Assessment
Name a reason a patient would have a chest tube
Air
Fluid
Surgical
What does a continuous bubbling mean?
Your patient has an air leak
True or false: When a chest tube goes to water seal that will help determine if the chest tube is ready to be removed
True
Your chest tube falls out..
What do you do?
Cover up the chest tube site on 3 sides and call the MD
watch patient's status!
True or false: Tidaling is a normal response to have in the atrium
True. Tidaling is normal and indicates the circuit is clean and working. It shows the changes in pressures in the thoracic cavity.
Name three areas / things that should be examined during your assessment?
What is
1. The patient (vitals, respiratory pattern)
2. The site
3. The equipment - Atrium: drainage, bubbling, tidaling, wall suction and suction setting
How can you troubleshoot a continuous air leak?
clamp periodically down the tube to assess for the location of the leakage
The physician plans to remove the chest tube, when should the pain medication be given?
30 minutes before
The physician orders a culture.. explain how this is done
Clean chest tube site at the needles port and attached a clean syringe and pull back to collect fluid
What are 2 reasons why tidaling might not be present?
When a pneumothorax is resolved; when there is a problem with the tube.
Your chest tube assessment reveals you have had 300mL of drainage over 4 hours, should you call the provider?
what is yes, drainage greater then 70 ml/hr should be reported
What does the orange beveal indicate when it is fully expanded?
The suction is hooked up and working within the system
DAILY DOUBLE: This question will receive double the points if answered correctly.
What supplies should be at the bedside when a chest tube is going to be removed?
Suture removal kit, tape, gauze, and vaseline gauze
There is no water in the water seal chamber.. explain how to add more water to the device.
Take needle and sterile water and insert through cushion hole on the back of the atrium
Explain how tidaling will look when the patient is not on a ventilator (how will the ball move)
as the patient breathes in, the ball will move up and as the patient exhales it will go down
How often should you assess the vital signs, drainage color, and respiratory effort of the patient?
at least every 4 hours
What is a typical setting for the suction to be set up as (not the wall suction)?
-20
Name a way you would expect the physician to ask the patient to breathe while the tube is being removed by the provider
Breath in and exhale out while the chest tube is being removed
Hold breath and chest tube is removed
My patient has been on water seal for 2 hours and starts developing shortness of breath and 02 sats are dropping.. what orders might you anticipate when you call the provider?
hook the patient back up to wall suction and receive an order for a chest xray