Chest Tubes

1.       Understand the mechanism of breathing.          Pressure relationships in the thoracic cavity:•             intrapulmonarypressure•             intrapleuralpressure•             importanceof negative pressure in intrapleural space 2.       Understand the rationale for insertion of chesttubes in specific medical-surgical conditions.•             Thoracotomy•             Lobectomy•             Pneumothorax•             Empyema3.       Understand the rationale of a water-seal system.          •      Preventreentry of air into the lung4.       Understand three mechanisms to drain fluid andair from the pleural cavity.   •             Positiveexpiratory pressure, deep breathing, and coughing•             Gravity•             Suction5.       Understand four types of pleural drainagesystems.      Pleura-evac: •             wetsuction control chamber•             drysuction control chamber•             Heimlichvalves•             pigtailcatheters6. Understand nursing responsibilities in caring for aclient with chest tubes.                Assessment of client•             vitalsigns•             lungsounds•             clinicalsigns of complications•             respiratorystatus•             dressing•             discomfort Maintaining chest tubes and closed chest drainage:•             ensuringthat the system is airtight.•             assessmentof drainage in the collection container•             assessmentof fluctuation of fluid level in the water-seal chamber of the Pleura-evac unit•             assessmentfor intermittent bubbling in the water of the water-seal chamber•             assessmentfor gentle bubbling in the suction control chamber•             inspectionof the air vent•             inspectionof the drainage tubing for kinks or loops•             Chesttube dressing changes as per hospital protocol.