Introduction

Chest tube thoracostomy is done to drain fluid, blood, or air from the space around the lungs.
Some diseases, such as pneumonia and cancer, can cause an excess amount of fluid or blood
to build up in the space around the lungs (called a pleural effusion). Also, some severe injuries
of the chest wall can cause bleeding around the lungs. Sometimes, the lung can be accidentally
punctured allowing air to gather outside the lung, causing its collapse (called a pneumothorax).
Chest tube thoracostomy (commonly referred to as "putting in a chest tube") involves placing a
hollow plastic tube between the ribs and into the chest to drain fluid or air from around the lungs.
The tube is often hooked up to a suction machine to help with drainage. The tube remains in the
chest until all or most of the air or fluid has drained out, usually a few days. Occasionally special
medicines are given through a chest tube.

The mechanics of ventilation relate to the negative intrathoracic pressure that draws air into the
lungs during spontaneous respiration. This negative pressure is best maintained in the pleural
space, which is the potential space between the parietal and visceral layers of the pleura.
Collections of air, fluid, or blood in the pleural space not only compress the lung tissue but also
cause the pleural pressures to become positive, causing inappropriate ventilation.
Chest drains are inserted to remove pathological collections of air or fluid in the pleural space,
to allow the re-creation of the essential negative pressures in the chest, and to permit complete
expansion of the lung, thereby restoring normal ventilation. Chest drains are very simple and
effective tools in the management of thoracic and pleural pathology. They need proper safe
insertion and correct management. Chest drains are lifesaving in critical care.
 Chest drainage systems work by combining the following 3 efforts:
 Expiratory positive pressure from the patient helps push air and fluid out of the chest (eg,
cough, Valsalva maneuver).
 Gravity helps fluid drainage as long as the chest drainage system is placed below the level
of the patient’s chest.
 Suction can improve the speed at which air and fluid are pulled from the chest.

I. BIOGRAPHIC DATA
 Name: Mr. R.A
Age: 55 years old
Add: Manuguit, Tondo Manila
Religion: Roman Catholic
Marital Status: Married
Occupation: Tricycle Driver
Room & Bed No.: A-3
Chief Complaint:
Provisional Diagnosis: Chest Tube Thoracostomy
Attending Physician: Robert L. Chang M.D.

II. Nursing History

A. Past Health History
1. Childhood Illness
The client had measles, chicken pox, and mumps when he was in elementary.
2. Immunizations
The client verbalized that he didn’t have complete immunizations during his
childhood. If he had one, he cannot remember what those were.
3. Allergies
The client said that he has no allergies to food or drugs.
4. Accidents
The client was hit by a jeep when he was on his way home with his tricycle. This was
the first time in his whole life.
5. Hospitalizations
The client verbalized that this is the first time he was hospitalized.
6. Medications used or currently taken
The patient usually takes over-the-counter medicines for colds, cough, headache,
and fever. As of the moment, he is taking Cefuroxime 500mg tab TID, Metronidazole
500mg tab TID, Tramadol 50mg cap TID, Ascorbic Acid 500mg tab BID as
prescribed by his physician.
7. Foreign travel (when, length of stay)
The client doesn’t have any foreign travel yet.
B. Family History

The Father of the Client died because of High blood, the paternal side of the client has a
history of high blood. He cannot recall what is the cause of death of his mother, because he was
very young when his mother died. Also, he cannot recall the name and cause of death of his
Grandparents in both sides. There were 3 siblings, the youngest died because of stabbed.

Pedro Avila Trinidad

V. Avila
66 years old
-Deceased
High blood -Deceased Unknown

Stabbed

Rodolfo
Raymundo Narciso
Avila
Avila Avila
55 years
60 years 52 years old
old
old
-Deceased

