lOMoARcPSD|26582732
e
NR341 Exam 1 Study Guide: Key
Concepts for Nursing Practice
Adult complex care (Chamberlain University)
Bed side equipment for CHEST TUBES
● Emergency equipment should be available
- Oxygen equipment
- Sterile water or sterile saline: helps restore the water seal
- Drain clamps: helps check for air leaks
- Occlusive dressing: place over site to prevent the redevelopment of a
pneumothorax Care for Chest tubes
● Should be included in the care plan
- Encourage the client to cough every 2 hours
- Assess the chest tube insertion sit for subcutaneous emphysema -
Monitor water seal chamber for tidaling
Chest tubes: removes air and fluid from the pleural cavity
● Traditional
● Pigtail chest tubes: are small 10f-14f with a curled end designed to keep thin in place.
- Smaller incision
- Less pain
- Smaller insertion site
- Prone to blockage due to their small diameter
Closed chest drainage system: every drainage system has 3 components
- Collection chamber
- Water seal: allows air to leave the pleural space during client expiration and
prevent room air from entering the pleural space during inspiration -
Suction control
Chest tube drainage devises: flutter valve
● Flutter valve
- Used for small to moderate sized pneumothorax
- One way valve in the center of the tube allows air to leave the pleural space
during the client expiration( positive pressure)
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
- Prevents room air from entering the pleural space during inspiration ( negative
pressure)
● Flutter valve and Drainage bag
- Small size of a flutter valve,
- Connected to a vented drainage bag
- Allows the device to be covered by clothing
- Increased mobility
- Vented opening drainage collection bags prevent tension pneumothorax
- Patients may go home with a chest tube connected to a flutter valve Chest tube
insertion:
● Pre Procedure
- Informed Consent for insertion of chest tube
- Confirming client was informed by the HCP of risks, benefits, and alternative
treatments
- Ensuring all questions the client has are answered
- Obtain clients signature
- Ensuring the client is competent and not under the influence of drugs and alcohol
- Offer Pain medication
- Ensure the required procedure equipment and supplies are in the room
- Position the client lying on the unaffected side with the upper arm placed in front
of the chest.
- Raise the HOB to lower the diaphragm
- Cleanse the insertion site per hospital policy
- Prepare the chest tube drainage unit ● Intra procedure
- Nursing care during inversion should focus on supporting the client
EMOTINALLY and PHYSICALLY
- Assess the client for pain and provide prescribe pain medication
- Monitor the clients respiratory status
- Assist the client in maintaining the proper position during the procedure ● Post
procedure
- Connect the tube to the chest tube drainage unit
- Cover the chest tube insertion with an occlusive dressing
- Verify the x ray for placement
- Monitor clinical status : vital signs, lung sounds and pain
- Evaluate for subcutaneous emphysema at the chest tube site
- Encourage the patient to breath deeply periodically to promote lung expansion
Nursing Management for chest tube
● Client assessment
- Position in an upright fowlers position to promote drainage
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
e e
- Document a comprehensive pulmonary assessment including RR, HR,Bp and
Tem
- Assess the clients work of breathing
- Ausculate breath sounds, pulse ox
- Frequency is dependant on nursing judgement
- Pain assessment
- Inspect dressing on chest and note any drainage
- Assess the insertion site for subcutaneous emphysema
- Assess insertion site for tube migration of signs of infection
- If subcutaneous emphysema is present, mark the area in which it occurs. If it
spreads notify the MD
- Ensure all tubing is free of kinks and occlusions ● Chest tube and drainage
system
- Unit below chest
- Insp ct tub for color, consistency, and amount
- Check it hourly for drainage amount
- Monitor water seal levels make sure it is refilled
- Assess the patient FIRST then chest tube
- Do not milk, strip or clamp the tube
- Avoid aggressive chest tube manipulation
- Clamping prevents the escape of air or fluid, increasing the risk of tension
pneumothorax ● Bed side equipment
- Two padded drain clamps
- Two sources of suction
- A bottle of sterile water or sterile saline Care of the Chest tube drainage system ●
Key safety measures
- Never lift the drainage system above the level of the clients chest
- Keep the tubing below the insertion
- Assure the tubing has no kinks or other obstructions that block drainage
- Secure all connections between the chest tube and drainage system with tape or
cable ties and inspect per facility
- Prevent accidental movement
- Should be positions hanging front the bed frame or standing on the floor securely
- Evaporation of the fluid in the water seal chamber can occur, refilled with sterile
water or saline as needed to maintain the prescribed level.
