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NURS 3532 - Skills 4 > Lab 4 > Flashcards

Lab 4 Flashcards

1
Q

what is the purpose of chest tubes & pleural drainage

A
  • to remove air and fluid from the pleural space

- to restore normal intrapleural pressure so the lungs can re-expand `

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2
Q

what is done for small accumulations of air or fluid in the pleural space

A
  • may not require removal by thoracentesis or chest tube

- may be reabsorbed over time

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3
Q

where can chest tubes be inserted (3)

A
  • ER
  • at pt’s bedside
  • in the OR
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4
Q

how are chest tubes inserted in the OR

A
  • via thoracotomy incisions
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5
Q

how is a chest tube inserted in the ER or at the bedside

A
  • the pt is placed in a sitting position or lying down w the affected side elevated
  • area prepared w antiseptic solution
  • site is infiltrated w a local anesthethic
  • then a small incision is made
  • then 1 or 2 chest tubes are placed
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6
Q

where is a chest tube to remove air placed

A
  • anteriorly, thru the second intercostals space
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7
Q

where is a chest tube to remove blood & fluids placed

A
  • posteriorly thru th 8th or 9th intercostal space
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8
Q

describe the clamping of the tubes during insertion of a chest tube

A
  • kept clamped during the insertion

- after tubes are in place, they are connected to drainage tubing and pleural drainage, and the clamp is removed

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9
Q

describe the connection of chest tube to drainage systems

A
  • each tube may be connected to a separate drainage system & suction
  • or a Y-connector is used to attach both chest tubes to the same drainage system
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10
Q

describe the dressing for chest tibe

A
  • tubes are sutured to the chest wall and the puncture wound is covered w an airtight dressing
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11
Q

most pleural drainage systems have __ basic components

A

3

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12
Q

list the 3 basic components of pleural drainage

A
  • collection chamber
  • water-seal chamber
  • suction control chamber
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13
Q

describe the purpose of the collection chamber

A
  • receives fluid and air from the chest cavity

- the fluid stays in this chamber while air vents to the second compartment

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14
Q

what should be assessed r/ the collection chamber

A
  • drainage amt & color

- any significant changes (note: it is normal for an increase in drainage if the pt gets up to ambulate)

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15
Q

describe the purpose of the water-seal chamber

A
  • contains 2 cm of water that acts as a 1-way valve to prevent backflow of air into the pt from the system
  • the incoming air enters from the collection chamber, and bubbles up thru the water
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16
Q

describe the bubbling in the water-seal chamber (3

A
  • initial bubbling of air when a pneumothroax is evacuated
  • intermittent bubbling with exhalation, coughing, or sneezing (d/t increase in intrathoracic pressure)
  • “tidalling” (fluctuations) seen which reflects the pressures in the pleural space
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17
Q

what does it mean if tidalling in the water-seal chamber is not seen (2)

A
  • the lungs have re-expanded

- kink or obstruction in the tubing

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18
Q

where does the air go after the water-seal chamber

A
  • the air exits the water seal and enters the suction chamber
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19
Q

describe assessment of the water seal chamber (2)

A
  • assess for tidalling

- monitor for air leaks

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20
Q

what is the purpose of the suction control chamber

A
  • applies controlled suction to the chest drainage system

- uses tubing with one end submerged in a column of water and the other end vented to the atmosphere

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21
Q

the amt of suction applied by the suction control chamber is regulated by?

A
  • the depth of the suction control tube in the water

- NOT by the amt of suction applied to the system

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22
Q

the suction control chamber is filled w…

A
  • 20 cm of water
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23
Q

what occurs when the negative pressure generated by suction in the suction control chamber exceeds 20 cm

A
  • the air from atmosphere enters the chamber thru a vent, and begins bubbling up thru the water
    = excess pressure relieved
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24
Q

describe the relationship betweeen negative pressure and suction in the suction control chamber

A
  • an increase in suction does not result in an increase in negative pressure to the system bc any excess suction merely draws in air thru the vented tubing
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25
Q

the suction pressure of the suction control chamber is usually ordered to be….