III. Patterns of Functioning

A. Psychological Health

The client’s usual means of coping is through praying. With his condition, he manages it
by taking a lot of rest, avoidance of movements, taking her medications, and following the
doctor’s orders. He also believes that these are means for her to have a fast recovery. The
client interacts well with others by talking nicely to them. He was observed to be friendly
because of her being approachable to others she doesn’t know well. He answers the questions
nicely and appropriately by exhibiting behaviors appropriate to her moods or feelings.
Furthermore, the client was not observed to be sad and depressed because he exhibits
gladness that is seen on her facial expressions and answers while talking to him. He thinks of
himself as handsome good appearance especially when dressed well. According to the client,
when it comes to money matters he verbalized that “Pag kailangan ng pera maghahanap ng
Bombay sa labas para makautang, ganon naman talaga ang buhay para makaraos sa
pangaraw-araw”. While in family problem they talked one on one with his wife to solve it. He
admits that he is oftentimes emotional especially when there is a problem within the family. He
exhibits her emotions by talking to his wife as also his way to manage his emotions. The family
copes by talking to and supporting each other. When asked what the family specifically does to
comfort him, the client said that they’ve been visiting him with warmth and full support for his
fast recovery. He added that he doesn’t feel any blame from them because of his condition.

Interpretation: He has his own family and his role as a father is to guide his children to have a
righteous life. Despite his health condition, he believes that he’s able to contribute betterment to
the society.

Analysis: Coping may be described as dealing with the problems and situations or contending
with them successfully. It is the cognitive and behavioral effort to manage specific external
and/or internal demands that are appraised exceeding the resources of the person. It also
varies among individuals and is often related to the individual’s perception of the stressful event.
Successful coping requires the person to deal effectively with the stressful events and
minimizes distress associated with them that result in adaptation. (Kozier et al. Fundamentals of
Nursing 7th Edition p 1020). Interaction patterns include: Ways of expressing love, sorrow,
anger, and so on, Most significant family member in person’s life, and openness of
communication with all family members.( Fundamentals of Nursing 7th Edition by Barbara Kozier
et.al page 193).Transition means adjustment to new interest, new values and new patterns of
behavior. In middle adulthood, sooner or later, all adults must make adjustments to physical
changes and must realize that the behavioral patterns of their younger years have to be
radically revised. (Kozier et al. Fundamentals of Nursing 7th Edition p. 193). Self-concept is
one’s mental image of oneself. A positive self-concept is essential to a person’s mental and
physical health. Individuals with a positive self-concept are better able to develop and maintain
interpersonal relationships and resist psychologic and physical illness. An individual possessing
a strong self-concept should be better able to accept or adapt to changes that may occur over
the life span. How one views oneself affects one’s interaction with others. (Kozier et al.
Fundamentals of Nursing 7th Edition p 957). Family Coping mechanisms are the behaviors
families use to deal with stress or changes imposed from either within or without. Coping
mechanisms can be viewed as an active method of problem solving developed to meet life’s
challenges. The coping mechanisms families and individuals develop reflect their individual
resourcefulness. Families coping patterns rather consistently over time or may change their
coping strategies when new demands are made on the family. The success of the family largely
depends on how well it copes with the stresses it experiences. (Kozier et al. Fundamentals of
Nursing 7th Edition p 193).

B. Socio-Cultural Patterns

1. Cultural Patterns
Mr. R.A. grew up in the province of Obando, Bulacan, he verbalized that “ Sa
Obando yung magdadasal o hihiling ka para mgakaanak”. According to him
whenever he’s in their province, they usually celebrate fiestas. One of the health
beliefs of Bulacan that he applies is using herbal plant such as ginseng to have a
strong and healthy body. He drinks it at least once a week. He also added that his
family is aligned with the common Filipino traditions such as celebrating Christmas.

Interpretation: Normal
Analysis: A belief system that the members of the culture hold, consciously and
unconsciously as absolute truth, these guides the everyday behavior and makes it
routine. Cultural norms can influence client’s beliefs about what constitutes illness and
personal responsibility. (Craven et al. Fundamentals of Nursing. pp 326)

2. Significant Relationships
The client is married and has 2 siblings which are now both married and has kids but
they are living together in one house. He also has his drinking buddies within their
place which are his co-tricycle driver, too. According to him, they drink after work as
their form of relaxation. His relationship to them is okay. He is not having any
problems on their attitudes and so are they. According to him, he has an open
communication with his family. He can easily tell them what he wants to tell be it
problems or anything. He can also easily recognized if one of the members of his
family is having a problem or not feeling well or is sad or angry, etc. and so are they.

