Nursing Case Study - Thoracentesis, Chest Tube Drainage System and Nursing Interventions

1.Given his diagnosis, are A.B.'s admission VS expected? Explain.

2.How does the underlying pathophysiology relate to A.B.'s presenting signs and symptoms?

Case Study Progress: The physician performs a thoracentesis and drains 1500mL of fluid. A specimen for culture and sensitivity (C&S) is sent to the laboratory, and A.B. is started on cefuroxime (Ceftin) 1g intravenously (IV) every 8 hours:

3.  What is a thoracentesis?

4.  The order for the cefuroxime (Ceftin) reads to infuse 1 g in 100mL 0.9% NaCl over 30

minutes. You have IV tubing that supplies 20 gtt/mL. At how many drops per minute will you regulate the infusion?

5.  What interventions will you implement to promote A.B.'s clearing pulmonary secretions?

Case Study Progress: The pleural C&S results indicate a large amount of Klebsiella organism growth that is not sensitive to cefuroxime (Ceftin):

6.  What action will you take next?

7.  Because fluid continues to collect in the pleural space, the physician decides to insert a pleural chest tube under nonemergent conditions. What is your responsibility as A.B.'s nurse regarding this procedure?

8.  What interventions will you implement afterward to maintain A.B.'s chest tube system?

9.  Evaluate each of the following statements about chest tube drainage systems. Enter T for true or F for false. State why false statements are incorrect.

_____ 1. The height of the water in the suction control mechanism limits the amount of suction transmitted to the pleural cavity.

_____ 2. A suction pressure of +20 cm H2 O is usually recommended for adults.

_____ 3. Bubbling in the water-seal chamber usually means that air is leaking from the lungs, the tubing, or the insertion site.

_____ 4. The rise and fall of the water level with the patient's respirations reflect normal pressure changes in the pleural cavity with respirations.

_____ 5. Because the chamber is a closed system, water cannot evaporate from the system.

_____ 6. To declot the drainage tubing, put lotion on your hands, compress the tubing, and vigorously strip long segments of the tubing before releasing.

_____ 7. You lower the bed on top of the drainage system and break it. You immediately clamp the chest tube, leaving it clamped until you can reestablish the drainage system.

_____ 8. The collection chamber is full, so you need to connect a new drainage system to the chest tube. It is fine to momentarily clamp the chest tube while you disconnect the old system and reconnect the new.

Case Study Progress: The next day you are again assigned to care for A.B. At the beginning of the shift, you assess A.B. and find that his condition is stable. His lung sounds remain diminished in the right lower lobe and his Spo2 is 95% on oxygen at 2L per nasal cannula. The chest drainage system is attached to suction at 20mm Hg; there is still an air leak present. His morning chest x-ray examination showed some residual pleural effusion. Four hours into your shift, he pages you through the call system and tells you he feels “short of breath.” You immediately go to his room. A.B. is sitting in the chair. 

10.  Describe the priority assessment you must perform at this time.

11.  You determine that the chest tube has become disconnected from the drainage system and is contaminated. What do you need to do?