Evaluate each of the following statements about chest tube drainage systems. Enter “T” for true or “F” for false. Discuss why the false statements are incorrect.

$\underline{\phantom{\text{xxx}}}$ $1$. It is the height of the column of water in the suction control mechanism, not the setting of the suction source, that actually limits the amount of suction transmitted to the pleural cavity.

$\underline{\phantom{\text{xxx}}}$ $2$. A suction pressure of $+20$ cm $\mathrm{H}_2 \mathrm{O}$ is commonly recommended for adults.

$\underline{\phantom{\text{xxx}}}$ $3$. Bubbling in the water-seal chamber usually means that air is leaking from the lungs, the tubing, or the insertion site.

$\underline{\phantom{\text{xxx}}}$ $4$. The rise and fall of the water level with the patient's respirations reflect normal pressure changes in the pleural cavity with respirations.

$\underline{\phantom{\text{xxx}}}$ $5$. The chamber is a closed system; therefore, water cannot evaporate.

$\underline{\phantom{\text{xxx}}}$ $6$. To declot the drainage tubing, put lotion on your hands, compress the tubing, and vigorously strip long segments of the tubing before releasing.

$\underline{\phantom{\text{xxx}}}$ $7$. You lower the bed on top of the drainage system and break it. You immediately clamp the chest tube, leaving it clamped until you can reestablish the drainage system.

$\underline{\phantom{\text{xxx}}}$ $8$. The chest tube becomes disconnected from the drainage system. Because you noted an air leak from the lung during your initial assessment, you can submerge the chest tube $1$ to $2$ inches below the surface of a $250$ mL bottle of sterile saline or water.

$\underline{\phantom{\text{xxx}}}$ $9$. The collection chamber is full, so you need to connect a new drainage system to the chest tube. It is appropriate to momentarily clamp the chest tube while you disconnect the old system and reconnect the new.

$\underline{\phantom{\text{xxx}}}$ $10$. The drainage system falls over, spilling the chest drainage into the other drainage columns. The total amount of drainage can be obtained by adding the amount of drainage in each of the columns.

The next day you are again assigned to care for A.B. At the beginning of the shift, you assess A.B. and find that his condition is stable. His lung sounds remain diminished in the right lower lobe and his Spo2 is 95% on oxygen at 2 L per nasal cannula. The chest drainage system is attached to suction at 20 mm Hg; there is still an air leak present. His morning chest x-ray examination showed some residual pleural effusion. Four hours into your shift, he pages you through the call system and tells you he feels "short of breath:' You immediately go to his room. A.B. is sitting in the chair.
You determine that the chest tube has become disconnected from the drainage system and is contaminated. What do you need to do?

The pleural C&S results indicate a large amount of Klebsie/lo organism growth that is not sensitive to cefuroxime (Cehin)
What interventions will you implement afterward to maintain A.B.'s chest tube system?

What about if a chest tube separates from the drainage tube and becomes contaminated?

The next day you are again assigned to care for A.B. At the beginning of the shift, you assess A.B. and find that his condition is stable. His lung sounds remain diminished in the right lower lobe and his Spo2 is 95% on oxygen at 2 L per nasal cannula. The chest drainage system is attached to suction at 20 mm Hg; there is still an air leak present. His morning chest x-ray examination showed some residual pleural effusion. Four hours into your shift, he pages you through the call system and tells you he feels "short of breath:' You immediately go to his room. A.B. is sitting in the chair.
After the chest drainage system has been reestablished, A.B.'s complaints of dyspnea resolve and you need to document what happened. Write an example of a documentation entry describing this event

The pleural C&S results indicate a large amount of Klebsie/lo organism growth that is not sensitive to cefuroxime (Cehin)
What action will you take next?

The physician performs a thoracentesis and drains $1500$ mL of fluid. A specimen for culture and sensitivity (C&S) is sent to the laboratory, and A.B. is started on cefuroxime (Ceftin) $1$ g IV piggyback q$8$h.

Because fluid continues to collect in the pleural space, the physician decides to insert a pleural chest tube under nonemergent conditions. What is your responsibility as A.B.'s nurse?

What cells in the body release the chemicals that cause allergic reactions? __________________

Air is warmed and humidified in the nasal passages. This helps to ________. a. ward off infection, b. decrease sensitivity during breathing, c. prevent damage to the lungs, d. all of the above.

The pleural C&S results indicate a large amount of Klebsie/lo organism growth that is not sensitive to cefuroxime (Cehin)
Because fluid continues to collect in the pleural space, the physician decides to insert a pleural chest tube under nonemergent conditions. What is your responsibility as A.B.'s nurse regarding this procedure?

Explain the principles of chest drainage and the nursing responsibilities related to the care of the patient with a chest drainage system.

The physician performs a thoracentesis and drains $1500$ mL of fluid. A specimen for culture and sensitivity (C&S) is sent to the laboratory, and A.B. is started on cefuroxime (Ceftin) $1$ g IV piggyback q$8$h.

The pleural C&S results indicate a large amount of Klebsiella organism growth that is not sensitive to cefuroxime (Ceftin). What action will you take next?

A.W., a 72-year-old woman with severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, "Oh, something just popped:' A.W. whispered to her walking companion, "I can't get any air.'' Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated,started on intravenous lactated Ringer's at KVO (keep vein open), and transported to the nearest emergency department (ED).On A.W.'s arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difficult to ventilate A.W. A portable chest x-ray (CXR) examination shows an 80% pneumothorax on the right.
Chart View Arterial Blood Gases (ABGs; 100% 0 2) pH 7.25 Paco2 92 mm Hg Pao2 32 mm Hg HC03 27 mmol/L Spo2 53%
As the nurse, it is your responsibility to ensure pain control. In A.W.'s case, would you administer pain medication before the chest tube insertion?

A.W., a $52$-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, "Oh, something just popped." A.W. whispered to her walking companion, "I can't get any air." Her companion yelled for someone to call $911$ and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer's (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED).

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difficult to ventilate A.W. A portable chest $x$-ray (CXR) shows an $80 \%$ pneumothorax on the right.

$$\begin{aligned} &\text { Arterial Blood Gases } \mathbf{( 1 0 0} \% \mathbf{0}_2 \mathbf{)} \\ &\qquad \begin{array}{ll} \mathrm{pH} & 7.25 \\ \mathrm{Paco}_2 & 92 \mathrm{~mm} \mathrm{Hg} \\ \mathrm{PaO}_2 & 32 \mathrm{~mm} \mathrm{Hg} \\ \mathrm{HCO}_3 & 27 \mathrm{mmol} / \mathrm{L} \\ \mathrm{SaO}_2 & 53 \% \end{array} \end{aligned}$$

Given the diagnosis of pneumothorax, explain why the paramedics had difficulty ventilating A.W.