NURS 2864 - Week 3 Chest Tube Case Studies

What developmental principles must be considered when preparing a 2-year-old like Mae for chest-tube insertion, and how do these guide your approach?

Toddlers fear separation, pain, and loss of control. Use simple, concrete words; keep explanations short; allow parent presence; use a calm voice; use medical play with a doll; describe sensory experiences (“You may hear beeps,” “The blanket might feel like a hug”); provide comfort items and distraction like bubbles or videos.

How should a nurse verbally prepare a toddler for chest-tube insertion while keeping Mae’s exact developmental stage and fears in mind?

Use brief, simple wording such as: “The doctor is going to help your breathing by putting a small tube near your ribs. It helps get the yucky fluid out.” Assure her the caregiver will stay nearby and describe what she might hear or feel without overwhelming her.

How does preparation differ for an older child compared to a toddler receiving a chest tube?

Older children receive more detailed explanations, opportunities to ask questions, choices such as music vs iPad distraction, and clear explanations of sedation (“You’ll get medicine that helps you sleep during tube placement”).

What is the nurse’s role in setting up the chest-tube drainage system before insertion, and what components must be prepared?

Gather and prime the system, fill the water-seal chamber to manufacturer level, fill suction chamber for wet systems, secure and tape all connections, prepare sterile supplies (drain sponges, occlusive dressing), and ensure wall suction is available and correctly set.

What should the nurse expect immediately after Mae’s chest tube is connected?

Immediate outflow of serous or serosanguinous fluid (possibly cloudy from infection), visible tidaling in the water-seal chamber, little or no bubbling (continuous bubbling = air leak), and an initially higher drainage amount that slowly decreases.

What risks are toddlers like Mae particularly prone to after chest-tube placement?

Bleeding, infection, tube dislodgement (high risk in toddlers), re-expansion pulmonary edema, respiratory distress from kinks/clogs, and pain that worsens breathing and movement.

What safety concerns should the nurse anticipate as Mae wakes from sedation following chest-tube insertion?

Agitation and attempts to pull the tube out, possible need for soft restraints or close caregiver presence, keeping tubing out of reach, monitoring for respiratory depression, and performing frequent vitals.

How should pain be assessed in a 2-year-old like Mae with a chest tube in place?

Use the FLACC scale (Face, Legs, Activity, Cry, Consolability), observe for guarding or refusal to move, note increased WOB, and use caregiver input on behavioral cues.

How do you explain to a toddler why the chest tube must stay in place?

Use simple statements: “This tube helps your lung get better. It takes out the yucky fluid so you can breathe easier. The tube stays until the doctor says your lung is all better. Mom/Dad is right here.”

What are the differences between wet suction and dry suction drainage systems?

Wet suction uses a water column to regulate suction (requires filling, continuous bubbling in suction chamber). Dry suction uses a dial, requires no water fill, and has minimal/no bubbling.

What provider orders are typically expected for a pediatric chest-tube placement?

Suction level (often –20 cmH₂O unless pediatric adjustment), drainage-system type (usually wet), drainage-measurement frequency, a post-insertion chest X-ray, pain-control regimen, dressing-change schedule, and neuro/resp monitoring frequency.

Which chest-tube findings in Mae require immediate reporting to the provider?

Sudden drainage increase >5–10 mL/kg/hr, bright red blood, new/worsening respiratory distress, continuous bubbling (air leak), absence of tidaling, tube dislodgement/disconnect, or new subcutaneous emphysema.

What does the “water seal” chamber indicate for nursing assessment and intervention?

Assess for tidaling, expect intermittent bubbling when coughing, avoid continuous bubbling, keep the system upright and below chest level, maintain water level, and never clamp unless ordered.

What should the nurse expect when Riley’s chest tube is attached for a traumatic tension pneumothorax?

Air evacuation causing initial bubbling in water-seal chamber, tidaling, minimal fluid output unless hemothorax present, and rapid improvement in respiratory distress once decompressed.

What risks must the nurse monitor for after chest-tube placement in a teenager with a traumatic pneumothorax?

Recurrent pneumothorax from obstruction/kinking, infection, bleeding, intercostal vessel injury, subcutaneous emphysema, pain-related hypoventilation/atelectasis, and dislodgement due to movement or impulsive behavior.

What safety concerns exist as Riley wakes from sedation after chest-tube placement?

Disorientation leading to pulling on the chest tube, respiratory depression from sedatives, risk-taking behavior such as trying to get out of bed, and a need to reinforce “no pulling/traction on tubing.”

How should pain be assessed in a 17-year-old with a chest tube?

Use a 0–10 numeric scale; assess location and quality; identify worsening factors like deep breathing/coughing; reassess after interventions.

How should the nurse explain to a teenager why the chest tube must remain in place?

Provide factual reasoning: “Air was trapped around your lung and collapsing it. The tube removes the air until your lung seals itself. If the tube comes out too early, the lung can collapse again.”

What is included in a focused respiratory assessment for Riley before chest-tube removal?

Assess work of breathing, chest expansion symmetry, air entry, subcutaneous emphysema, presence/absence of air leak, tidaling, O₂ saturation/vitals trends, and pain-related hypoventilation.

How should the nurse perform pain assessment for Riley at this stage of recovery?

Use a 0–10 scale at rest and during deep breathing/coughing, and ask how pain affects mobility.

How should the nurse prepare Riley for a chest-tube dressing change?

Explain steps (“You’ll feel some tugging”), ensure privacy, premedicate if ordered, place him in semi-Fowler or comfortable sitting position, and verify tube security before loosening the dressing.

What equipment is required for a chest-tube dressing change?

Sterile gloves, clean gloves, sterile scissors if needed, drain sponges, occlusive dressing (e.g., petroleum gauze/hydrocolloid), tape or securement device, chlorhexidine/skin prep, waste bag, and mask/eye protection per protocol.

What are the step-by-step actions for performing a chest-tube dressing change?

Hand hygiene, don gloves, remove old dressing while stabilizing tube, assess site (redness, drainage, subcutaneous emphysema, tube migration), hand hygiene and sterile gloves, cleanse inner→outer, apply sterile drain sponge, apply occlusive dressing, tape airtight (“picture-frame”), ensure no tubing kinks, reassess respiratory status and water-seal chamber.

What must be documented after completing a chest-tube dressing change?

Reason for change, site assessment (odor, drainage, redness, approximation), tube status (cm marking, securement), dressing type applied, patient tolerance and before/after pain level, drainage-system findings (tidaling, bubbling, water level), and education reinforced.