Interpretation: Normal
Analysis: The effectiveness if family communication determines the family’s
ability to function cooperative, growth-producing unit. Messages are constantly being
communicated among family members both verbally and nonverbally. The
information transmitted influences how members work together, fulfill their assigned
roles in the family, incorporate family values and develop skills to function in society.
Intra-family communication plays a significant role in the development of self-esteem
which is necessary for the growth of personality. (Kozier et al. Fundamentals of
Nursing 7th Edition p. 193)

3. Recreation Patterns
The client’s form of recreation is by drinking alcoholic beverages with his co-
tricycle driver after work which means every night they never failed to drink. He’s
also fond of taking care with his grandchildren. “Nawawala ang pagod ko pag
 inaalagaan ko ang mga apo ko.” as verbalized by the client. He also watches TV and
reads newspaper as a form of his relaxation.

Interpretation: Not normal

Analysis: Recreation or fun is the expenditure of time in a manner designed for
therapeutic refreshment of one's body or mind. It contributes to life satisfaction,
quality of life, health and wellness, and that the use of recreation as a diversion may
have clinical applications to individuals with chronic pain and other health
impairment. It is essential to the longevity of human beings, especially because it
helps counteract stress.(Encyclopedia of Occupational Health and Safety)

4. Environment
“Maingay sa amin lalo na yung mga bata doon.” as verbalized by the client. He also
admitted that their environment there is not totally safe. “Alam mo naman pag Tondo.
Maraming mandurukot at kung anu-ano pa.” But despite that he has a noisy and not
so safe environment, he described his house as peaceful, safe, and clean. “Medyo
masikip nga lang kami dahil maliit lang yung bahay namin.” he added.

Interpretation: Normal
Analysis: An environment is all at the many factors that influence or affect the
life and survival of the client or person. A safe environment in the client’s home,
workplace or school maintains the client’s privacy and reduces to a minimum the risk
of injury and infection. Safety in home reduces the risk of accidents and illnesses and
the subsequent need for health care services. Safety is positively correlated to health
promotion. (Potter and Perry. Fundamentals of Nursing. 1157)

5. Economic
According to the client, sometimes they have problems regarding their food
allowance because sometimes, their daily budget for food which is P150 is not
enough for their family as big as 9 members. “Umuutang na lang kami sa bumbay
pag ganun.” as he verbalized. They are also receiving a monthly allowance from his
relative which is very helpful in terms of money matters. He said that his being a
tricycle driver is not enough to sustain their everyday expenses. When it comes to
medical care, they get money from their relative.

Interpretation: Normal
Analysis: A family's socioeconomic status is based on family income, parental
education level, parental occupation, and social status in the community (such as
contacts within the community, group associations, and the community's perception
of the family). (North Central Regional Educational Laboratory. Available:
http://www.ncrel.org.)

C. Spiritual Patterns

1. Religious Beliefs and Practices

The client is a Roman Catholic. When he still had a good condition, he attends mass.
His family and he observe religious practices such as not eating meat during holy
week, celebrating Christmas, and celebrating Christ the King every November.

Interpretation: Normal.
Analysis: Adherents of particular religions deal with the differing doctrines and
practices espoused by other religions in a variety ways. All strains of thought appear
in different segments of all major world religions.(Potter and Perry. Fundamentals of
Nursing)

2. Values and Valuing

The client admitted to being brought up in a conservative family and he adapted

that value to his family now. He is a strict but loving father as he described
himself. He also said that his family observes the used of ‘po’ and ‘opo’ as a sign
of respect to elders.

Interpretation: Normal.

Analysis: Value is a concept that describes the beliefs of an individual or culture.

A set of values may be placed into the notion of a value system. Values are
considered subjective and vary across people and cultures. Types of values
include ethical/moral values, doctrinal/ideological (political, religious) values,
social values, and aesthetic values. It is debated whether some values are
innate.