A

-20 cm H2O

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26
Q

what are 2 types of suction control chambers

A
  • wet

- dry

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27
Q

describe the wet suction control chamber

A
  • the system outlined previously
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28
Q

what is a way to tell that wet suction is functioninf

A
  • bubbling of the water
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29
Q

what needs to be done with the water in a wet suction control chamber

A
  • needs to be added periodoically –> evaporates over time
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30
Q

describe a wet suction control chamber

A
  • no water
  • uses either a restrictive device or a regulator (internal to the chest drainaqge system) to dial the desired negative pressure
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31
Q

what indicates that the suction is working in a dry suction control chamber

A
  • a visual alert (no bubbling)
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32
Q

describe assessment of the suction control chamber

A
  • assess for gentle bubbling (if water seal ssytem)

- check suction float ball (if dry system)

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33
Q

what is the benefit of using a disposable plastic chest drainage system

A
  • allow pt mobility

- decrease the risk of breaking or spilling the drainage system

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34
Q

what is a Heimlich valve

A
  • another device used to evacuate air from the pleural space
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35
Q

describe the Heimlich valve

A
  • consists of a rubber flutter 1-way valve within a rigid plastic tube
  • attaches to the external end of the chest tube
  • placed between the chest tube and the drainage bag
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36
Q

describe how the Heimlich valve works to remove air

A
  • the valve opens whenever the pressure is greater than the atmospheric pressure and closes when the reverse occurs
  • allows for escape of air but prevents the re-entry of air into the pleural space
  • functions like a water seal
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37
Q

when is the Heimlich valve usually used (2)

A
  • for emergency transport

- special care home situations

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38
Q

what is a benefit of small chest tubes? what are cons?

A
  • benefit: used in selected pts bc are less traumatic

- con: smaller = can become kinked, occluded, or dislodged more easily

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39
Q

the drains in small chest tubes may be… (2) which are less traumatic

A
  • straight

- “pigtail” catheters (curled at the distal end) –> less traumatic

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40
Q

if a small chest tube is occluded, what can be done

A
  • can be irrigated by the physician using sterile water
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41
Q

what can be performed thru pigtail catheters

A
  • chemical pleurodesis
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42
Q

small chest tubes are not suitable for…

A
  • trauma

- drainage of blood

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43
Q

small chest tubes and heimlich valves should be used w caution in what kinds of pts? why?

A
  • pts on mechanical ventilators d/t potential for rapid accumulation of air and a tension pneumothorax
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44
Q

when should a system leak w chest tubes be suspected

A
  • if bubbling is continuous
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45
Q

describe what to do if bubbling is continuous w a chest tube (suspection of system leak) (2)

A
  • to determine the source of the leak, momentarily clamp the tubing successively from the chest tube insertion site to the drainage set, observing for bubbling to cease –> if ceases, the leak is above the clamp
  • retape tubing connection
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46
Q

if the leak in a chest tube system continues, what should you do

A
  • notify the physician

- may be necessary to replace the drainage apparatus or to secure the chest tube with an air-occlusive dressing

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47
Q

what do high fluid lvls in the water seal indicate?

A
  • residual negative pressure
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48
Q

what needs to be done if there are high fluid lvls in the water seal

A
  • may need to be vented by using the high negativity release valve available on the drainage system to release the residual pressure from the system
  • do not lower water-seal column when wall suction is not operating or when the pt is on gravity drainage
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49
Q

describe how to maintain the tubing w a chest tube system (4)

A
  • keep all tubing loosely coiled below chest lvl
  • tubing should drop straight from bed or chair to drainage unit
  • do not let tubing be compressed
  • keep all connections between chest tubes, drainage tubing, and drainage collector tight, and tape at connections
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50
Q

what should you observe for general care of chest tube systems

A
  • observe for air fluctuations (tidalling) and bubbling in the water-seal chamber –> should rise w inspiration and fall w expiration
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51
Q

what does it mean if tidalling is not observed in the chest tube system

A
  • the drainage is blocked
  • the lungs are re-expanded
  • or the system is attached to suction
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52
Q

how do you assess for tidalling if the chest tube is connected to suction

A
  • disconnect from wall suction to check
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53
Q

what should you assess for in a pt with a chest tube inserted

A
  • assess VS, lung sounds, pain
  • assess for manifestations of reaccumulation of air and fluid in the chest
  • assess for bleeding
  • assess for chest drainage site infection
  • assess for poor wound healing
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54
Q

what are signs of reaccumulation of air & fluid in the chest

A
  • decreased or absent breath sounds
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55
Q

what is a sign of signif bleeding w a chest tube

A
  • > 100 mL/hr
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56
Q

what are signs of chest drainage site infection (4)

