Exam 3 - ABG's, Respiratory, Renal Flashcards
ABG’s range and what does it measure
pH range?
PaCO2?
HCO3?
PaO2?
SaO2?
pH = 7.35-7.45: measures acid-base balance-changes affect body function
PaCO2 = 35-45: influenced by respiratory changes
HCO3 = 22-26: influenced by metabolic changes in kidney.
PaO2 = 80-100: partial pressure of oxygen in arterial blood
Sa02 = 95% or greater: Oxygen saturation
A client in the emergency department reports that he has been vomiting excessively for the past 2 days. His arterial blood gas analysis shows a pH of 7.50, PaCO2 of 43 mm Hg, PaO2 of 75 mm Hg, and HCO3− of 42 mEq/L. Based on these findings, the nurse documents that the patient is experiencing which type of acid-base imbalance?
a) Respiratory alkalosis
b) Metabolic alkalosis
c) Respiratory acidosis
d) Metabolic acidosis
b) Metabolic alkalosis
The nurse is caring for a pt who is anxious & dizzy following a traumatic experience. The arterial blood gas findings include: pH 7.48, PaO2 110, PaCO2 25, & HCO3 24. The nurse would anticipate which initial intervention to correct this problem?
- Encourage the pt to breathe in & out slowly into a paper bag.
- Immediately administer oxygen via a mask & monitor oxygen saturation.
- Prepare to start an intravenous fluid bolus using isotonic fluids.
- Anticipate the administration of intravenous sodium bicarbonate.
Answer: 1
Rationale 1: This pt is exhibiting signs of hyperventilation that is confirmed with the blood gas results of respiratory alkalosis. Breathing into a paper bag will help the pt to retain carbon dioxide & lower oxygen levels to normal, correcting the cause of the problem.
Rationale 2: The oxygen levels are high, so oxygen is not indicated, & would exacerbate the problem if given. Intravenous fluids would not be the initial intervention.
Rationale 3: Not enough information is given to determine the need for intravenous fluids.
Rationale 4: Bicarbonate would be contraindicated as the pH is already high.
A pt’s blood gases show a pH greater of 7.53 & bicarbonate level of 36 mEq/L. The nurse realizes that the acid-base disorder this pt is demonstrating is which of the following?
- respiratory acidosis
- metabolic acidosis
- respiratory alkalosis
- metabolic alkalosis
Answer: 4
Rationale 1& 2: Respiratory acidosis & metabolic acidosis are both consistent with pH less than 7.35.
Rationale 3: Respiratory alkalosis is associated with a pH greater than 7.45 & a PaCO2 of less than 35 mmHG. It is caused by respiratory related conditions.
Rationale 4: Arterial blood gases (ABGs) show a pH greater than 7.45 & bicarbonate level greater than 26 mEq/L when the pt is in metabolic alkalosis.
http://www.adamw.org/med/apps/abg.cgi
When evaluating arterial blood gases (ABGs), which value is consistent with metabolic alkalosis?
a. PaCO2 36
b. pH 7.48
c. HCO3 21 mEq/L
d. O2 sat 95%
b. pH 7.48
When analyzing an arterial blood gas report of a pt with COPD & respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms?
a) The kidneys retain bicarbonate.
b) The kidneys excrete bicarbonate.
c) The lungs will retain carbon dioxide.
d) The lungs will excrete carbon dioxide.
a) The kidneys retain bicarbonate.
A nurse reviews the arterial blood gas results of a client and notes the following: pH 7.45, PCO2 of 30 mm Hg, and HCO3 of 22 mEq/L. The nurse analyzes these results as indicating which condition?
a. Metabolic acidosis, compensated
b. Respiratory alkalosis, compensated
c. Metabolic alkalosis, uncompensated
d. Respiratory acidosis, uncompensated
b. Respiratory alkalosis, compensated
A client with a 3-day history or nausea and vomiting presents to the emergency department. Arterial blood gases are drawn and the nurse reviews the results, expecting to note which of the following?
a. A decreased pH and an increased CO2
b. An increased pH and a decreased CO2
c. A decreased pH and a decreased HCO3-
d. An increased pH with an increase HCO3-
d. An increased pH with an increase HCO3-
client who is found unresponsive has arterial blood gases drawn and the results indicate the following: pH is 7.12, PCO2 is 90 mm Hg, and HCO3- is 22 mEq/L. The nurse interprets the results as indicating which condition?
a. Metabolic acidosis with compensation
b. Respiratory acidosis with compensation
c. Metabolic acidosis without compensation
d. Respiratory acidosis without compensation
d. Respiratory acidosis without compensation
•A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care?
