Medical Surgical Chest tube #1

Question

The nurse is caring for a client who has a chest tube following cardiac surgery and observes a dramatic decrease in chest tube drainage from the first hour to the second hour after surgery. Evaluation of the chest tube system indicates which problem?

Answers

  1. The lungs are not at risk and are fully inflated.
    • Rationale:

      This answer is not correct because a sudden decrease in chest tube drainage is not an indication of lung inflation or recovery. Chest tubes placed following cardiac surgery are typically mediastinal chest tubes used to keep drainage from collecting at the incision site.

  2. The client is recovering without further drainage.
    • Rationale:

      This answer is not correct because chest tube drainage should not decrease so drastically so soon following cardiac surgery. A slow decrease in chest tube drainage over a period of several days is the desirable outcome indicating that recovery is taking place.

  3. There may be tube obstruction due to a drainage clot.
    • Rationale:

      This answer is correct because the first hours following cardiac surgery may have chest tube drainage as high as 100 mL/hr but should begin slowing down after a few hours, not just in the second hour. Therefore, there must be an obstruction such as a clot or kink in the tubing.

  4. Tension pneumothorax is pending, so call the health care provider immediately.
    • Rationale:

      This answer is not correct because a sudden decrease in chest tube drainage is not an indicator of tension pneumothorax. A mediastinal shift towards the unaffected side is the classic manifestation of a tension pneumothorax.

Overview

The focus of this question is about understanding the mechanics of a chest tube and being able to troubleshoot when complications occur. A drastic and sudden decrease in drainage indicates a likely blockage somewhere within the chest tube system.

Explanation

Learning Outcomes

Chest tubes that are inserted during cardiac surgery are used to drain fluid from the surgical site which builds up as a result of the inflammatory process that naturally occurs following surgery. It is essential for the nurse to recognize signs that the tube is not functioning properly or the client is experiencing complications. A significant decrease in drainage in the first few hours following surgery is not a normal finding and could indicate an obstruction to drainage.

Test Taking Tip

Eliminate similar answer choices. Answer options 1 & 2 are nearly identical, leaving options 3 & 4.

Video Rationale