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16 Cards in this Set
- Front
- Back
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where does the tube go?
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into the pleural space to decrease pressure
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negative intrathoracic pressure
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inspiration
diaphragm contracts |
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positive intrathoracic pressure
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expiration
diaphragm relaxes |
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indications for a chest tube
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to remove fluid and or air from pleural space
restores negative pressure re-expands the lung |
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2 types of chest tubes
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mediastinal 4 intercoastal space
pleural 7th intercoastal space |
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what to do if tube is pulled out
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cover with a sterile, occlusive dressing
look at pt: assess, ABG's Call physician and determine if it is worth seeing if they can tolerate it |
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conditions requiring a Chest Tube
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thorocotomy
pneumothorax hemothorax pleural effusion emphysema bronchopleural fistula |
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nursing priorities with chest tube
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mark output hourly at first, then q shift
keep device below site check for bubbling |
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CT insertion responsibilities
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prepare chest tube and collection device
position client in fowlers analgesicss assist with insertion CXR to confirm position |
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chest tube maintenance
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assure dress occlusiveness
check system for water seal fluctuations, bubbling suction check collection device |
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what not to do with the tubing
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strip the tubing, except manually after OHS
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Nursing assessments
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breath sounds
RR PO2 Pain SQ emphysema shoulder ROM Daily CXR |
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Call RN stat if:
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SOB
pain increased drainage or bleeding trauma to site disconnected or dislodged |
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complications of chest tube
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disconnection-clamp
dislodged |
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indications of a tension pneumo
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retraction, HR, BP, decreased CO-->decreased renal perfusion-->renal failure
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removal responsibilities
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remove when lung is re-expanded: bubbling stops and drainage minimal
clamp 1st and observe for tolerance pre-medicate cut suture inhale deeply and bear down vaseline gauze to seal off and 4x4's document pt tolerance and procedure |