IV. Activities of Daily Living

ADL Before During Interpretation

Hospitalization Hospitalization and Analysis
1. Nutrition  Has a very  On DAT NORMAL.
good appetite; diet with SAP Different people
eats 2-3 cups  Usually need different
of rice per drinks 1 bottle amounts of food.
meal of Gatorade The amount of
 Eats everyday food you need
3x/day every day from
 Usually the four food
eats fish, meat, groups and other
and vegetables foods depends on
or whatever his your age, body
wife cooks size, activity level.
 He usually (Pg. 1023) Peer
prefers fried groups
foods. distinguished by
 Drinks age, sex,
approximately occupation, or
7 cups of other interest also
water, 1-2 cups influence by
of coffee per person’s food
day. choices. (pg.
1028) The
 He is also
average adult
fond of drinking
 alcoholic drinks about 1500
beverages ml per day with
every night moderate activity
with his and temperature,
friends. but needs 2500
ml. per day, an
additional 1000
ml.
(Fundamentals of
Nursing, Kozier,
pp. 1067-1068)
An insufficient
fluid intake
reduces the
amount of fluid in
the chime, which
enters the large
intestine which in
turn results in
drier, harder
feces.
( Fundamentals
of Nursing,
Kozier, pg. 1185)
2. Elimination  urinates  experienced DEVIATION
without difficulty FROM NORMAL.
difficulty and defecating Act of defecating
experiences  urinates without must be free from
no pain when difficulty any difficulties.
voiding Normal stool is
 urine is light semisolid in
amber in consistency. The
color, is amount and
aromatic, and character of the
adequate in stool is
amount determined by the
 voids 5-6x/day amount and kind
or 10x or more of food ingested.
after drinking (Fundamentals of
beer Nursing, Phoebe
 defecates Williams and Luz
everyday or Tungpalan, pg.
after eating 321) Urination,
 stool is light Freshly voided
brown to urine is generally
brown in color clear in
appearance and
pale to deep
yellow. When
formed, urine is
sterile and
 aromatic.
(Essentials of
Human Anatomy
and Physiology,
Elaine Marieb,
pg. 487-488)
3. Exercise  His  lying on DEVIATION
primary bed most of FROM
exercise the time NORMAL. For
according  doesn’t exercise to be
to him is move much effective, it
his work  his should be
as a primary regular and
tricycle exercise now sustained.
driver is walking Generally,
across the exercising at
room towards least thrice a
the CR and week is
back to bed advised.
(Fundamentals
of Nursing,
Kozier, pg. 104)
4. Hygiene  bathes 1-3x  “Pinupunasan NORMAL.
every day, ko lang siya Bathing provides
shampoos hair dahil bawal relaxation and
and cleanses lang siyang comfort and it
body with maligo.” as gives most
soap and verbalized by people a sense of
towel the wife well-being.
 brushes teeth  Sweating Healthy feet are
3x a day profusely crucial in helping
 gets  Changes people stand and
fingernails clothes when walk. Nails should
cleaned and necessary be trimmed as
cut needed. Proper
 changes oral hygiene
clothes includes daily
everyday brushing,
 combs hair flossing, and
everyday rinsing of teeth
and care of
dentures. Regular
check-ups ensure
the health of the
teeth and gums.
Normal grooming
patterns includes
daily brushing
and combing of
hairs. (Craven
 and Hirnle.
Fundamentals of
Nursing.4th
Edition.pp704-
705)
5. Substance  Smokes  does not ABNORMAL.
Use cigarettes 10 smoke Nicotine and
sticks per day cigarettes alcohol causes
 drinks  does not many harmful
alcoholic drink alcoholic physiologic
beverages beverages effects and is a
after each precursor of lung
working hours cancer and
coronary artery
diseases.
Nicotine has a
stimulating effect
on the body and
smokers often
have more
difficulty falling
asleep than non
smokers.
Smokers are
usually easily
aroused and
often describe
themselves as
light sleepers.
(Fundamental of
Nursing, Kozier,
pg. 956)

6. Sleep and  usually sleeps  usually sleeps ABNORMAL The

Rest at around at around 12 sleep wake cycle
10pm and midnight and is very important
wakes up at wakes up at 5- to adults. Those
6am 6 am who usually have
 usually sleeps  usually sleeps an active lifestyle
4-5 hours a 3-4 hours are thought to
day  Sleeps lightly require 7 to 8
 describes and is easily hours of sleep
sleep as awaken by each night..
complete and disturbances in Source:
stated feeling the Fundamentals of
relaxed after environment Nursing, 7th Ed by
waking up  Naps when he Kozier, et.al,
 sleeps is sleepy since Page 1116
soundly and according to
describes him there is
 sleep as deep nothing he can
 does not nap do aside from
during the sleeping
afternoons or
any time of the
day besides
night time
 his primary
relaxation
activities are
watching TV
or drinking
with his
friends