______ change, accidental disconnection of tubing, or damage to the drainage system.

A

drainage system change

46
Q

Do not strip or ______ tubing; only perform this action when prescribed. Stripping creates a high negative pressure and can damage lung tissue.

A

milk

47
Q

_____ are a complication associated with chest tubes. It can result if a connection is not taped securely.

A

air leaks

48
Q

Monitor the water seal chamber for _____ which is a finding of air leaks. Check all the connections and notify the provider if an air leak is noted.

A

continuous bubbling

49
Q

If prescribed, gently apply a padded clamp to determine the ______ of the air leak. Remove the clamp immediately following assessment.

A

location

50
Q

Accidental disconnection, system breakage, or removal are complications that can occur at anytime. If the tubing separates, instruct the client to _____ as much as possible and to cough to remove as much air as possible from the pleural space.

A

exhale

51
Q

If the chest tube drainage system is compromised, immerse the end of the chest tube in _____ to restore the water seal.

A

sterile water

52
Q

If a chest tube is accidentally removed, dress the area with dry, _______.

A

sterile gauze

53
Q

Sucking chest wounds, prolonged clamping of the tubing, kinks or obstruction in the tubing, or mechanical ventilation with high levels of positive end expiratory pressure (PEEP) can cause a ________.

A

tension pneumothorax

54
Q

Assessment findings include tracheal deviation, absent breath sounds on one side, distended neck veins, respiratory distress, asymmetry of the chest, and _____.

A

cyanosis.

55
Q

Provide pain meds _____ minutes before removing chest tubes.

A

30 minutes.

56
Q

Assist the provider with sutures and chest tube ____.

A

removal

57
Q

Instruct the client to take a deep breath, exhale and _______ or to take a deep breath and hold it ( increases intrathoracic pressure and reduces risk of air emboli) during chest tube removal.

A

bear down (Valsalva maneuver)

58
Q

Apply airtight sterile _______ dressing. Secure in place with a heavyweight stretch tape when you remove a chest tube.

A

petroleum jelly gauze

59
Q

Obtain chest x rays as prescribed after chest tube removal. This is performed to verify continued resolution of the pneumothroax, hemothorax, or _____.

A

pleural effusion

60
Q

Monitor for excessive wound drainage, signs of infection, or _________ after removing a chest tube removal.

A

recurrent pneumothorax

61
Q

A nurse preparing to care for a client following chest tube placement. Which of the following items should be available in the client’s room? (Select all that apply)

A. Oxygen
B. Sterile water
C. Enclosed hemostat clamps
D. Indwelling urinary catheter
E. Occlusive dressing
A

A, B, C, E

Oxygen should be readily available in case the client develops respiratory distress following chest tube placement.

If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal

Hemostat clamps should be available for the nurse to use to check air leaks

Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax

62
Q

A nurse is caring for a client who has a chest tube and drainage system in place. The nurse observes that the client’s chest tube was accidentally removed. Which of the following actions should the nurse take first?

A. Place the tubing in sterile water to restore the water seal
B. Apply sterile gauze to the insertion site
C. Place tape around the insertion site
D. Assess the client’s respiratory status

A

B.

Using ABC priority framework, the application of a sterile gauze to the site should be the first action for the nurse to take. This allows the air to escape and reduces the risk of the tension pneumothorax

63
Q

A nurse is assessing a client who has a chest tube and drainage system in place. Which of the following are expected findings? (Select all that apply)

A. Continuous bubbling in the water seal chamber
B. Gentle constant bubbling in the suction control chamber
C. Rise and fall in the level of water in the water seal chamber with inspiration
D. Exposed sutures without dressing
E. Drainage system upright at chest level

A

B, C

Gentle bubbling in the suction control chamber is an expected finding as air is being removed

A rise and fall of the fluid level in the water seal chamber upon inspiration and expiration indicate that the drainage system is functioning properly

64
Q

A nurse is assisting a provider with the removal of a chest tube. Which of the following should the nurse instruct the client to do?

A. Lie on his left side
B. Use the incentive spirometer
C. Cough at regular intervals
D. Perform the Valsalva maneuver

A

D.

The client should be instructed to take a deep breath, exhale, and bear down as the chest tube is being removed. This increases intrathoracic pressure and reduces the risk of an air embolism

65
Q

A nurse is planning care for a client following the insertion of a chest tube and drainage system. Which of the following should be included in the plan of care? (Select all that apply)

A. Encourage the client to cough every 2 hours
B Check for continuous bubbling in the suction chamber
C. Strip the drainage tubing every 4 hours
D. Clamp the tube once a day
E. Obtain a chest x ray

A

A, B, E

Cough every 2 hours to promote oxygenation and lung re-expansion

Check for continuous bubbling in the suction chamber to verify that suction is being maintained at an appropriate level

A chest x ray is obtained following the procedure to verify chest tube placement

Med Surg 1 (15 decks)

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