After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must:
A. Monitor fluctuations in the water-seal chamber.
B. Clamp the chest tube once every shift.
C. Encourage coughing and deep breathing.
D. Milk the chest tube every 2 hours.
Correct Answer: C. Encourage coughing and deep breathing
When caring for a patient who is recovering from a pneumonectomy, the nurse should encourage coughing and deep breathing to prevent pneumonia in the unaffected lung. Assist the patient with splinting painful areas when coughing, deep breathing. Supporting chest and abdominal muscles makes coughing more effective and less traumatic.
Option A: Because the lung has been removed, the water-seal chamber should display no fluctuations. Bubbling during expiration reflects venting of pneumothorax (desired action). Bubbling usually decreases as the lung expands or may occur only during expiration or coughing as the pleural space diminishes. The absence of bubbling may indicate complete lung re-expansion (normal) or represent complications such as an obstruction in the tube.
Option B: Reinflation is not the purpose of a chest tube. Know the location of air leak (patient- or system-centered) by clamping thoracic catheter just distal to exit from the chest. If bubbling stops when the catheter is clamped at the insertion site, leak is patient-centered (at the insertion site or within the patient).
Option D: Chest tube milking is controversial and should be done only to remove blood clots that obstruct the flow of drainage. Although routine stripping is not recommended, it may be necessary occasionally to maintain drainage in the presence of fresh bleeding, large blood clots, or purulent exudate (empyema).
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