A
  • drainage
  • erythema
  • fever
  • increased WBC
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57
Q

describe the clamping of chest tubes (3)

A
  • not routinely clamped
  • a physician order is required
  • a physician may order clamping for 24 hrs to evaluate for reaccumulation of fluid or air before discontinuing the chest tube
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58
Q

what should a pt w chest tube’s be encouraged to do (3)

A
  • breath deeply periodically to facilitate lung expansion
  • encourage ROM exercises to the shoulder on the affected side
  • incentive spirometry every hr while awake to prevent atelectasis or pneumonia
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59
Q

where should the chest drainage system be positioned

A
  • never elevate to the lvl of the pt’s chest (will cause fluid to drain back into the lungs)
  • secure unit to the drainage stand
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60
Q

what do you do if the drainage chambers of a chest tube are full

A
  • notify the physician and anticipate changing the system

- do not try to empty it

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61
Q

what should you do if the drainage system breaks

A
  • place the distal end of the chest tubing connection in a sterile water container at a 2-cm level as an emergency water seal
62
Q

describe the assessment of chest tube drainage ; what should be reported to the physician

A
  • mark the time of measurement and fluid lvl on the drainage unit according to the unit standards
  • report any changes in the quantity of characteristics of drainage (ex. clear yellow to bloody) to the physician & record the change
  • notify physician if >100mL/hr drainage
63
Q

describe what should be done if the drainage system is overturned & the water seal is disrupted

A
  • return it to an upright position

- encourage the pt to take a few deep breaths, followed by forced exhalations and cough manoeuvres

64
Q

describe the traditional practice of routine milking and/or stripping to maintain patency of chest tubes

A
  • no longer recommended bc it can cause dangerously high inrtapleural pressure and damage to pleural tissue
  • drainage & blood are not likely to clot inside the chest tubes bc the newer chest tubes are made w a coating that makes them nonthrombogenic
65
Q

what may occur if the chest tube is not stabilized

A
  • dislodgement of the tube
66
Q

a nurse should be mindful that insertion of a chest tube, as well as its continued presence can be..

A
  • painful to the pt
67
Q

describe how to obtain a sample from a chest tube (4)

A
  • form a loop in the tubing in an area to get the most recently drained fluid
  • swab the sampling site of the tubing w antiseptic and allow to air-dry
  • aspirate from the sampling site w syringe –> cap syringe –> label w pts name, date, time, and source of specimen
  • send to labratory
68
Q

describe the changing of chest tube dressings

A
  • not routinely changed

- if there is visible drainage, notify the physician

69
Q

describe chest tube dressings if ordered (6)

A
  • remove old dressing carefully to avoid removing unsecured chest tube
  • assess the site & culture site if needed
  • cleanse the site w NS
  • apply sterile gauze and tape to secure the dressing
  • date the dressing
  • document dressing change
70
Q

What should be assessed r/t chest tube dressings/tubings (7)

A
  • check for subcut emphysema (“rice krispies”) around the site
  • check if dressing is dry & intact
  • check occlusive dressings (ex. jelonet)
  • ensure chest tube secure
  • check for dependent loops, clotting, coiled drainage tubing
  • follow tubing from insertion site to chamber
  • check for signs of infection
71
Q

some physicians prefer ____ for chest tube dressings; why?

A
  • some prefer use of petroleum gauze

- to prevent an air leak

72
Q

describe how to set up the suction control chamber in dry suction systems (3)

A
  • after connecting pt to system, turn the dial on the chest drainage system to amt ordered (usually -20 cm pressure)
  • connect suction tubing to a wall suction source
  • increase the suction until the correct amt of negative pressure is indicated
73
Q

how do we keep the suction control chamber at the appropriate water lvl

A
  • add sterile water as needed
74
Q

what does it mean if there is no bubbling in the suction control chamber (3)

A
  • there is no suction
  • the suction is not set high enough
  • the pleural air leak is so large that suction is not high enough to evacuate it
75
Q

describe the process of maintaining the water lvl in the suction control chamber (4)

A
  • add sterile water as needed
  • keep the muffler covering the suction control chamber in place to prevent more rapid evaporation of water and to decrease the noise of bubbling
  • after filling the suction control chamber to the ordered suction amt, connect the suction tubing to the wall suction
  • dial the wall suxction regulator until continuous gentle bubbling is seen in the suction control chamber
76
Q

why is the clamping of chest tubes during transport or when the tube is accidentally disconnected no longer advocated?

