The nurse is caring for a male client with a chest tube. If the chest drainage system is accidentally disconnected, what should the nurse plan to do?
a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.
Answer A.
If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out - not if the system is disconnected. The nurse shouldn’t clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected.
a. Place the end of the chest tube in a container of sterile saline.
b. Apply an occlusive dressing and notify the physician.
c. Clamp the chest tube immediately.
d. Secure the chest tube with tape.
Answer A.
If a chest drainage system is disconnected, the nurse may place the end of the chest tube in a container of sterile saline or water to prevent air from entering the chest tube, thereby preventing negative respiratory pressure. The nurse should apply an occlusive dressing if the chest tube is pulled out - not if the system is disconnected. The nurse shouldn’t clamp the chest tube because clamping increases the risk of tension pneumothorax. The nurse should tape the chest tube securely to prevent it from being disconnected, rather than taping it after it has been disconnected.
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Respiratory