Care of Patients with Pleural Disorders and Chest Tube Drainage

Team-Based Learning

Instructional Activity Sequence for TBL
Readiness Assurance
Preparation (Pre-class) Diagnosis-Feedback 1hr 50 mins of class time 5. Instructor Input (1hr 20 mins)

Application of Course Concepts
2 hours of clinical skills practice

1. Individual Study

2. Individual Test (10mins)

6. Application Orientated Activities

3. Team Test

4. Appeals (5mins)

(15mins)

Team Test .

He developed SOB and pleuritic chest pain when having dinner with his family. 20-year-old man. RR 28/min. was admitted to the hospital. T: 36. 89 b/min. with no past medical history or involve in any accident. His vital signs is BP 112/70mmHg. He has stopped smoking 3 years ago.7.Case Scenario Peter. An initial assessment revealed hyperresonance to percussion . SpO2 95%.

The most probable diagnosis for Peter is: A: Empyema B: Hematoma C: Spontaneous pneumothorax D: Open pneumothorax E: Pleural effusion .1.

Spontaneous pneumothorax Blebs are weakened out-pouchings in the upper lung. which can rupture. causing pneumothorax. .

Pneumothorax Pneumothorax Traumatic Spontaneous Open Close Tension Pnenumothorax .

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Air leak into pleural space during inspiration Air prevents from leaking out during expiration Increased thoracic pressure Mediastinum Shift SHOCK DEATH .

2. To determine whether Peter develops tension pneumothorax. the nurse assesses the patient specifically for: A: Pleuritic chest pain B: Diminished breath sounds on the affected side C: Dull percussions on the injured side D: Decreased chest movement on the affected side E: Severe respiratory distress and tracheal deviation .

Traumatic / Spontaneous Pneumothorax Tension Pneumothorax Hemothorax SIMILARITIES DIFFERENCES .

Traumatic / Spontaneous Pneumothorax Tension Pneumothorax Hemothorax SIMILARITIES •Pleuritic Chest pain •Absence/Diminished breath sound •Unequal chest expansion •SOB DIFFERENCES •Hyperresonance to percussion •Severe Respiratory Distress •Hypotension •Distended neck vein •Tracheal deviation •Dullness to percussion •Hypotension .

Pleural Effusion • Excess fluid in the pleural cavity • Causes – Increased capillary hydrostatic pressure – Increased capillary permeability – Decreased plasma oncotic pressure – Obstruction of lymphatic drainage .

Treatments Thoracentesis Chest-tube insertion .

The chest tube drainage system relieves Peter’s pneumothorax by A: Enhancing chest wall movement B: Injecting air into the pleural space C: Preventing air from entering the cavity D: Restoring negative pressure in the pleural space E: Increasing the amount of pleural fluid .3.

4. Which 3 chambers are found

in a closed chest drainage system?
• Water seal, pressure, and drainage collection chambers Water seal, suction control, and drainage collection chambers Gravity, suction control, and drainage collection chambers Pressure, water seal, and gravity chambers


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5. The main purpose of the water seal

chamber is to:
A: Prevent air from going into his chest B: Detects air leaks C: determines the amount of suction applied D: Provide high negative pressure E: Reflect the amount of drainage in the pleural space

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Chest Drainage System Collection Chamber Water Seal Chamber Suction Control Chamber .

Chest Drainage System Collection Chamber Water Seal Suction Control •Drain air & fluid from the pleural space •Observe & record drainage .

Chest Drainage System Collection Chamber Water Seal Suction Control •2 cmH2O •Act as one-way valve by bubbling out air •Observe fluctuations in the water level .

Chest Drainage System Collection Chamber Water Seal Suction Control •Connected to suction wall • Remove air & fluid more quickly .

Nurses’ Roles Chest Tube Insertion Care of Patient with Chest Tube Chest Tube Removal .

6. Which of the following is the most appropriate position for Peter when preparing him for chest-tube insertion A: Prone position with head to the side B: Lateral supine position with the legs bent C: Upright seated position. leaning over a table D: Semi-Fowler’s position with a pillow under the back E: Supine position with the legs straighten .

