Chest Trauma and Chest Tubes

Question 1

What is a pneumthorax?

Answer 1

air trapped in the pleural space from a hole in the lung (collapsed lung)

Question 2

What are clinical manifestations of a pneumothorax?

Answer 2

decreased movement of involved chest wall, diminished/absent breath sounds, hyperresonance on percussion

Question 3

What is priority treatment for patients with a pneumothorax?

Answer 3

patients get a chest tube with flutter valve or chest drainage system if it is greater than 15-20%

Question 4

What is a tension pneumothorax?

Answer 4

air in pleural space that does not escape which puts more pressure on organs

Question 5

What are manifestations of a tension pneumothorax?

Answer 5

1. cyanosis
2. air hunger
3. tracheal deviation away from the affected side to the good lung

Question 6

What is the treatment for a tension pneumothorax?

Answer 6

a thoracentesis is performed where a needle is stuck in the pleural space to release air, this is not permanent so you keep doing it until patients gets a chest tube with drainage system

Question 7

What is a hemothorax?

Answer 7

blood in the pleural space

Question 8

What are the clinical manfiestations of a hemothorax?

Answer 8

1. dullness of percussion because of blood rather than air
2. decreased H&H
3. possible shock

Question 9

What is the main treatment for a hemothroax?

Answer 9

chest tube with drainage

Question 10

What is a flail chest?

Answer 10

fracture of 2+ adjacent ribs in 2+ places with loss of chest wall stability

Question 11

What are manifestations of a flail chest?

Answer 11

paradoxical movement of chest wall and respiratory distress

Question 12

What is a flail chest commonly associated with?

Answer 12

hemothorax, pneumothorax, or a pulmonary contusion which is a chest bruise that starts swelling

Question 13

What are treatment options for a flail chest?

Answer 13

1. Give oxygen to maintain saturation

2. stabilize flail segment with positive pressure ventilation from either CPAP or BiPAP, intubation, or mechanical vent

Question 14

What is the first compartment of the chest tube do?

Answer 14

receives fluid and air from pleural space. the fluid stays in this chamber and air vents to second

Question 15

When should the physician be notified when assessing a chest tube?

Answer 15

70 mL/ hour= TOO MUCH so notify the provider

Question 16

What is the second compartment of the chest tube do?

Answer 16

this is the water seal chamber where there is intermittent bubbling during exhalation.
water will rise during inspiration and fall with expiraiton

Question 17

What does continuous bubbling indicate?

Answer 17

continuous bubbling indicates an air leak which is BAD

Question 18

How can a nurse intervene to stop continuous bubbling in the second chamber?

Answer 18

clamp tubing starting closest to patient and work toward system. When bubbling stops, leak is above the clamp

Question 19

What is the third compartment of the chest tube do?

Answer 19

it is used for suction control

Question 20

What does the wet suction control do?

Answer 20

20 cm of water controls suctioning and the goal here is to see gentle bubbling
too much bubbling can indicate a leak and too little can indicate no suctioning occurring

Question 21

What does the dry suction control do and how should it be increased?

Answer 21

visual alert to see if suction is working, and to increase, turn dial on the drainage system not the wall suction

Question 22

What should the nurse do if the chest tube is pulled out?

Answer 22

cover insertion site with a 3 sided dressing gauze ASAP and only tape 3 sides, leaving one side open so that air can come outside of the unsealed side

Question 23

What should the nurse do if the suction collection device is pulled out?

Answer 23

air can directly enter into the chest because this is an open chest tube so put the end in sterile water until it can be replaced

Question 24

Where should the chest tube system be placed?

Answer 24

keep system below insertion site because it it is above, fluid and blood will flow back into the patient

Question 25

What is the major complication of milking the tube?

Answer 25

do not strip/milk the tubes because it can cause barotrauma which is when the lung is pulled at because of the high pressure