Advanced Skills

chest tube

catheter inserted into the pleural space in the chest cavity to remove air, blood, and/or fluids

anatomical location of lungs

sit to left and right of heart

diaphragm

sheet of muscle that sits at the bottom of the thoracic cavity and separates it from the abdominal cavity

visceral pleura

membrane that covers the outside of the lungs

parietal pleura

membrane tha tlines the interior chest wall

pleural space

space between the visceral pleura and parietal pleura; normally contains between 10-20 mL of pleural fluid for lubrication during inspiration and expiration

inspiration

diaphragm contracts and pulls downward while intercostal muscles pull upward

expiration

diaphragm relaxes and chest recoils

pneumothorax

when a lung collapses due to leaked air in the pleural space

hemothorax

when a lung collapses due to blood in the pleural space

spontaneous pneumothorax

happens suddenly without any known cause

traumatic pneumothorax

caused by a chest injury, such as a bullet owund, that pierces the pleural membranes

tension pneumothorax

medical emergency caused by a large pneumothorax that impacts cardiovascular functioning

what is a visible sign of a tension pneumothorax?

trachial deviation

pleural effusion

accumulation of fluid in the pleural space, often due to medical conditions such as cancer or heart, kidney, or liver failure

chylothorax

collection of lymph in the pleural space

empyema

pyogenic infection of the pleural space

hydrothorax

accumulation of serous fluid in the pleural space

where is the proximal end of a chest tube located?

inserted in the patient’s pleural space

where is the distal end of a chest tube located?

connected to a closed drainage system

tidaling

rise and fall of water in water seal chamber that rises with inspiration and falls with expiration

what does continuous bubbling in a water seal chamber indicate?

air leak

what are the benefits of a Heimlich valve as opposed to a drainage system?

functions in any position, never needs to be clamped, can be worn under clothing, and can be hooked up to suction if required

what is a possible complication concerning the skin around the chest tube insertion site?

subcutaneous emphysema

equipment to keep in the room of a patient with a chest tube

rubber tipped clamps, gauze pads, sterile water

how often should you assess the integrity of the drainage system and tubing?

every 1-4 hours

should you clamp tubing if the client requires transport out of the room?

no

how can you determine the location of an air leak in a chest tube drainage system?

momentarily clamp tube, starting at the insertion site and working your way towards the drainage device

what should you do if the patient’s chest tube becomes dislodged?

call for assistance, cover chest tube insertion site ONLY ON 3 SIDES with sterile occlusive dressing

when should you replace a chest tube drainage system?

only when the collection chamber is full or the system is contaminated or damaged

assessments related to a chest tube

vital signs, pulse ox, resp assessment, client’s understanding

when should you notify the provider regarding chest tube output?

if initial output is over 1500 mL or if 200 mL/hr - could indicate vascular injury

evaluation related to chest tube placement

ability to cough and deep breathe, proper functioning and maintenance, decreased dyspnea

do you clamp tubing before removal of a chest tube?

no

what is the nurse’s role during the removal of a chest tube?

comfort patient, explain procedure, provide physical and emotional support

how often should you assess a recently removed chest tube insertion site?

minimum of every 15 minutes for at least an hour after removal

first-pass effect

metabolism of a drug in the liver and gut wall that reduces its concentration before it reaches systemic circulation

advantages of IV push medication

reduces first-pass effect, rapid onset, rapid access, does not require repeated needlesticks for administering repetitive doses

disadvantages of IV push medication

meds given cannot be retrieved, higher likelihood of incompatibilities, speed shock, IV site complications

speed shock

adverse systemic reaction when a medication is introduced into the bloodstream; sudden peak of medication increases risk of side effects

rights of medication administration

patient, medication, dose, route, time, documentation, reason, response

physical incompatibilities

visible or measurable change that makes the preparation unsafe

chemical incompatibilities

alterations of the integrity and potency of active ingredient

therapeutic incompatibilities

agents are antagonistic to one another

ampule

single-use glass bottle that you break

vial

single- or multi-dose plastic or glass container with rubber seal top

prefilled syringes

many used during emergency medication situations

assessments prior to IV push

vital signs, pain level, lab results, skin around IV site

documentation related to IV push medications

date/time of administration, med amount and dose, IV site location, administration route and rate, flush solution, indication for medication, pt assessment related to medication, and patient response