A charge nurse is teaching a newly licensed nurse about nationally notifiable diseases. Which of the following diseases should the charge nurse include in the teaching as being reportable?

A. Presence of 50 mL/hr in the drainage chamber: Some drainage after chest tube placement is expected. A rate of 50 mL/hr is within a typical range for postoperative monitoring, especially in the first 24 hours, and does not usually require immediate provider notification unless it increases significantly or becomes bloody.

B. Tidaling occurs when the client is breathing: Tidaling, or the rise and fall of fluid in the water seal chamber with respiration, indicates that the chest tube system is patent and functioning correctly. This is an expected finding and reflects normal intrathoracic pressure changes during breathing.

C. Continuous bubbling in the water seal chamber: Continuous bubbling in the water seal chamber suggests an air leak in the system. This is abnormal and requires provider notification because persistent air leaks can impair lung re-expansion, compromise respiratory function, and may indicate malfunction of the system or a worsening pneumothorax.

D. Oxygen saturation of 92% on room air: An oxygen saturation of 92% is slightly below normal but may be expected immediately postoperative or in clients with lung compromise. It requires monitoring and supplemental oxygen if needed, but it is not as urgent as a continuous air leak in the chest tube system.

A. Slurred speech: Slurred speech is typically associated with intoxication from central nervous system depressants, such as alcohol or opioids, rather than withdrawal. During withdrawal, the client is more likely to exhibit hyperactive or restless behavior.

B. Constricted pupils: Pupillary constriction (miosis) occurs with opioid intoxication. In contrast, opioid withdrawal usually causes dilated pupils (mydriasis) due to sympathetic nervous system overactivity.

C. Sedation: Sedation is a common effect of opioid use, not withdrawal. During withdrawal, clients are generally hyperalert, restless, and may experience insomnia rather than excessive sleepiness.

D. Yawning: Yawning is a classic sign of opioid withdrawal and reflects autonomic nervous system activation. It is often accompanied by lacrimation, rhinorrhea, sweating, and other early withdrawal symptoms.