- Infection
- Confusion
- Ineffective coughing and deep breathing
- Difficulty chewing solid foods
•#3- In kyphosis the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airway, ineffective coughing and deep breathing should receive priority attention
•A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first?
- Elevate the head of the bed 30-45 degrees
- Encourage the client to cough and deep breathe
- Auscultate the lungs to detect abnormal breath sounds
- Contact the physician
•#1: Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physicians must be kept informed of changes in a client’s status, but the priority in this case is alleviating the symptoms
•A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins?
- Urinalysis
- Sputum culture
- Chest radiograph
- Red blood cell count
•#2- A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Neither a UA or chest radiograph nor a RBC count needs to be obtained before initiation of antibx therapy for pna.
•A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia?
- Age
- Osteoarthritis
- Vegetarian Diet
- Daily Bathing
•#1- The client’s age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, URTIs, malnutrition, immunosuppression, and the presence of chronic illness. OA, vegetarian diets, and frequent bathing are not predisposing factors.
•A client with pneumonia has a temperature of 102.6 degrees F (39.2 C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?
- Position changes every 4 hours
- Nasotracheal suctioning to clear secretions
- Frequent linen changes
- Frequent offering of a bedpan
•#3- Frequent linen changes are appropriate for the client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client’s productive cough. Frequent offering of a bedpan is not indicated by the data provided.
•The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
- Decreased cardiac output
- Pleural effusion
- Inadequate peripheral circulation
- Decreased oxygenation of the blood
•#4- A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis. Pleural effusions are a potential complication of pna but are not the primary cause of decreased oxygenation. Inadequate peripheral circulation is also not the cause of cyanosis that develops with bacterial pna.
•A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for:
- A mild but constant aching in the chest
- Severe midsternal pain
- Moderate pain that worsens on inspiration
- Muscle spasm pain that accompanies coughing
•#3- Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement. Pleruitic chest pain is usually described as sharp, not mild or aching. Pleuritic chest pain is not localized to the sternum, and it is not the result of a muscle spasm.
•Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia?
- Coma
- Apathy
- Irritability
- Depression
•#3- Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
•Which of the following symptoms is most common in clients with active tuberculosis?
- Weight loss
- Increased appetite
- Dyspnea on exertion
- Mental status changes
•#1- TB typically produces anorexia and weight loss. Other signs and symptoms may include fatigue, low grade fever, and night sweats. Increased appetite is not a symptom of the TB; dyspnea on exertion and change in mental status are not common symptoms of TB
•A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for:
- Decreased serum creatinine
- Difficulty swallowing
- Hearing loss
- I.V. infiltration
•#3- Streptomycin can cause toxicity to the 8th cranial nerve, which is responsible for hearing, balance, and body position sense. Nephrotoxicity is a side effect that would be indicated with an increase in creatinine. Streptomycin is given via IM injection
•What is the rationale that supports multidrug treatment for clients with tuberculosis?
- Multiple drugs potentiate the drugs’ actions
- Multiple drugs reduce undesirable drug adverse effects
- Multiple drugs allow reduced drug dosages to be given
- Multiple drugs reduce development of resistant strains of the bacteria
•#4-Use of a combination of antiTB drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat TB. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications i.e. antihypertensive, to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antiTB drugs.
•A client has a positive reaction to the Mantoux test. The nurse correctly interprets this reaction to mean that the client has:
- Active tuberculosis
- Had contact with Mycobacterium tuberculosis
- Developed a resistance to tubercle bacilli
- Developed passive immunity to tuberculosis
•#2- A positive Mantoux skin test indicates that the client has been exposed to tubercle bacilli. Exposure does not necessarily mean that active disease exists. A positive Mantoux test does not mean that the client has developed resistance. Unless involved in treatment, the client may still develop active disease at any time. Immunity to TB is not possible.
•The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). •pH 7.35; PC02 62; PO2 70; HCO3 34 •The nurse should:
- Apply a 100% nonrebreather mask
- Assess the vital signs
- Reposition the client
- Prepare for intubation
•#2- Clients with COPD have Co2 retention and respiratory drive is stimulated when the PO2 decreases. The HR, RR, and BP should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.
•Which of the following physical assessment findings are normal for a client with advanced COPD?
- Increased anteroposterior chest diameter
- Underdeveloped neck muscles
- Collapsed neck veins
- Increased chest excursions with respiration
•#1- Increased AP diameter is a characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the HF that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.
•Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema?
- To promote oxygen intake
- To strengthen the diaphragm
- To strengthen the intercostal muscles
- To promote carbon dioxide elimination
•#4- Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles
•Which of the following is a priority goal for the client with COPD?
