A nurse is caring for a client who has a right sided pneumothorax following chest tube insertion

A, B, C, E

Oxygen should be readily available in case the client develops respiratory distress following chest tube placement.

If the chest tube becomes disconnected, the end of the tubing should be placed in sterile water to restore the water seal

Hemostat clamps should be available for the nurse to use to check air leaks

Immediately place an occlusive dressing over the chest tube insertion site if becomes disconnected. This allows air to escape and reduces the risk for a tension pneumothorax

What should be kept at the bedside of a client with a chest tube?

2.4 A bottle of sterile water must be located at the bedside to use in case of accidental disconnection of chest tube from drainage unit.

When caring for a client with a chest tube the nurse notes continuous bubbling in the chest tube water seal chamber What does this indicate?

Continuous bubbling may indicate an air leak, and newer systems have a measurement system for leaks — the higher the number, the greater the air leak. The water-seal chamber can also monitor intrathoracic pressure (Teleflex Medical Incorporated, 2009).

Which immediate action should a nurse take if a client's chest tube is accidentally disconnected from the disposable water seal system?

A chest tube drainage system disconnecting from the chest tube inside the patient is an emergency. Immediately clamp the tube and place the end of chest tube in sterile water or NS.

What is the nurse's priority assessment when caring for a patient with a chest tube?

What are the nursing responsibilities when caring for a client with a chest tube to a drainage system? Look at the client first- (color, level of consciousness, airway patency, respiratory rate, depth, rhythm, chest movement- symmetry, lung sounds, lips/ nailbeds).