● Client Activity
- Provide frequent position changes to promote drainage
- Encourage cough and deep breathing or use incentive spirometer hourly to
promote expansion of the collapsed lung
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
- Show ambulatory clients how to carry and protect the drainage system
- Discontinue suction only if ordered by the HCP
- Ensure system is below the level of clients chest during all activities Chest tube
complications
● Assess client response
- Check abcs
- If patient is pulseless and breathless initiate rapid response code
- If client breathing is okay and the chest tube is no longer connected to the
drainage system assess for signs of tension pneumothorax
- Continue to monitor the clients airway and breathing ● Determine source of air
leak
- Check the dressing
- Check all connections
- Check drainage collection system for crack
- Start the insertion clamp closest to the client to observe for bubbling
- Repeat until you identify the air leak
● Actions for Safety
Removing a Chest Tube: when the lung is fully expanded, indicated by the lack of bubbling in
the water seal changer of the collection device
- Full expansion occurs when the parietal and visceral pleura meet
- No air or fluid seen in the parietal cavity
- Most facilities HCP will remove chest tube with nurse present
- Admin pain medications 30-60 min before the tube is removed to decrease comfort ●
Removal process
- Explain what will happened
- Have the client practice taking deep breaths and holding it while bearing down to
increase intrathoracic pressure.
- Place an airtight dressing such as gauze saturated with petroleum jelly to immediately
cover the insertion site and prevent air from entering
- Assure a chest x-ray have been completed within 60 minutes to assess for
complications following the removal
- Observe the wound for drainage and reinforce the dressing as needed
- Monitor and record vital signs
- Assess the client for respiratory distress, which may signify a recurrence of the original
problem.
Differences: Pneumothorax and Hemothorax
- Dyspnea /both
- Pleuritic chest pain/ both
Downloaded by NELSON KIIRU ()
e
NR341 Exam 1 Study Guide: Key
Concepts for Nursing Practice
Adult complex care (Chamberlain University)
Bed side equipment for CHEST TUBES
● Emergency equipment should be available
- Oxygen equipment
- Sterile water or sterile saline: helps restore the water seal
- Drain clamps: helps check for air leaks
- Occlusive dressing: place over site to prevent the redevelopment of a
pneumothorax Care for Chest tubes
● Should be included in the care plan
- Encourage the client to cough every 2 hours
- Assess the chest tube insertion sit for subcutaneous emphysema -
Monitor water seal chamber for tidaling
Chest tubes: removes air and fluid from the pleural cavity
● Traditional
● Pigtail chest tubes: are small 10f-14f with a curled end designed to keep thin in place.
- Smaller incision
- Less pain
- Smaller insertion site
- Prone to blockage due to their small diameter
Closed chest drainage system: every drainage system has 3 components
- Collection chamber
- Water seal: allows air to leave the pleural space during client expiration and
prevent room air from entering the pleural space during inspiration -
Suction control
Chest tube drainage devises: flutter valve
● Flutter valve
- Used for small to moderate sized pneumothorax
- One way valve in the center of the tube allows air to leave the pleural space
during the client expiration( positive pressure)
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
- Prevents room air from entering the pleural space during inspiration ( negative
pressure)
● Flutter valve and Drainage bag
- Small size of a flutter valve,
- Connected to a vented drainage bag
- Allows the device to be covered by clothing
- Increased mobility
- Vented opening drainage collection bags prevent tension pneumothorax
- Patients may go home with a chest tube connected to a flutter valve Chest tube
insertion:
● Pre Procedure
- Informed Consent for insertion of chest tube
- Confirming client was informed by the HCP of risks, benefits, and alternative
treatments
- Ensuring all questions the client has are answered
- Obtain clients signature
- Ensuring the client is competent and not under the influence of drugs and alcohol
- Offer Pain medication
- Ensure the required procedure equipment and supplies are in the room
- Position the client lying on the unaffected side with the upper arm placed in front
of the chest.