- Maintaining functional ability
- Minimizing chest pain
- Increasing carbon dioxide levels in the blood
- Treating infectious agents
•#1- A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client’s functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.
•The nurses assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?
- Normal breath sounds
- Prolonged inspiration
- Normal chest movement
- Coarse crackles and rhonchi
•#4- Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged AP diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become over distended.
A client with COPD is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD?
- High oxygen concentrations will cause coughing and dyspnea
- High oxygen concentrations may inhibit the hypoxic stimulus to breathe
- Increased oxygen use will cause the client to become dependent on oxygen
- Administration of oxygen is contraindicated in client who are using bronchodilators
•#2-Clients who have a long history of COPD may retain CO2. Gradually the body adjusts to higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then become hypoxemia. Administration of high concentrations of O2 eliminates this respiratory stimulus and leads to hypoventilation. O2 can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased O2 use will not create an oxygen dependency; clients should receive O2 as needed. O2 is not contraindicated with the use of bronchodilators.
•A slightly obese female client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:
- Resonant sounds
. 2. Hyperresonant sounds.
- Dull sounds.
- Flat sounds.
•Answer A. When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thud like and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.
•A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?
- Dyspnea
2. Bradypnea - Bradycardia
- Decreased respirations
•Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain.
•Nurse Oliver observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse conclude?
- The system is functioning normally
2. The client has a pneumothorax.
- The system has an air leak.
- The chest tube is obstructed.
•Answer C. Constant bubbling in the chamber indicates an air leak and requires immediate intervention. The client with a pneumothorax will have intermittent bubbling in the water-seal chamber. Clients without a pneumothorax should have no evidence of bubbling in the chamber. If the tube is obstructed, the nurse should notice that the fluid has stopped fluctuating in the water-seal chamber.
A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client?
- Initiate oxygen therapy as prescribed and reassess the client in 10 minutes
- Draw blood for an arterial blood gas (ABG)
- Encourage the client to relax and breathe slowly through the mouth
- Administer bronchodilators as prescribed
- Administer bronchodilators as prescribed
•In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids, and, possibly, IV theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an ABG. It would be futile to encourage the client to relax and breathe slowly.
A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma?
- Promote bronchodilation
- Act as an expectorant
- Have an anti-inflammatory effect
- Prevent development of respiratory infections
3.Have an anti-inflammatory effect
Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections
•A client who underwent a lobectomy and has a water-seal chest drainage system is breathing with a little more effort and at a faster rate than 1 hour ago. The client’s pulse rate is also increased. The nurse should:
- Check the tubing to ensure that the client is not lying on or kinking it.
- Increase the suction.
- Lower the drainage bottles 2-3 feet below the level of the client’s chest.
- Ensure that the chest tube has two clamps on it to prevent air leaks
1.Check the tubing to ensure that the client is not lying on or kinking it.
In this case, there may be some obstruction to the flow of air and fluid out of the pleural space, causing air and fluid to collect and build up pressure. This prevents the remaining lung from re-expanding and can cause a mediastinal shift to the opposite side. The nurse’s first response is to assess the tubing for kinks or obstruction. Increasing the suction is not done without a physician’s prescription. The normal position of the drainage bottles is 2-3 feet below chest level. Clamping the tubes obstructs the flow of air and fluid out of the pleural space and should not be done.
•Following a thoracotomy, the client has severe pain. Which of the following strategies for pain management will be the most effective for this client?
- Repositioning the client immediately after administering pain medication
- Reassessing the client 30 minutes after administering pain medication
- Verbally reassuring the client after administering pain medication
- Readjusting the pain medication dosage as needed according to the client’s condition
2.Reassessing the client 30 minutes after administering pain medication
It is essential that the nurse evaluate the effects of pain medication after the medication has had time to act; reassessment is necessary to determine the effectiveness of the pain management plan. Although it is prudent to check for discomfort related to positioning when assessing the client’s pain, repositioning immediately after is not necessary. Verbal reassurance may be useful to instill confidence in the treatment plan; however, it is not as important as the effectiveness of the medication. Readjusting the pain medication dosage as needed according to the client’s condition is essential, but the effectiveness of the medication must be evaluated first.
•Which of the following is an expected outcome for an adult client with well-controlled asthma?
- Chest x-ray demonstrates minimal hyperinflation
- Temperature remains lower than 100 degrees F (37.8 C)
- Arterial blood gas analysis demonstrates a decrease in PaO2
- Breath sounds are clear
- Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest X-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.
•Which of the following findings would most likely indicate the presence of respiratory infection in a client with asthma?