A
  • the danger of rapid accumulation of air in the pleural space causing tension pneumothorax is far greater than that of a small amt of atmospheric air entering the pleural space
77
Q

when might chest tubes be momentarily clamped

A
  • to change the drainage apparatus

- to check for air leaks

78
Q

clamping for more than a few moments is indicated only when?

A
  • when assessing how the pt will tolerate chest tube removal –> stimulates chest tube removal and identify if there will be negative clinical repercussions with tube removal
79
Q

when is clamping of the chest tube to stimulate chest tube removal done?

A
  • 4-6 hrs before the tube is removed

- pt is monitored closely

80
Q

if a chest tube becomes disconnected, what is the most important intervention

A
  • immediate re-establishment of the water seal system and attachment of a new drainage system ASAP
  • may be immersed in sterile water (~2cm) until the system can be re-established
81
Q

what is a CVAD

A
  • a catheter that is placed into large blood vessels (ex. subclavian vein, jugular vein) when access to the vascular system is needed frequently
82
Q

what 3 methods can central venous access be achieved

A
  • centrally inserted catheters
  • peripherall inserted catheters (PICCs)
  • implanted ports
83
Q

who can insert: a centrally inserted catheter? PICC? implanted port?

A
  • implanted port & centrally inserted catheter = physician

- PICCs = specialized nurse

84
Q

what do CVADs allow for (5)

A
  • enable frequent, continuous, rapid, or intermittent admin of fluids & meds
  • allow for the admin of drugs that are potential vesicants
  • allow for admin of blood & blood products
  • allow for admin of parental nutrition
  • may be used for hemodyanmic monitoring and venous blood sampling
85
Q

CVADs are indicated for what types of pts? (2)

A
  • pts w limited peripheral vascular access

- pts who have a projected need for long-term vascular access

86
Q

what are advantages of CVADs (3)

A
  • reduced need for multiple venipunctures
  • decreased risk of extravasation injury (but can still happen if the device is displaced or damaged)
  • immediate access to the central venous system
87
Q

what are disadvantages of CVADs (2)

A
  • increased risk of systemic infection

- invasiveness of the insertion procedure

88
Q

what are some examples of medical conditions that are indications for CVADs (13)

A
  • cancer (chemo)
  • infection (long term anitbiotics)
  • pain (long term pain meds)
  • drugs that increase the risk of phlebitis
  • parental nutrition
  • solutions w higher dextrose content
  • multiple diagnostic blood tests/samples over a period of time
  • blood transfusions over a period of time
  • renal failure (hemodialysis or continuous renal replacement)
  • shock, burns (infusions of high volumes of fluid & electrolyte replacement)
  • hemodynamic monitoring (measuring CVP to assess fluid balance)
  • heart failure (ultrafiltration)
  • autoimmune disorders (plasmapheresis)
89
Q

what are centrally inserted catheters (CVCs)

A
  • CVADs whose catheter rests in the distal end of the SVC near its junction w the right atrium
  • the other end of the catheter exists thru a separate incision on the chest or abdominal wall
90
Q

CVCs are available as…. (4)

A
  • single
  • double
  • triple
  • or quadruple lumen catheters
91
Q

what is the benefit of multilumen catheters

A
  • useful in critically ill ots bc each lumen can be simultaneously used to provide a different therapy
    ex. incompatible drugs can be infused in separate lumens without mixing, and a third lumen can provide access for blood sampling
92
Q

what is a tunnelled vs nontunelled catheter

A
  • A non-tunneled catheter is inserted directly into a central vein but the tunneled variety uses an extender piece that is placed into the subcutaneous tissue, in addition to the central catheter
  • tunnelled = surgically placed
93
Q

where are non-tunnelled catheters usually placed (3)

A
  • in the subclavian vein
  • internal jugular vein
  • femoral vein (rare)
94
Q

who are non-tunnelled catheters best for

A
  • pts with short-term needs in an acute care setting
95
Q

what is the benefit of tunnelled catheters (3)

A
  • suitable for long-term needs
  • provides stability
  • decreases infection risk
96
Q

what must be done after placement of a CVC

A
  • verify accurate placement by chest radiography

- must be done before it is used

97
Q

care requirements for a CVC includes (4)

