CEC/SIM

Question 1

Where are chest tubes inserted? and what are they doing?

Answer 1

Inserted into the pleural space of lungs to help re-expand the lungs
OR
Placed in the mediastinum to drain blood/fluid from around the heart after cardiac surgery

Question 2

How do the chest tubes drain?

Answer 2

Wet suction: regulated by height of water in the suction control chamber when connected to wall suction
Dry suction: suction monitor

Question 3

Nursing management of chest tube (generally)

Answer 3

Keep system below pt chest
No kinks or clots
Monitor drainage: color, amount

Question 4

Management for water seal chamber

Answer 4

Ensure that there isn’t excessive bubbling = air leak

Question 5

What should you watch for in a wet suction control chamber? What should you see?

Answer 5

water evaporates over time so ensure that the water isn’t gone. You want it at the 2cm line.
It should gently bubble d/t suction working

Question 6

What should you assess on pt with chest tube?

Answer 6

Lung sounds 
SQ crepitus (crackling on palpation) d/t carbon dioxide escaping tissues

Question 7

What to do if chest tube becomes dislodged?

Answer 7

Cover the site with a sterile dressing, and tape on three sides (this allows air to escape and prevent tension pneumothorax) and notify physician immediately.

Question 8

Milking or stripping tubing?

Answer 8

Not recommended anymore because it creates too much negative pressure (always follow hospital policies)

Question 9

Clamping tubing?

Answer 9

Increase risk of patient developing a tension pneumothorax. Never do it without an order and follow hospital policies

Question 10

How and when would you administer Narcan?

Answer 10

Opioid overdose
Pt is somnolent / difficult to arose / no response to physical stimulation
Shallow resps, rate < 8
Pinpoint pupils
Delivery: nostril spray

Question 11

What are monitoring parameters for Narcan?

Answer 11

Assign staff to monitor sedation and resp status and remind pt to deep breathe every 1-2 min
Keep Narcan readily available
Second dose may be needed w/n 30 min
Monitor VS

Question 12

What is the care for a patient during death/dying? (7)

Answer 12

Give time on monitor as time of death + contact the provider
Ensure that the provider (resident second year and above) fills out the death certificate in collaboration with county coroner.
Call donor information line to determine pts eligibility
Prepare the body for the family; stay with family if they want
All tubes and lines stay in until death certificate has been confirmed
Place in morgue bag and prepare transport
Tags are on pt: inside bag on toe and tag on outside of the bag