Question

SCENERIO:

A 77-year-old man who was admitted to the intensive care unit (ICU) post-surgery for peritonitis following a perforated colon. Due to your superior intellect nursing skills over the course of a few days, he is stabilized and recovering from sepsis. You are now attempting to wean him off of the ventilator. Unfortunately, on his way home from the hospital he hits a tree and sustains blunt chest trauma. A chest tube was inserted in the ER to treat a pneumothorax and hemothorax. Although he is in a lot of pain, he is ecstatic to have you as his nurse again. You note that the drainage system has drained 400ml of light red fluid in the first 6hrs after insertion. The patient is becoming increasingly anxious and SOB during the past hour.

QUESTIONS:

1. What do you anticipate to be potential causes of his acute onset SOB at this time? What are you going to do first and why?

2. Describe the purpose of the chest tube and nursing considerations for placement and removal. When would you anticipate a patient is in need of a chest tube and how do you determine when a patient is ready to have one removed?

Answer 1

1. The patient is suffering from acute onset shortness of breath at this time and the major reason is quiet indicative of pneumothorax due to blunt chest trauma. While the patient hit the tree and got the blunt chest injury he is likely to have collapsed lungs that is a the conditions where the human lungs looses its capacity to expand and accommodate air and this cause shortness of breath. The first thing that we would do for this patient is to help him with artificial intubation that would support him to breath, and in severe case would also put him on ventilator to help him breath.

2. Chest tube is highly recommended in this case, as in case of pneumothorax and here hemothorax the pleural space is filled with gas or fluid or blood that causes inability to accommodate air and inability to breath, this space is to be drained using a chest tube that is inserted in patient's chest and the fluid accumulated is drained out of it to relieve the patient. Nursing consideration for insertion of chest tube is, the nurse in supervision or with help of the specialist insert the chest tube at appropriate area of accumulation as suggested or indicated by the ultrasound examination, the chest tube needs to be drained in a proper apparatus and observed for no entanglation, also sutures should be placed to keep it in place. While removal the nurse should consider that the chest tube is not infected or rotten at any point, sutures should be removed before pulling the tube out and when the fluid drainage is ceased for more than 4 hours the patient is ready for removal of tube.