3rd. 4th 5th or 6th intercostal space in the mid axillary line .

Chest Tube Insertion (Before) • • • • • • Informed consent Administer pain medication Prepare equipment Set up drainage system Obtain baseline vital signs Position patient .

Chest Tube Insertion (During) • • • • • Assist Dr with chest tube insertion Monitor patient’s condition Provide emotional support Apply dressing on the insertion site Taped all connections .

Chest Tube Insertion (Immediately After) • • • • • Call for chest x ray Monitor patient’s vital signs hrly X 6hrs Administer pain medications Observe complications Assess drainage system .

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Chest Tube Insertion Care of Patient with Chest Tube Chest Tube Removal .

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Care of Patient with Chest-tube drainage system Monitor & Maintain Respiratory Function I Assess Insertion Site Check Chest-tube Drainage System .

Monitor & Maintain Respiratory Function • • • • • • Monitor vital signs & SpO2 Auscultate breath sounds Encourage deep breathing & coughing Encourage use of incentive spirometery Prop up patient Reposition patient .

Assess Insertion Site .

7. you detect crepitation and tissue swelling. When palpating around Peter’s chest tube insertion site. you suspect: A: Infection B: Subcutaneous emphysema C: Tension Pneumothorax D: Unresolved pneumothorax E: Bleeding .

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Assess Insertion Site • Bleeding • Infection • Subcutaneous emphysema .

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Check Chest Drainage System • Tubing avoid dependent loops. kinking & clamping • Connection taped securely • Drainage bottle below level of patient’s chest .

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Check Chest Drainage System • Check water seal • Level • Bubbling • Fluctuations • Check suction pressure • Assess drainage .

Chest Tube Drainage .

8. Peter needs to be transported to the x ray department. The concern during transport include assure that: A: the chest tube is clamped B: the chest tube bottle is below the insertion site C: Suction tubing is open to air D: B & C E: A & B .

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you notice the drainage tubing was disconnected from the drain. At the X ray department.9. Your first action is to A: Re-established connection B: Clamp Peter’s chest tube immediately C: Notify doctor immediately D: Send him back to the ward immediately and change another drainage system E: Check Peter’s vital signs .

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Common Problems • Disconnection of drainage tubing from drain – Clamp with artery forceps – Re-establish connection ASAP – Notify Dr – KIV chest x ray • Lack of Drainage – check tubing for kinks or obstruction .

Common problems • Collecting bottle fall over – Re-establish water seal level • Intrapleural drain fall out – Tie the purse-string suture – Cover with gauze and pressure bandage – Notify Dr – Monitor Patient .

Chest Tube Insertion Care of Patient with Chest Tube Chest Tube Removal .

The doctor plan to remove the Peter’s chest tube. Which of the following signs suggests the pneumothorax has resolved? A: An air leak in the water seal chamber B: Bubbling in the suction control chamber C: Clear lung sound that extend to the periphery D: More than 100mil of fluid in the collection chamber E: C & D .10.

Removal of Chest Tube (Indicator) • • • • Little to no drainage Normal breathing Fluctuations in water seal stopped Chest X ray shows lung re-expansion with no residual air or fluid • Able to tolerate chest tube clamping • Monitor respiratory status .

Removal of Chest Tube • Administer pain medication • Prepare equipment • Patient hold his breath. Dr tie the purse string & nurse remove the chest tube in one quick movement • Apply dressing • Monitor respiratory status • Arrange for chest X ray .

Pleural Conditions Chest Tube Insertion Care of Patient with Chest Tube Chest Tube Removal .

Team Test 4. Appeals (5mins) (15mins) . Individual Study 2. Individual Test (10mins) 6. Instructor Input (1hr 20 mins) Application of Course Concepts 2 hours of clinical skills practice 1. Application Orientated Activities 3.Instructional Activity Sequence for TBL Readiness Assurance Preparation (Pre-class) Diagnosis-Feedback 1hr 50 mins of class time 5.

Clinical Lab Skills • • • • • Prepare Equipment Set up drainage system Apply dressing on the insertion site Taped all connections Documentation .

Video Show Mosby’s Chest Tubes and Closed Chest Drainage System RD539Vhe2007 .