- Raise the HOB to lower the diaphragm
- Cleanse the insertion site per hospital policy
- Prepare the chest tube drainage unit ● Intra procedure
- Nursing care during inversion should focus on supporting the client
EMOTINALLY and PHYSICALLY
- Assess the client for pain and provide prescribe pain medication
- Monitor the clients respiratory status
- Assist the client in maintaining the proper position during the procedure ● Post
procedure
- Connect the tube to the chest tube drainage unit
- Cover the chest tube insertion with an occlusive dressing
- Verify the x ray for placement
- Monitor clinical status : vital signs, lung sounds and pain
- Evaluate for subcutaneous emphysema at the chest tube site
- Encourage the patient to breath deeply periodically to promote lung expansion
Nursing Management for chest tube
● Client assessment
- Position in an upright fowlers position to promote drainage
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
e e
- Document a comprehensive pulmonary assessment including RR, HR,Bp and
Tem
- Assess the clients work of breathing
- Ausculate breath sounds, pulse ox
- Frequency is dependant on nursing judgement
- Pain assessment
- Inspect dressing on chest and note any drainage
- Assess the insertion site for subcutaneous emphysema
- Assess insertion site for tube migration of signs of infection
- If subcutaneous emphysema is present, mark the area in which it occurs. If it
spreads notify the MD
- Ensure all tubing is free of kinks and occlusions ● Chest tube and drainage
system
- Unit below chest
- Insp ct tub for color, consistency, and amount
- Check it hourly for drainage amount
- Monitor water seal levels make sure it is refilled
- Assess the patient FIRST then chest tube
- Do not milk, strip or clamp the tube
- Avoid aggressive chest tube manipulation
- Clamping prevents the escape of air or fluid, increasing the risk of tension
pneumothorax ● Bed side equipment
- Two padded drain clamps
- Two sources of suction
- A bottle of sterile water or sterile saline Care of the Chest tube drainage system ●
Key safety measures
- Never lift the drainage system above the level of the clients chest
- Keep the tubing below the insertion
- Assure the tubing has no kinks or other obstructions that block drainage
- Secure all connections between the chest tube and drainage system with tape or
cable ties and inspect per facility
- Prevent accidental movement
- Should be positions hanging front the bed frame or standing on the floor securely
- Evaporation of the fluid in the water seal chamber can occur, refilled with sterile
water or saline as needed to maintain the prescribed level.
● Client Activity
- Provide frequent position changes to promote drainage
- Encourage cough and deep breathing or use incentive spirometer hourly to
promote expansion of the collapsed lung
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
- Show ambulatory clients how to carry and protect the drainage system
- Discontinue suction only if ordered by the HCP
- Ensure system is below the level of clients chest during all activities Chest tube
complications
● Assess client response
- Check abcs
- If patient is pulseless and breathless initiate rapid response code
- If client breathing is okay and the chest tube is no longer connected to the
drainage system assess for signs of tension pneumothorax
- Continue to monitor the clients airway and breathing ● Determine source of air
leak
- Check the dressing
- Check all connections
- Check drainage collection system for crack
- Start the insertion clamp closest to the client to observe for bubbling
- Repeat until you identify the air leak
● Actions for Safety
Removing a Chest Tube: when the lung is fully expanded, indicated by the lack of bubbling in
the water seal changer of the collection device
- Full expansion occurs when the parietal and visceral pleura meet
- No air or fluid seen in the parietal cavity
- Most facilities HCP will remove chest tube with nurse present
- Admin pain medications 30-60 min before the tube is removed to decrease comfort ●
Removal process
- Explain what will happened
- Have the client practice taking deep breaths and holding it while bearing down to
increase intrathoracic pressure.
- Place an airtight dressing such as gauze saturated with petroleum jelly to immediately
cover the insertion site and prevent air from entering
- Assure a chest x-ray have been completed within 60 minutes to assess for
complications following the removal
- Observe the wound for drainage and reinforce the dressing as needed
- Monitor and record vital signs
- Assess the client for respiratory distress, which may signify a recurrence of the original
problem.
Differences: Pneumothorax and Hemothorax
- Dyspnea /both
- Pleuritic chest pain/ both
Downloaded by NELSON KIIRU ()
