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Fall Block 1 Medsurg/Patho > Chest tubes > Flashcards

Chest tubes Flashcards

1
Q

What does the pleural cavity cover?

A

The lungs

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2
Q

What does the Mediastinal cavity cover?

A

The heart

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3
Q

What should be in the pleural cavity?

A

Nothing except 5-10mL of lubricating fluid for inhale & exhale ease

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4
Q

What is the thorax natural state?

A

Expansion

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5
Q

What is the lung natural state?

A

Collapse

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6
Q

The thorax and lungs exist has _____ forces and state of ___ intrapleural pressure?

A

opposing
Negative

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7
Q

What happens if the negative pressure is lost in the pleura space?

A

the 2 pleura separate (lung collapses)

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8
Q

Who requires chest drainage?

A

-Heart failure
-Thoracic surgery
-Central line accidentally gets in intrapleural space
-Spontaneous bleb rupture
-Malignacies
-Decrease in colloidal osmotic pressure

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9
Q

Pneumothorax

A

Air in pleural space

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10
Q

Spontaneous pneumothorax

A

no apparent cause

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11
Q

Hemothorax

A

Blood in pleural space

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12
Q

Thoracotomy

A

Surgical opening into thorax

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13
Q

Thoracentesis

A

Removal of pleural fluid with large bore needle (Provider done)

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14
Q

Pleural effusion

A

excess fluid in pleural space (CXR if >300mLs)
-Impairs oxygenation, decreases surface area, SOB

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15
Q

Empysema

A

Pus in pleural space

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16
Q

What would you hear if somebody had a pleural effusion?

A

No or decreased breath sounds

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17
Q

If somebody has open heart surgery what would be in their pleural space?

A

Blood and air

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18
Q

If somebody has a bleb and spontaneous lung collapse what would be in their pleural space?

A

air

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19
Q

What is the next best nursing action if <20% pneumothorax?

A

bedrest, limited activity, let it reabsorb on its own

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20
Q

What is the next best nursing action if >20% pneumothorax?

A

contact HCP for thoracentesis or insertion of chest tube attached to an underwater seal

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21
Q

What is the nursing action with chest tube insertion?

A

-Stay w/ patient (painful)
-Premedicate
-Obtain thoracotomy tray, chest tube, & drainage system
-Help maintain correct position

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21
Q

Where would a chest tube be placed if draining air?

A

Apex of lung

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22
Q

Where would a chest tube be placed if draining blood?

A

Base of lung

23
Q

What are the 3 compartment of the atrium?

A
  1. Suction chamber
  2. Water seal chamber
  3. Drainage chamber
24
Q

When is increased CT drainage expected?

A

During ambulation

25
Q

What does the collection chamber do?

A

Accepts air or fluid from the system through extension tubing directly attached to the patients chest tube

26
Q

What does the water seal chamber do?

A

Acts as a one way valve to prevent airflow back into the patient
-Filled with sterile water to 2 cm mark
(allow air to leave pleural space but not reenter)

27
Q

What does the suction chamber do?

A

-Regulates amount of negative suction being exerted on intrapleural space
-Ensure dial is turned
-Has visual alert to indicate correct suction (orange)

28
Q

Increasing the vacuum suction source will _____ pressure

A

NOT increase

29
Q

The extension tubing is either attached to ____ or ________. It should never be _________

A

Wall suction or Open to air (under water suction)
occluded

30
Q

What is the danger of clamping/occluding the air vent?

A

Tension pneumothorax

31
Q

How much suction is chest tubes typically at?

A

20cm

32
Q

When the provider is ready to ‘wean the patient’ from the chest tube, the nurse will receive an order to “change CT from sx to UWS” so the nurse would

A

Turn off suction
Take tubing off
Leave open to air

33
Q

Assessment of pt with chest tube in place?

A

-VS
-Resp assessment: O2 stat, ABG, resp effort, lung auscultation, skin/mucous membrane color, cap refill, CXR findings
-Get OOB
-Aggressive Pulm toilet

34
Q

Management of pt with chest tube in place?

A

-HOB raised
-Collection chamber below level of chest
-ATC pain meds
-Teach about pul toilet/ Splinting
-ROM exercises w/ affected should

35
Q

How should you assess insertion site?

A

-Occlusive, dry, intact
-Bleeding: mark edge of are and notify HCP
-Palpate for subcutaneous emphysema (aka crepitus) which is atmospheric air in subQ space, notify HCP

36
Q

How should you assess the extension tubing?

A

Ensure connections intact & avoid excessive dependent looping

37
Q

How should you assess the collection chamber?

A

-Check blood/fluid output
-Not volume and appearance
-Chart I&O and mark
-Expected increase ambulation
-Expected decrease sleeping

38
Q

How should you assess the water seal chamber?

A

-ensure water level at 2cm w/ sterile water
-Assess for fluctuations or tidaling if under water suction
-Assess for abnormal bubbling (intermittent is okay continuous is not)

39
Q

Is it expected to see tidaling in the water chamber when the pt coughs?

A

Yes

40
Q

What does no tidaling mean?

A
  1. lungs have re-expanded or time to take out
  2. kink/ obstruction
  3. suction is on
41
Q

What does continuous bubbling mean?

A

potential leak in system

42
Q

If continuous bubbling noted in the water seal, what should you do?

A

Gently apple a padded clamp on drainage tubing close to occlusive dressing momentarily

43
Q

If bubbling stops with clamp–>

A

indicates leak at exit site or inside pt

44
Q

If bubbling continues with clamp–>

A

indicate air leak is between clamp and drainage system (check connections or replace system-nurse can do it)

45
Q

When is it appropriate to clamp a chest tube?

A
  1. Determine air leak location
  2. To replace drainage system
  3. If provider orders it (see if pt tolerates it before removal)

NO clamping during transport or if accidentally disconnected

46
Q

What is a pneumostat?

A

For the pt who sis ready to go home but chest tube not quite ready to come out
(like pneumothorax)

47
Q

What is a PleurX catheter system used for?

A

-Recurrent pleural effusions (HF or malignancies)
-Malignant ascites (fluid in peritoneum)

48
Q

When does a patient drain fluid with a pleurX catheter system?

A

Drains at home when symptomatic

49
Q

Benefits of PleurX?

A

-Less hospital trips & decreased length of stay
-pt has control
-decreased resp complications
-safe and easy

50
Q

Which pt gets CT to suction vs UWS?

A

Provider decision
Usually start on suction than UWS

51
Q

The provider orders the pt with a CT to walk in hall TID. Can that be done?

A

Yes, x2 nurses. If connected to suction disconnect adn leave air vent to open and keep drainage container low

52
Q

What do i do if CT inadvertently pulled out of the chest?

A

Vaseline gauze (occlusive) placed on exit site to prevent atmospheric pressure from entering pleural space

53
Q

What to do if the tubing accident ally becomes disconnected?

A

Take tube that is disconnected and stick it in bottle of sterile saline and create immediate UWS that way

54
Q

Chest tube removal-

A

-Done by provider
-Cut sutures
-Apply sterile petroleum gauze dsg
-Have pt to take deep breath & bear down
-Remove tube
-Airtight dressing applied
-Mark drainage

Fall Block 1 Medsurg/Patho (10 decks)

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