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The provider writes an order for a client to have a chest tube removed. Which of the following are appropriate reasons to discontinue a chest tube? Select all that apply.

Breath sounds diminished on auscultation.

Improved respiratory status.

Symmetrical rise and fall of the chest.

Oxygen saturation at least 90%.

Continuous bubbling in water seal chamber.

Chest is asymmetrical on inspiration and expiration.

Bilateral breath sounds clear on auscultation.

Answer and Explanation

Correct Answer : B,C,G

Choice A Reason:

Breath sounds diminished on auscultation indicate that there may still be fluid or air in the pleural space, suggesting that the chest tube is still needed to drain the pleural cavity. This is not an appropriate reason to discontinue a chest tube as it indicates ongoing issues that need to be resolved.

Choice B Reason:

Improved respiratory status is a key indicator that the chest tube has successfully resolved the underlying issue, such as a pneumothorax or pleural effusion. When the patient shows signs of stable and improved breathing, it suggests that the chest tube has served its purpose and can be safely removed.

Choice C Reason:

Symmetrical rise and fall of the chest during respiration indicate that both lungs are expanding and contracting normally. This symmetry is a sign that the pleural space is no longer compromised, making it an appropriate reason to remove the chest tube.

Choice D Reason:

Oxygen saturation at least 90% is a general indicator of adequate oxygenation but does not specifically address the condition of the pleural space. While important, it is not a direct reason to discontinue a chest tube without other supporting signs.

Choice E Reason:

Continuous bubbling in the water seal chamber indicates an ongoing air leak, which means that the chest tube is still necessary to evacuate air from the pleural space. This is not an appropriate reason to remove the chest tube.

Choice F Reason:

An asymmetrical chest on inspiration and expiration suggests that there is still an issue with lung expansion, possibly due to fluid or air in the pleural space. This condition requires the chest tube to remain in place until resolved.

Choice G Reason:

Bilateral breath sounds clear on auscultation indicate that both lungs are free of fluid and air, and are functioning normally. This is a strong indicator that the chest tube has achieved its purpose and can be safely removed.

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Correct Answer is A

Explanation

Choice A Reason:

Constant bubbling in the water seal chamber of a chest drainage system typically indicates an air leak. This can occur if there is a break in the system, allowing air to enter. The air leak could be from the chest tube insertion site, the tubing, or the drainage system itself. Identifying and correcting the source of the air leak is crucial to ensure the system functions properly and the patient’s condition does not worsen.

Choice B Reason:

A tension pneumothorax is a life-threatening condition where air accumulates in the pleural space and cannot escape, leading to increased pressure on the lungs and other thoracic structures. While a tension pneumothorax can cause significant respiratory distress, it is not typically indicated by constant bubbling in the water seal chamber. Instead, signs of tension pneumothorax include tracheal deviation, hypotension, and severe respiratory distress.

Choice C Reason:

A kink in the tubing of a chest drainage system can obstruct the flow of air and fluid, but it does not cause constant bubbling in the water seal chamber. Instead, a kink would likely result in a lack of drainage or intermittent bubbling as the obstruction temporarily blocks and then allows passage of air or fluid.

Choice D Reason:

Increased drainage in a chest tube system indicates that more fluid or air is being removed from the pleural space, but it does not cause constant bubbling in the water seal chamber. Increased drainage might be seen in cases of hemothorax or pleural effusion, where large amounts of fluid are present.

Choice E Reason:

Tidaling refers to the normal rise and fall of water in the water seal chamber with the patient’s respiratory cycle. It indicates that the chest tube is patent and functioning correctly. Absence of tidaling could suggest that the lung has fully re-expanded or that there is an obstruction in the system. However, tidaling itself does not cause constant bubbling.

A. Document that the nasogastric tube is in the correct place. B. Notify the health care provider. C. Check for placement by auscultating for air injected into the tube. D. Retest the pH using another strip.

Correct Answer is B

Explanation

Choice A Reason:

Documenting that the nasogastric tube is in the correct place is not appropriate in this scenario. The normal pH range for gastric contents is typically between 1.5 and 3.5. A pH of 7.35 is much higher than this range, indicating that the tube may not be in the stomach. Therefore, documenting the tube as correctly placed could lead to potential complications, such as improper feeding or medication administration.

Choice B Reason:

Notifying the health care provider is the correct action. A pH of 7.35 suggests that the nasogastric tube may be misplaced, possibly in the respiratory tract or another non-gastric location. Immediate notification of the health care provider is crucial to prevent any adverse outcomes and to take corrective measures, such as confirming placement with an X-ray or re-inserting the tube.

Choice C Reason:

Checking for placement by auscultating for air injected into the tube is not a reliable method for verifying nasogastric tube placement. While this method was traditionally used, it has been found to be inaccurate and is no longer recommended. The sound of air entering the stomach can be misleading and does not confirm correct placement.

Choice D Reason:

Retesting the pH using another strip is not the best immediate action. While it is important to ensure the accuracy of the pH reading, a pH of 7.35 is significantly outside the normal gastric range, and retesting is unlikely to yield a different result. The priority should be to notify the health care provider to address the potential misplacement of the tube.

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The provider writes an order for a client to have a chest tube removed. Which of the following are appropriate reasons to discontinue a chest tube? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is taking care of a 60-year-old client with constant bubbling in the water seal chamber. The nurse knows that constant bubbling in the water seal of a chest drainage system indicates which problem?

Correct Answer is A

Explanation

The nurse is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents, checks the gastric pH, and notes a pH of 7.35. Based on this information, which action should the nurse take at this time?

Correct Answer is B

Explanation

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