Thoracic Chest Procedures

Question 1

Why are Thoracentesis Performed ?

Answer 1

To remove fluid or air from the pleural space

Question 2

Throacentesis provide what ?

Answer 2

Analysis of lung fluids to determine cause of the effusion

Question 3

Thoracentesis fluid may be sent for what ?

Answer 3

for culture or cancer cells

Question 4

What should be done pre-procedure for Thoracentesis ?

Answer 4

• Check for signed informed consent (invasive procedure)
• Stop any anticoagulant medications
• Obtain baseline vital signs, O2 saturation & pain level
• Be sure that a chest x-ray has been performed
• Position client sitting on side of bed, feet supported, & leaning over bedside table
  (if pt. can’t sit up, lie on unaffected side w/HOB @ 45º)

Question 5

How should you position a client receiving a Thoracentesis ?

Answer 5

Sitting on edge of bed
feet supported
leaning over the bedside table

Question 6

How should you position a client receiving a Thoracentesis, who can’t sit up ?

Answer 6

Lie on unaffected side With HOB at 45º

Question 7

Where is the fluid, blood, or exudate being removed from in a Thoracentesis ?

Answer 7

Pleural space

Question 8

During a Thoracentesis procedure, the client must be ?

Answer 8

Very still; no coughing or deep breaths

Question 9

As the fluid is removed in a Thoracentesis, what should happen to the lung ?

Answer 9

It should re-expand

Question 10

What should the nurse be assessing during a Thoracentesis procedure ?

Answer 10

Vital signs, oxygen sats and pain level

Compare to baseline

Question 11

If a large amount of fluid is removed in a Thoracentesis, what should you watch for ?

Answer 11

Hypovolemia & shock

Question 12

What should be done again post-Thoracentesis procedure ?

Answer 12

Another chest x-ray

Question 13

What should the nurse check for post-Thoracentesis procedure ?

Answer 13

Check puncture site and dressing for bleeding

Question 14

What other things should be done post-Thoracentesis procedure ?

Answer 14

• Monitor vital signs
• Listen to lungs for absent or reduced breath sounds on the affected side
• Monitor for subcutaneous emphysema, infection, and tension pneumothorax

Question 15

What should you have a client do post-thoracentesis procedure ?

Answer 15

Turn, cough, and deep breathe

Question 16

What has happened in a client who requires a chest tube ?

Answer 16

The lung has collapsed

Question 17

If the chest tube is placed in the upper anterior chest (2nd intercostal space), what is it removing ?

Answer 17

Air

Question 18

If the chest tube is placed laterally in the lower chest (8th or 9th intercostal space), then it is for ?

Answer 18

Drainage

Question 19

_________ rises, and ________ settles ?

Answer 19

Air rises

Drainage settles

Question 20

Can a client have both air & drainage in the lung ?

Answer 20

Yes!

Question 21

What happens if a client has both air & drainage in the lung ?

Answer 21

They are Y-connected together and attached to a closed chest drainage unit (CDU)

Question 22

How are chest tubes secured ?

Answer 22

It is sutured to the chest wall & with an airtight dressing applied around the chest tube exit site

• the chest tube is then connected to a closed chest drainage unit

Question 23

• What is the purpose of the CDU ?

Answer 23

The purpose to restore the normal vacuum pressure in the pleural space.

(the CDU does this by removing all air and fluid in a closed one-way system until the problem is corrected)

Question 24

What are the 3 chambers of the CDU ?

Answer 24

1. ) Drainage collection chamber
2. ) Water seal chamber
3. ) Suction Control chamber

Question 25

Drainage Collection Chamber ?

Answer 25

The chest tube connects to a 6 foot (flexibility to move) connection tube that leads to the drainage collection chamber

Question 26

What do you do if the Drainage Collection Chamber fills up ?

Answer 26

Get another

one chamber holds 2,000mL

Question 27

What can happen if a Drainage Collection Chamber over fills ?

Answer 27

If it over fills, it can cause tension pneumothorax & spill into the water chamber

Question 28

What is the purpose of a water seal chamber ?

Answer 28

To promote one-way flow out of the pleural space which will prevent air from moving back up the system and into the pleural space

Question 29

The Drainage chamber and the Water seal chamber are connected by what ?

Answer 29

Connected by a small tube that allows the drainage to remain in the first chamber and the air to go down into the water of the water seal chamber

Question 30

The Water seal chamber contain what ?

Answer 30

Contains 2cm of water which acts as a one-way valve.

In other words, we are preventing backflow

Question 31

In a Water Seal Chamber, you may see bubbling when ?

Answer 31

When the client coughs, sneezes, or exhales. (normal)

Question 32

______________ bubbling is okay when the client coughs, sneezes, or exhales ?

Answer 32

Intermittent

Question 33

You will see a sight rise and fall of water in the water seal tube when what ?

Answer 33

As the client breathes

Question 34

What happens if titling stops in the water seal chamber ?

Answer 34

It usually means that the lung has re-expanded

Question 35

What type of control chamber will be used if the client needs suction to remove air or fluid ?

Answer 35

Suction Control Chamber