A nurse is caring for a client who has a newly inserted chest tube. The nurse should clarify which of the following prescriptions with the provider?
A.
Vigorously strip the chest tube twice daily.
B.
Assist the client out of bed three times daily.
C.
Notify the provider when tiddling ceases.
D.
Administer morphine 2 mg IV bolus every 3 hr. PRN for pain.
The Correct answer and Explanation is:
The prescription that the nurse should clarify with the provider is:
A. Vigorously strip the chest tube twice daily.
Explanation:
Chest Tube Management:
Chest tubes are commonly used to drain air (pneumothorax) or fluid (pleural effusion, hemothorax) from the pleural space. Proper management of chest tubes is crucial for the recovery and comfort of the client. Each of the listed prescriptions pertains to different aspects of care and monitoring for a client with a chest tube:
- Stripping the Chest Tube:
- Vigorously stripping a chest tube involves squeezing and pulling the tube to clear any potential clots or blockages. This practice is no longer recommended in modern clinical care due to its potential complications. Vigorous stripping can create negative pressure in the pleural space, which may increase the risk of damaging lung tissue or worsening a pneumothorax. It may also contribute to the formation of more clots, which can obstruct the tube. Instead, gentle milking (if absolutely necessary) is preferred to move clots along the tubing. The general consensus is to avoid stripping or milking the chest tube unless specifically advised by the healthcare provider based on the client’s condition.
- Assisting the Client Out of Bed:
- Assisting the client out of bed three times daily is a standard practice to promote mobility and prevent complications such as pneumonia and muscle atrophy. This is generally appropriate for a client with a chest tube, as long as it is done carefully to avoid dislodging the tube or causing discomfort.
- Notifying the Provider When Tidaling Ceases:
- Tidaling refers to the rise and fall of the water level in the water-seal chamber of the chest tube drainage system, reflecting fluctuations in intrathoracic pressure with breathing. Ceasing of tidaling may indicate that the lung has re-expanded or there is a possible obstruction in the chest tube. This change should be reported to the provider for further evaluation.
- Administering Morphine for Pain:
- Administering morphine 2 mg IV bolus every 3 hours as needed for pain is a common practice for managing postoperative or procedural pain related to chest tube insertion. This prescription is appropriate and aligns with pain management protocols.
Conclusion:
The most critical prescription to clarify is the one involving vigorous stripping of the chest tube (A). This practice is outdated and potentially harmful, and should not be routinely performed. Instead, the nurse should confirm with the provider the appropriate management techniques for the chest tube to ensure optimal care and patient safety.