Nursing Prioritization Delegation Assignment Q 43
You are supervising a nursing student who is providing care for a patient with thoracotomy with a chest tube. What findings would you clearly instruct the nursing student to notify you about immediately?
A. Chest tube drainage of 10 to 15 mL/hr.
B. Continuous bubbling in the water seal chamber.
C. Complaints of pain at the chest tube site.
D. Chest tube dressing dated yesterday.
Correct Answer: B. Continuous bubbling in the water seal chamber
Continuous bubbling indicates an air leak that must be identified. With the physician’s order you can apply a padded clamp to the drainage tubing close to the occlusive dressing. If the bubbling stops, the air leak may be at the chest tube insertion, which will require you to notify the physician. If the air bubbling does not stop when you apply the padded clamp, the air leak is between the clamp and the drainage system, and you must assess the system carefully to locate the leak.
Option A: Chest tube drainage of 10 to 15 mL/hr is acceptable. Alert physician if drainage greater than 100 mL per hour in an adult and 3 mL/Kg/hour in a 3 hour period or 5 to 10 mL/Kg in any 1 hour period in pediatric patients.
Option C: The patient’s complaints of pain need to be assessed and treated. This is important but is not as urgent as investigating a chest tube leak. Severe pain during chest drain therapy significantly influences the well being of the patient and leads to severe pathophysiological disorders. Early mobilization, sufficient coughing to mobilize secretions, and effective deep breathing are only possible with adequate pain management.
Option D: Chest tube dressings are not changed daily but may be reinforced. In adults, chest tube dressing should be changed every other day and prn. In pediatric patients, if it is an uncomplicated chest tube insertion site, the dressing should be left as is until it is soiled or lifting. Changed ONLY when necessary and with a physician present.