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Care of Patient With Chest-Tube Drainage
Care of Patient With Chest-Tube Drainage
1. 2. 5. 6. Application
Individual Individual Instructor Orientated
Study Test Input (1hr Activities
(10mins) 20 mins)
A: Empyema
B: Hematoma
C: Spontaneous pneumothorax
D: Open pneumothorax
E: Pleural effusion
Spontaneous pneumothorax
Traumatic Spontaneous
Open Close
Tension Pnenumothorax
Air leak into pleural space
during inspiration
Mediastinum Shift
SHOCK
DEATH
2. To determine whether Peter develops
tension pneumothorax, the nurse assesses
the patient specifically for:
SIMILARITIES
DIFFERENCES
Traumatic / Tension Hemothorax
Spontaneous Pneumothorax
Pneumothorax
SIMILARITIES
•Pleuritic Chest pain
•Absence/Diminished breath sound
•Unequal chest expansion
•SOB
DIFFERENCES
•Hyperresonance to •Severe Respiratory •Dullness to
percussion Distress percussion
•Hypotension •Hypotension
•Distended neck vein
•Tracheal deviation
Pleural Effusion
• Excess fluid in the pleural cavity
• Causes
– Increased capillary hydrostatic pressure
– Increased capillary permeability
– Decreased plasma oncotic pressure
– Obstruction of lymphatic drainage
Treatments
Chest-tube insertion
Thoracentesis
3. The chest tube drainage
system relieves Peter’s
pneumothorax by
A: Enhancing chest wall movement
B: Injecting air into the pleural space
C: Preventing air from entering the cavity
D: Restoring negative pressure in the pleural
space
E: Increasing the amount of pleural fluid
4. Which 3 chambers are found
in a closed chest drainage
system?
• Water seal, pressure, and drainage
collection chambers
• Water seal, suction control, and drainage
collection chambers
• Gravity, suction control, and drainage
collection chambers
• Pressure, water seal, and gravity
chambers
5. The main purpose of the water seal
chamber is to:
•2 cmH2O
Chest Tube
Removal
6. Which of the following is the most
appropriate position for Peter when
preparing him for chest-tube insertion
Chest Tube
Removal
Care of Patient with Chest-tube
drainage system
I
Monitor & Maintain Assess
Respiratory Insertion Site
Function
Check
Chest-tube
Drainage System
Monitor & Maintain
Respiratory Function
A: Infection
B: Subcutaneous emphysema
C: Tension Pneumothorax
D: Unresolved pneumothorax
E: Bleeding
Assess Insertion Site
• Bleeding
• Infection
• Subcutaneous emphysema
Check Chest Drainage System
• Tubing avoid dependent loops, kinking &
clamping
A: Re-established connection
B: Clamp Peter’s chest tube immediately
C: Notify doctor immediately
D: Send him back to the ward immediately
and change another drainage system
E: Check Peter’s vital signs
Common Problems
• Disconnection of drainage tubing from drain
– Clamp with artery forceps
– Re-establish connection ASAP
– Notify Dr
– KIV chest x ray
• Lack of Drainage
– check tubing for kinks or obstruction
Common problems
• Collecting bottle fall over
– Re-establish water seal level
• Intrapleural drain fall out
– Tie the purse-string suture
– Cover with gauze and pressure bandage
– Notify Dr
– Monitor Patient
Chest Tube Care of Patient
Insertion with Chest Tube
Chest Tube
Removal
10. The doctor plan to remove the Peter’s
chest tube. Which of the following signs
suggests the pneumothorax has resolved?
Chest Tube
Removal
Instructional Activity Sequence for TBL
Application of Course
Concepts
Readiness Assurance
Preparation Diagnosis-Feedback
(Pre-class) 2 hours of clinical skills practice
1hr 50 mins of class time
1. 2. 5. 6. Application
Individual Individual Instructor Orientated
Study Test Input (1hr Activities
(10mins) 20 mins)