MS3 Chest Tubes post 5Q

A nurse is caring for a client with a newly placed chest tube for a pneumothorax. The nurse observes continuous bubbling in the water seal chamber. What is the priority nursing intervention?

• Reinforce the dressing to prevent air leakage

• Notify the provider immediately

• Clamp the chest tube to stop the bubbling

• Check the system for leaks and loose connections

Answer explanation

Rationale:  
Continuous bubbling in the water seal chamber suggests an air leak in the chest tube system. The nurse should assess connections and dressing integrity, ensuring the tubing is secure before escalating concerns. Clamping the chest tube may worsen tension pneumothorax. 

A nurse is caring for a client with a newly inserted chest tube for a pneumothorax. Which findings indicate the chest tube is functioning normally? (Select all that apply.)

• Continuous, excessive bubbling in the air leak meter

• The chest tube drainage system positioned at chest level

• Fluctuation or Tidaling of water levels in the chamber with respirations

• The chest tube is clamped for routine assessment every shift

• The bellows in the suction chamber is expanded when connected to suction

Answer explanation

A properly functioning chest tube system ensures effective drainage and lung re-expansion. The bellows in the suction chamber should expand when connected to suction, confirming that negative pressure is being applied appropriately. The drainage system must be positioned below chest level to facilitate gravity-assisted drainage and prevent backflow. Fluctuation (tidaling) of water levels in the chamber with respirations indicates an open pleural pathway and effective air or fluid removal. Continuous, excessive bubbling in the water seal chamber suggests an air leak, which requires further assessment. Routine clamping of the chest tube is not recommended, as it can lead to tension pneumothorax or impaired drainage unless specifically ordered for troubleshooting or removal preparation 

A nurse is assessing a client with a chest tube inserted for a pneumothorax. What actions should the nurse plan to take in the care of the client? Select all that apply. 

• Verify that the chest tube tubing is free from kinks or dependent loops that could obstruct drainage 

• Assess the chest tube insertion site for signs of infection, subcutaneous emphysema, or dislodgement 

• Ensure a sterile dressing is intact around the chest tube insertion site to prevent air leaks 

• Keep two chest tube clamps and a sterile occlusive dressing at the bedside in case of accidental dislodgement 

• Monitor respiratory status, including lung sounds, O2 saturation, and signs of respiratory distress 

Answer explanation

Effective nursing care for a client with a chest tube for pneumothorax focuses on maintaining tube function, preventing complications, and ensuring respiratory stability. The nurse must keep the tubing free of kinks to allow proper drainage, assess the insertion site for infection or dislodgement, and ensure a sterile dressing remains intact to prevent air leaks. Having 2 chest tube clamps and a sterile occlusive dressing at the bedside is essential for quick intervention if accidental dislodgement occurs. Continuous monitoring of lung sounds, O2 saturation, and respiratory distress allows early detection of complications and supports timely intervention for lung re-expansion .

A nurse is assessing a client with a chest tube who has developed subcutaneous emphysema. Which finding requires urgent intervention?

• Mild localized swelling around the chest tube insertion site

• Crackling upon palpation under the skin extending toward the neck

• Slight tenderness at the chest tube site without respiratory distress

• An initial air leak in the drainage system right after insertion

Answer explanation

Rationale: Crackling under the skin extending toward the neck suggests worsening subcutaneous emphysema, which may progress to airway compromise, requiring immediate intervention. Mild swelling and slight tenderness are expected findings and do not indicate an urgent issue. A small, stable air leak in the chest tube drainage system can occur but is not necessarily an emergency unless it worsens significantly. 

A nurse is assessing a client with a chest tube and notices no fluctuation (tidaling) in the water seal chamber. Obstruction in the chest tube drainage has been ruled out as a cause. What is the most likely cause in this situation?

• The lung has fully re-expanded

• There is a leak in the collection chamber

• The suction pressure is too high

• The client is taking shallow breaths

Answer explanation

Rationale: Obstruction in the chest tube drainage is the most common cause of no fluctuation or tidaling. However, once that has been ruled out as a cause, once the lung has fully re-expanded, no further fluctuation (tidal breathing) occurs in the water seal chamber because intrapleural pressure changes have stabilized.   

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