CHEST TUBES

Question 1

Purpose: to reestablish negative pressure in the pleural space

((Negative pressure in the pleural space makes thing stick so that the lung expands when the chest wall ))

Answer 1

Chest Tubes

Question 2

IN a _____ chest tube remoces air

Answer 2

Pneumothorax

Question 3

In _____, chest tube removes blood

Answer 3

Hemothorax

Question 4

A chest tube is placed in a pt for a hemothorax (blood). What would you (the LPN) report to the nurse? Or, what would you (the RN) report physician?
a. Chest tube is not bubbling
b. Chest tube drains 800 mL in the first 10 hours
c. Chest tube is not draining
d. Chest tube is intermittently bubbling

Answer 4

C

The chest tube is supposed to drain instead of bubbling

Question 5

A chest tube is placed in a pt for a pneumothorax (air). What would you (the LPN) report to the nurse? Or, what would you (the RN) report physician?
a. Chest tube is not bubbling
b. Chest tube drains 800 mL in the first 10 hours
c. Chest tube is not draining
d. Chest tube is intermittently bubbling

Answer 5

A

With a pneumothorax, blubbling is expected

Question 6

Apical (top) chest tube removes ____

Answer 6

Air

Question 7

Basilar chest tube removes ____

Answer 7

Blood / fluid

Question 8

Good or bad

1. An apical chest tube is draining 300 mL the first hour
2. A basilar chest tube is draining 200 mL the first hour is
3. An apical chest tube is not bubbling
4. A basilar chest tube is not bubbling

Answer 8

1. is bad … Bubbling (air) is expected
2. expected, good
3. This is a bad sign because bubbling (air) is expected
4. This is a good sign because bubbling (air) is not expected

Question 9

Pt presents with a unilateral hemopneumothorax. How to care for this pt?

Answer 9

Place an apical chest tube for the pneumothorax and a basilar for the hemothorax

*Pt needs both

Question 10

Bilateral pneumothorax needs what kind of chest tue?

Answer 10

Apical chest tube on the right and one on the left

Question 11

Pt presents with a unilateral hemopneumothorax. How to care for this pt?

Answer 11

Place an apical and a basilar chest tube on the side of the problem … Always assume trauma and surgery is unilateral unless otherwise specified

Question 12

Were would you place a chest tube for a postop right pneumonectomy?

Answer 12

• Postop right pneumonectomy does not need a chest tube … Since the right lung was removed, there is no need for a chest tube
• Chest tube will however be used for lobectomy (removal of a lobe of the lung), or wedge
resection

Question 13

What happens if one of those drainage devices is knocked iver?

Answer 13

Ask pt to take a deep breath and set the device back up
- it is not a medical emergency.. no need to call the physician

Question 14

What are types of closed chest drainage devices

Answer 14

Jackson-Pratt
Emisso
Pneumovac
Hemovac

Question 15

What to do if the water seal of chest tube breaks?

Answer 15

CLAMP
CUT
SUBMERGE
UNCLAMP

*alphabetical

Question 16

The water seal chamber of the chest tube in a pt with a pneumothorax/hemothorax breaks. What is the first course of action for the nurse?
a. Clamp the tube
b. Cut the tube away
c. Submerge (or stick) the end of the tube under sterile water
d. Unclamp the tube if it was initially clamped

Answer 16

In this case, the first course of action is the clamp the tube

Question 17

The water seal chamber of the chest tube in a pt with a pneumothorax/hemothorax breaks. What is the priority (best) action of the nurse?
a. Clamp the tube
b. Cut the tube away
c. Submerge (or stick) the end of the tube under sterile water
d. Unclamp the tube if it was initially clamped

Answer 17

In this question, the priory action for the nurse is to submerge the end of the tube under sterile water because doing so prevents air from getting into the chest. At the same time, this allows air or blood from the chest to get out
• This solves the problem by reestablishing the water seal

Note
Clamping, unclamping, and placing the tube under water must be done in 15 seconds or less

Question 18

If a chest tube gets pulled out …
1. What is the first step
2. What is the best step

Answer 18

1. Take a gloved hand and cover the opening (first step)
2. Take a sterile Vaseline gauze and tape 3 sides (best step)

Question 19

What is the nursing action when a chest tube is bubbling?

Answer 19

Where is it bubbling? When is it bubbling?

In the water seal chamber
a. If it is intermittent, it is good (document it)
B. if it is continous, it is bad and indicates a break/leak in the system (find it and tape it)

In the suction control chamber
A. If it is intermittent, suction pressure is too low (increase it at the wall ubntil it is continous)
B. If it is continous, it is good (document it)

Question 20

A straight catheter is to a Foley catheter, as a ______________ is to a chest tube

Answer 20

Thoracentesis

Question 21

What are the rules for clamping chest tube?

Answer 21

• Do not clamp a tube for more than 15 seconds without a physician’s order
• Use rubber tooth (will not puncture tubing), double clamps
extra secure
• Therefore, when the water seal breaks, the nurse has no more than 15 seconds to clamp, cut the tube, submerge it under sterile water, and then unclamp it

Question 22

What findings would support the finding that the client is experiencing pain

Answer 22

1. Resistance with passive movements
2. ventilator asynchrony: the client may be biting on the tube or experiencing tachypnea as a result of paon
3. Restlessness
4. Muscle tension
5. Pupillary dilation: pain triggers teh sympathetic nervous system, the release of the catecholamines cause pupillary dilation