ATI Question!!!

[NurseScholar]

today while studying the ati my study group had difficulties answering the following question:

chest tube insertion following thoracic surgery. assess chest tube drainage system. which finding needs immediate further action?

-fluctuation of drainage in the tubing with inspiration

-drainage of 75ml in the 1st hour after surgery

-continuous bubbling in the water seal chamber

-several small dark red blood clots in the tubing.

any thought as to the correct answer and your rationale would be greatly appreciated. i chose #2 and #3 which are both incorrect according to the ati.

my thought was that answer 2 (drainage of 75ml) might be indicative of hemorrhage as my instructor told the class that fluid drainage in a chest tube that is in excess of 75-100ml/hr may indicate hemorrhage. what nursing interventions would you implement after assessing that your patient may have a free bleed? would you just notify the pcp or are there any other prudent measures you might take to slow the bleeding?

and

can someone please explain diaphragmatic breathing as related to patient teaching, in other words what is it and how would you teach it to your patient?

thanks! !!

[onduty23]

3 is the answer

constant bubbles means their is an air leak present which is not good

[onduty23]

3 not good then its 4 because of the risk of pe from the small clots

[Daytonite, BSN, RN]

This is a straight knowledge question. Let me explain. Fluctuation of drainage in the tubing with inspiration is NORMAL so you want to be seeing that. Drainage of 75mg in the first hour after surgery is also NORMAL and nothing to be concerned about. Several small dark red blood clots in the tubing after thoracic surgery is also NORMAL. Chest tubes are inserted not only to re-expand the lung, but also to drain blood and fluid from the area if there has been surgery into it. However, continuous bubbling in the water seal chamber shouldn't be occurring. Bubbling should only occur as air is being pushed out through the chest tube when the patient takes a deep breath or inspiration. Chest tube drainage is supposed to be a closed drainage system. So, if there is bubbling occurring continuously in the water seal it means that there is a hole or leak somewhere in the tubing or system.

[gt4everpn, BSN, RN]

today while studying the ati my study group had difficulties answering the following question:

chest tube insertion following thoracic surgery. assess chest tube drainage system. which finding needs immediate further action?

-fluctuation of drainage in the tubing with inspiration

-drainage of 75ml in the 1st hour after surgery

-continuous bubbling in the water seal chamber

-several small dark red blood clots in the tubing.

any thought as to the correct answer and your rationale would be greatly appreciated. i chose #2 and #3 which are both incorrect according to the ati.

my thought was that answer 2 (drainage of 75ml) might be indicative of hemorrhage as my instructor told the class that fluid drainage in a chest tube that is in excess of 75-100ml/hr may indicate hemorrhage. what nursing interventions would you implement after assessing that your patient may have a free bleed? would you just notify the pcp or are there any other prudent measures you might take to slow the bleeding?

and

can someone please explain diaphragmatic breathing as related to patient teaching, in other words what is it and how would you teach it to your patient?

thanks! !!

the answer is 3 continous bubbles is a sign of an air leak, it is normal for drainage to fluctuate during inspiration/expiration. i would notify the m.d if someone is bleeding internally i would have no way of knowing where it is occuring at that moment so that would be the next best thing to do.

[NurseScholar]

thank you all for your assistance.