Chest Tubes NCLEX

Question 1

This part of the chest tube collection container will have: Gentle, steady, or continous bubbling.

Answer 1

Suction Control chamber.

Far Right of device

Question 2

The middle chamber of the chest tube container is called
Water Seal Chamber & Air Leak Monitor

What is a normal reaction in this chamber

Abnormal findings

Answer 2

Gentle up & down motion called: Tidaling

Abnormal findings; Continous bubbling, Air leak

Question 3

Client ask: What does it mean when there is Tidaling in the water seal chamber

Best nurses response

Answer 3

It shows your lungs haven’t re-expanded yet

Question 4

Possible indication of lung re-expansion in the Water Seal area of chest tube container

Answer 4

Tidaling has stopped

Question 5

Monitor for Fluctuation in Water Seal No Fluctuation could indicate this problem

Answer 5

Blockage on tube

Question 6

The Air Leak Container at bottom of Water Seal

Is Continous Bubbling a normal sign?

Answer 6

No, intermediate bubbles are normal (Sneezing / Cough)

Continous bubbling = Air Leak

Question 7

Collection chamber

Asses how often during the first 24 hours.

Answer 7

Every hour first 8 hours

Then every 8 hours after

Question 8

Notify HCP

(Bright/ Dark) red blood, Over ____ mL + (after 1st hour of placement)

Answer 8

Bright red/ >100mL

Dark blood (old blood) drainage is Normal.
Document

Question 9

Patients collection chamber stops filling with blood after several hours of collection.

Do you inspect the device or the patient first

What kind of inspection will you do?

Answer 9

Patient

Ausculate the lungs, diminished breath sounds is Danger, Priority

Question 10

Patient has stopped draining blood from chest tube.

Upon Ausculation, Diminished breath sounds

What do you do next

Answer 10

Turn patient, Cough, Deep Breath

Reposition

Question 11

Priority nursing intervention for a client with a 3 chambered Chest Drainage System for hemothorax

Answer 11

Assess clients respitory status frequently

Question 12

After placement of a chest tube the clients skin has a distinctive “popping / crepitus” sound that is associated with Subcutaneous Emphysema

What is the Priority nursing intervention

Answer 12

Mark diameter with a Marker to ensure it is not spreading

Question 13

Chest tube becomes disconnected from patient

Nursing interventions

Answer 13

1. Tell patient: Cough & Exhale immediately as much as possible
2. Immediately, apply occulsive (petroleum gauze) on 3 side. Which allows air out

Question 14

Essential equipment to have at the bedside of a client with closed chest drainage system (3)

Answer 14

Sterile connector, sterile petroleum gauze, padded clamp

Question 15

Disconnection from drainage tube without contamination No Damage

What to do

Damage to Water Seal Chest Tube

What to do

Answer 15

No Damage: Antiseptic swab and reconnect

Damage to Water Seal Chest Tube:
Place distal end sterile saline

Question 16

When do we clamp a chest tube?

Answer 16

Never

Question 17

While removing a chest tube instruct patient to do this

Answer 17

Valsalva maneuver

Deep breath, hold it, & bear down

Question 18

3 big No,Nos

Answer 18

1. Never Strip or milk tube
2. Never continous bubbles in Water Seal or Air Leak Chamber
3. Never Clamp during transport

Question 19

Suction should be set on

Answer 19

> 80 mmHg