Chest Tube Management Case Study (60 min)
Included In This Lesson
Study Tools For Chest Tube Management Case Study (60 min)
Outline
Mr. Jones is a 19 year old male who was in a motor vehicle collision yesterday. He sustained a fractured left radius and fractures to ribs 4-7 on the left side. He was admitted to the trauma med-surg floor last night. This morning, he suddenly develops shortness of breath and ‘chest tightness’. He says “I feel like I can’t get a deep breath” and appears very anxious.
What nursing assessments should be performed at this time for Mr. Jones?
You assess Mr. Jones to find his SpO2 is 90%, his RR is 32, HR 108, and BP 117/72. You auscultate his lungs but find that lung sounds are diminished and almost absent over the left upper lobe.
What might be occurring physiologically? How would this be diagnosed?
You notify the provider who orders a STAT Chest x-ray. The chest X-ray confirms the patient has a moderate sized pneumothorax on the left side, with no shifting of the mediastinum or trachea. The provider determines the patient needs a chest tube placed. You gather supplies, set up the drainage system and assist with placement of the chest tube on the left side.
What output would you expect to see on initial placement of Mr. Jones’s chest tube?
You secure the chest tube with an occlusive dressing and place the drainage system at the foot of the bed. The provider orders the chest tube to be placed to water seal, without suction.
Describe how ‘water seal’ works.
What safety considerations should you take for the tubing and drainage system?
What assessments would you perform to monitor the effectiveness of the chest tube?
You note intermittent bubbling in the air leak chamber and no output in the drainage chamber. The patient’s lungs sound clear, though still slightly diminished in the left upper lobe. SpO2 is has risen to 96% on 2L nasal cannula. Four hours later, you are checking the chest tube system again and notice continuous bubbling in the air leak chamber.
What could be the possible causes of an air leak?
What should you do if you discover there is a hole in the drainage system tubing?
You notice the connections had come loose, so you tighten them, which fixes the air leak. Later that evening when turning the patient, the chest tube becomes accidentally dislodged from the patient’s chest.
What should your first nursing action be? Explain.
Mr. Jones remained stable even without the chest tube, therefore the provider decided that his pneumothorax had resolved and there was no need to replace it. You continue to monitor for any possible complications or redevelopment of a new pneumothorax.
MedSurg
Concepts Covered:
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Central Nervous System Disorders – Brain
- Neurological
- Noninfectious Respiratory Disorder
- Respiratory
- Hematologic Disorders
- Delegation
- Perioperative Nursing Roles
- Lower GI Disorders
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Factors Influencing Community Health
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Medication Administration
- Vascular Disorders
- Renal Disorders
- Shock
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Gastrointestinal Disorders
- Respiratory Emergencies
- Newborn Complications
- Peripheral Nervous System Disorders
- Studying
- Integumentary Disorders
- Upper GI Disorders
- Communication
- Microbiology
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Integumentary Disorders
- Acute & Chronic Renal Disorders
- Liver & Gallbladder Disorders
- Musculoskeletal Disorders
- Circulatory System
- Shock
- Cardiovascular
- EENT Disorders
- Postoperative Nursing
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Fundamentals of Emergency Nursing
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Tissues and Glands
- Urinary System
- Emergency Care of the Neurological Patient
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Nervous System
- Respiratory Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Emergency Care of the Respiratory Patient