- Cough productive of yellow sputum
- Bilateral expiratory wheezing
- Chest tightness
- Respiratory rate of 30 breaths/min
•A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms-wheezing, chest tightness, and increased respiratory rate are all findings associated with an asthma attack and do not necessarily mean an infection is present.
The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack?
- Occupational exposure to toxins
- Viral respiratory infections
- Exposure to cigarette smoke
- Exercising in cold temperatures
2.Viral respiratory infections
The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.
The nurse has assisted the physicians at the bedside with insertion of a left subclavian, triple lumen catheter in a client admitted with lung cancer. Suddenly, the client becomes restless and tachypnea. The nurse should:
- Assess breath sounds
- Remove the catheter
- Insert a peripheral IV
- Reposition the client
1.Assess breath sounds
The nurse should first assess for bilateral breath sounds since a complication of central line insertion is a pneumothorax, which would cause an increase in respiratory rate and drop in oxygen, causing irritability. The nurse should also assess blood pressure and heart rate for the complication of bleeding. A chest x-ray will be performed to determine correct placement and complications. A central line was most likely placed because peripheral IV access was not available or adequate for the client. Repositioning may be considered after assessments are done
While assessing a thoracotomy incisional area from which a chest tube exits, the nurse feels a crackling sensation under the fingertips along the entire incision. Which of the following should be the nurse’s first action?
- Lower the head of the bed and call the physician
- Prepare an aspiration tray
- Mark the area with a skin pencil at the outer periphery of the crackling
- Turn off the suction of the chest drainage system
•This crackling sensation is subcutaneous emphysema. Subcutaneous emphysema is not an unusual finding and is not dangerous if confined, and the nurse should mark the area to detect if the area is expanding. Progression can be serious, especially if the neck is involved; a tracheotomy may be needed at that point. If emphysema progresses noticeably in 1 hour, the physician should be notified. Lowering the head of the bed will not arrest the progress or provide any further information. A tracheotomy tray would be useful if subcutaneous emphysema progresses to the neck. Subcutaneous emphysema may progress if the chest drainage system does not adequately remove air and fluid; therefore, the system should not be turned off.
When teaching a client to deep breathe effectively after a lobectomy, the nurse should instruct the client to do which of the following?
- Contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3-5 sec, then exhale
- Contract the abdominal muscles, take a deep breath through the mouth, and exhale slowly as if trying to blow out a candle
- Relax the abdominal muscles, take a slow deep breath through the nose, and hold it for 3-5 sec
- Relax the abdominal muscles, take a deep breath through the mouth, and exhale slowly over 10 seconds
1.Contract the abdominal muscles, take a slow deep breath through the nose and hold it for 3-5 sec, then exhale
The recommended procedure for teaching clients postoperatively to deep breathe includes contracting (pulling in) the abdominal muscles and taking a slow, deep breath through the nose. This breath is held 3-5 seconds, which facilitates alveolar ventilation by improving the inspiratory phase of ventilation. Exhaling slowly as if trying to blow out a candle is a technique used in pursed-lip breathing to facilitate exhalation in clients with COPD. It is recommended that the abdominal muscles be contracted, not relaxed, to promote deep breathing. The client should breathe through the nose.
A client has a chest tube attached to a water-seal drainage system and the nurse notes that the fluid in the chest tube and in the water-seal column has stopped fluctuating. The nurse should determine that:
- The lung has fully expanded
- The lung has collapsed
- The chest tube is in the pleural space
- The mediastinal space has decreased
1.The lung has fully expanded
Cessation of fluid fluctuation in the tubing can mean one of several things: the lung has fully expanded and negative intrapleural pressure has been re-established; the chest tube is occluded; or the chest tube is not in the pleural space. Fluid fluctuation occurs because, during inspiration, intrapleural pressure exceeds the negative pressure generated in the water-seal system. Therefore, drainage moves toward the client. During expiration, the pleural pressure exceeds that generated in the water-seal system, and fluid moves away from the client. When the lung is collapsed or the chest tube is in the pleural space, fluid fluctuation is likely to be noted. The chest tube is not inserted in the mediastinal space.
Which of the following should be readily available at the bedside of a client with a chest tube in place?
- A tracheostomy tray
- Another sterile chest tube
- A bottle of sterile water
- A spirometer
A bottle of sterile water should be readily available and in view when a client has a chest tube so that the tube can be immediately submersed in the water if the chest tube system becomes disconnected. The chest tube should be reconnected to the water-seal system as soon as a sterile functioning system can be re-established. There is no need for a tracheostomy tray, another chest tube, or a spirometer to be placed at the bedside for emergent use.