Case Study: Working with Chest Tubes Mr. Emery was admitted to the hospital to have a lung biopsy and resection. Following surgery he is transferred to the surgical unit with two right pleural chest tubes connected to pleur-evac systems with 20 cm of dry suction. Chest tube A is anterior and chest tube B is lower and posterior. Orders Include:
- Up to the chair as tolerated
- Cough and deep breath 10 times per hour
- Change dressing daily
- IV of Lactated ringers at 75 ml/hour
- Regular diet
The purpose of chest tube A is mainly to drain: A. Air * B. Pus C. Fluid D. Blood
It is very important to encourage Mr. Emery to cough and deep breath as ordered in order to: A. Reexpand the lung * B. Prevent pneumonia C. Treat pain D. All the above
During the initial assessment the nurse notes continual drainage in chest tube A and no bubbling in chest tube B. This suggests: A. A normal assessment B. An air leak in tube A * C. An air leak in tube B D. Air leak in both tubes
The most appropriate intervention by the nurse is: A. Assess the system for patency B. Tape all connection securely C. Make sure dressing is occlusive D. All the above
During the assessment, the nurse notices a popping feeling under the skin around the chest tube. This is charted as: A. Bubbling B. Infection C. Crepitus * D. Normal
After the 2nd post operative day, the bubbling disappears and the physician pulls one of the chest tubes. What instruction should the nurse give to the patient prior to removal of the tube? A. Lay flat and breath deeply B. Hold breath and bear down as tube is removed* C. No special instruction is needed D. Lay in trendelenberg position with arms overhead
Once the tubes are removed, a chest x-ray is usually ordered to: A. Assess for full lung inflation* B. Look for signs of infection C. Assess for any abscess formation D. All the above
