Question

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.

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?
3. What do you think about his drainage? Are you concerned? Why or why not?

Answer 1

1. The patient in the given case hits the tree and has a blunt chest trauma, this is indicative of pneumothorax and hemothorax as the fluid drainage shows red discharge in last 6 hours. Pneumothoraxis also known as collapse of lungs and the condition when the air fills between the pleural space and cause pain and shortness of breath during inhalation. This is the major reason why the client here is experiencing acute onset of shortness of breath.

2. As suggested insertion of chest tube and air elimination through catheter or needle is the first line treatment for pneumothorax. This is considered to be medical interventions that are put in place in given case, as a nurse the first thing that i would like to do for this patient is communicate with him and make him comfortable, also implement some nursing interventions and position change to aid in breathing.

3. Chest tube is the flexible plastic tube that is inserted through chest wall into the pleural space or mediastinum of the patient, the main aim of this tube is to aid in breathing by enabling inflation of lungs during collapse.It is used to remove the accumulated air or fluid from the pleural space and help in breathing and relief form pain.

4. Chest tube placement and removal should be done under appropriate skills and knowledge as it is an invasive procedure and requires knowledge for the anatomy of human body. Nursing considerations while placement includes managing the aseptic measures, proper instrumentation, application of anaesthesia, and proper positioning of the patient. Whereas, during removal is indicated if the amount of drainage has ceased, or the system holds no suction, advised by the physician or the tube is clogged. Nurse should consider inspecting the sutures before removal of the tube and also inspect for signs of infection.

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