A
  • injection cap change
  • cleansing
  • flushing
  • dressing change
98
Q

what is an important consideration w Hickman catheters

A
  • clamps are needed to make sure the valve is closed
99
Q

what is an important consideration w Groshong catheters

A
  • has a valve that opens as fluid is withdrawn or infused - remains closed when not in use
100
Q

what is a PICC

A
  • central venous catheter inserted into a vein in the arm
101
Q

where are PICC lines inserted

A
  • inserted at or just above the antecubital fossa

- advanced to a position w the tip ending in the distal one third of the SVC

102
Q

what type of lumens are available w PICCs (3)? which are preferred?

A
  • single
  • double –> preferred
  • triple lumens
103
Q

PICCS are used w which pts?

A
  • pts who need vascular access for 1 week to 6 months (can be in place for longer if needed)
104
Q

the technique for placement of a PICC line involves..

A
  • insertion of the catheter thru a needle with the use of a guide wire or forceps to advance the line
105
Q

what are advantages of a PICC over a CVC (4)

A
  • lower infection rate
  • fewer insertion related complications
  • decreased cost
  • ability to be inserted at the pt’s bedside or in the outpt area
106
Q

what are complications of CVADs (6)

A
  • catheter occlusion
  • phlebitis
  • embolism
  • catheter-related infection (local or systemic)
  • pneumothroax
  • catheter migration
107
Q

if phlebitis occurs w CVADs, when does it usually happen?

A
  • 7-10 days after insertion
108
Q

what are important considerations w PICCs

A
  • do not use the arm w the PICC to obtain a BP reading or draw blood
109
Q

what might cause a catheter occlusion w a CVAD 4)

A
  • clamped or kinked catheter
  • tip against wall of vessel
  • thrombosis
  • precipityate buildup in lumen
110
Q

what are clinical manifestations of catheter occlusion (2)

A
  • sluggish infusion or aspiration

- inability to infuse or aspirate

111
Q

describe nursing & collaborative management for catheter occlusion (5)

A
  • instruct pt to change position, raise arm, cough
  • assess for and alleviate clamping or kinking
  • flush w NS with a 10 mL syringe (do not force)
  • fluroscopy to determine cause & site
  • anticoag or thrombolytic agents
112
Q

what are possible causes of an embolism r/t CVADs (3)

A
  • catheter breakage
  • dislodgement of thrombus
  • entry of air into circulation
113
Q

what are clinical manifestations of embolism (4)

A
  • chest pain
  • resp distress
  • hypotension
  • tachycardia
114
Q

describe nursing management for embolism (4)

A
  • admin O2
  • clamping catheter
  • place pt on left side w head down (air emboli)
  • notify physician
115
Q

what are possible causes of a catheter-related infection with CVADs (3)

A
  • contamination during insertion or use
  • migration of organisms along catheter
  • immunosuppressed pt
116
Q

what are signs of a local infection r/t CVADs (5)? systemic (3)?

A
  • local: red, tenderness, purulent drainage, warmth, edema

- systemic: fever, chills, malaise

117
Q

describe nursing management for catheter-related local infection (3)

A
  • culture of drainage from the site
  • warm, moist compress
  • catheter removal if indicated
118
Q

describe nursing for management for a systemic catheter-related infection (4)

A
  • blood cultures
  • antibiotic therapy
  • antipyretic therapy
  • catheter removal if indicated
119
Q

what is a possible cause of a pneumothorax r/t CVADs

A
  • perforation of visceral pleura during insertion
120
Q

what are clinical manifestations of pneumothorax r/t CVADs (4)

A
  • decrease in or absent breath sounds
  • resp distress
  • chest pain
  • unilateral distension of the chest
121
Q

describe nursing management for a pneumothorax r/t CVAD (3)

A
  • admin O2
  • position in semi-fowlers
  • prep for chest tube insertion
122
Q

what are possible causes of catheter migration r/t CVADs (5)

A
  • improper suturing
  • insertion site trauma
  • changes in intrathoracic pressure
  • forceful catheter flushing
  • spontaneous movement
123
Q

what are clinical manifestations of catheter migration (5)

A
  • sluggish infection or aspiration
  • edema of chest or neck during infusion
  • pt complaint of gurgling sound in ear
  • dysrhytmias
  • increased external catheter length
124
Q

describe nursing management for catheter migration (2)

