A patient has a chest tube inserted for a pneumothorax. What ...

[beccaep]

A patient has a chest tube inserted for a pneumothorax. What should the nurse expect when assessing the drainage system?
 
  1. periodic bubbling in the water seal chamber immediately after insertion
  2. no evidence of tidaling
  3. vigorous bubbling in the suction control chamber
  4. large amount of bloody drainage in the drainage collection chamber

Question 2

The nurse is caring for a patient on mechanical ventilation with positive end expiratory pressure (PEEP). When assessing the patient, which finding would indicate the possibility of tension pneumothorax?
 
  1. new onset of absent breath sounds over the right lung
  2. blood pressure of 170/80
  3. pulse oximetry readings ranging from 94 to 96
  4. crackles and wheezing heard in both lungs

[ansleighelindsey]

Answer to Question 1

Correct Answer: 1
When a chest tube is inserted in the pleural space for a pneumothorax, the trapped air is allowed to escape and periodic bubbling is observed in the water seal as the lung reexpands. The water column in the water seal should rise with inspiration and fall with expiration (tidaling). There should be gentle bubbling in the suction control chamber to avoid rapid evaporation of the fluid in the chamber. Large amounts of bloody drainage would be anticipated after chest tube insertion for hemothorax.

Answer to Question 2

Correct Answer: 1
In a tension pneumothorax, air enters the pleural space with each breath but does not exit. Progressive accumulation of air in the pleural space leads to collapse of the lung on the affected side and hypoxia. As a result, the patient would have absent breath sounds on the affected side rather than adventitious sounds (crackles and wheezes). As the pressure in the thorax increases, cardiac output declines and the patient becomes hypotensive. A pulse oximetry reading of 94 demonstrates adequate oxygenation.