A
  • fluroscopy to verify position

- assistance w removal and new CVAD placement

125
Q

what is an implanted infusion port

A
  • CVC connected to a single or double implanted subcutaneous injection port
  • catheter is placed into the desired vein and the other end is connected to a port that is surgically implanted in a subcut pocket on the chest wall
  • port consists of a metal sheath w a self-sealing silicone septum
126
Q

how are drugs inserted thru an implanted infusion port

A
  • drugs are slowly injected thru the skin, into the port

- after being filled, the reservoir slowly releases the medicine into the blood stream

127
Q

how is the implanted infusion port accessed

A
  • via the septum by means of a special noncoring needle that has a deflected tip
128
Q

what is the purpose of the deflected tip used to access an implanted infusion port

A
  • prevents damage to the septum that could render the port useless
129
Q

what is the benefit of implanted infusion ports (3)

A
  • convenient for long-term therapy
  • can remain in the body for years
  • offers cosmetic advantages
130
Q

what is the care requirements for an implanted infusion port

A
  • requires regular flushing
131
Q

what may occur within the port septum of an implanted infusion port

A
  • formation of “sludge” = accumulation of clotted blood and drug precipitate
132
Q

nursing management of CVADs includes: (4)

A
  • assessment
  • dressing change and cleansing
  • injection cap changes
  • flushing
133
Q

catheter and insertion site assessment includes.. (7)

A

inspecting the site for:

  • redness
  • edema
  • warmth
  • drainage
  • tenderness or pain
  • observe the catheter for misplacement or slippage
  • comprehensive pain assessment
134
Q

what should particularly be noted when completing a pain assessment for someone w a CVAD (4)

A
  • chest pain
  • neck discomfort
  • arm pain
  • pain at the insertion site
135
Q

what type of dressing is preferred for CVADs?

A
  • transparent semi-permeable –> allow observation of the site without having to be removed
136
Q

transparent CVAD dressings can be left in place for how long?

A
  • up to 1 week
137
Q

when should CVAD dressings be changed

A
  • when ordered

- if becomes damp, loose, soiled

138
Q

what is the cleansing agents of choice for cleaning of the skin around the catheter insertion site? why?

A

chlorhexidine

  • its effects last longer
  • improved killing of bacteria
139
Q

when are injection caps changed

A
  • at regular intervals according to institution policy

- when they are damaged from excessive punctures

140
Q

what should the pt be taught during cap changes

A
  • to turn the head to the opposite side of the CVAD insertion site
141
Q

if the catheter cannot be clamped during cap change, what should be done

A
  • pt asked to lie flat in bed
  • perform the Valsalv manoeuvre
    (to prevent air embolism)
142
Q

what is one of the most effective ways to maintain lumen patency and prevent occlusion of a CVAD

A
  • flushing
143
Q

what type of syringe is to be used to flush CVADs

A
  • syringe w a barrel capacity of 10 mL or more to avoid excess pressure on the catheter
144
Q

what should you do if resistance is felt when flushing a CVAD? why?

A
  • do not apply force

- this could result in rupture of the catheter or in the creation of an embolism if a thrombus is present

145
Q

what method is preferred when flushing a CVAD

A
  • push-pause method (1-2mL with each push)

- creates turbulence = promote the removal of debris that adheres to the catheter lumen

146
Q

during the removal of a CVAD, the pt is instructed to?

A
  • perform the Valsalva manoeuvre as the last 5-10 cm of the catheter is withdrawn
147
Q

what should be done immediately after removal of the CVAD

A
  • apply pressure to the site w sterile gauze to prevent air from entering and to control bleeding
148
Q

what else is done after removal of a CVAD

A
  • inspect the catheter tip to ensure it is intact

- after bleeding stops, an antiseptic ointment and sterile dressing are applied to the site

149
Q

what indicates a problem w chest tubes

A
  • bubbling in the water seal chamber = air leak

- no tidaling in the water seal chamber (either = occlusion of lung re-expansion)

150
Q

what indicates a problem w chest tubes

A
  • bubbling in the water seal chamber = air leak

- no tidaling in the water seal chamber (either = occlusion of lung re-expansion)

151
Q

what medical emergency may occur w chest tubes

A
  • pneumothorax

NURS 3532 - Skills 4 (4 decks)

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