Medical Surgical Chest tube #4

Question

The nurse is caring for a client with a pneumothorax and observes continuous bubbling in the water seal chamber. Which action by the nurse is best?

Answers

  1. Continue to monitor. Continuous bubbling is expected.
    • Rationale:

      This answer is not correct because continuous bubbling indicates an air leak in the system. If the bubbling was intermittent, then continuous monitoring of the water seal chamber would be indicated.

  2. Notify the provider of the continuous bubbling.
    • Rationale:

      This answer is correct because continuous bubbling in the water seal chamber is evidence of an air leak. A water seal chamber is a one-way valve that allows air to exit through the chest and prevents it from returning back to the client. It is important to notify the provider so the leak can be evaluated.

  3. Encourage coughing and deep breathing.
    • Rationale:

      This answer is not correct because although coughing and deep breathing is encouraged in clients with chest tubes, at this point in time, the water seal needs to be evaluated for leaks. The flow of air from the leak into the pleural space can inhibit lung expansion.

  4. Change the client's position to promote ventilation.
    • Rationale:

      This answer is not correct because although changing the client’s position promotes drainage and ventilation, an air leak needs to be addressed. Having an air leak somewhat defeats the purpose of having a chest tube drainage system.

Overview

A client with a pneumothorax is expected to have intermittent bubbling in the water seal chamber as air is drained from the chest. However, continuous bubbling indicates an air leak and requires prompt attention.

Explanation

Learning Outcomes

A client with a pneumothorax is expected to have intermittent bubbling in the water seal chamber. This happens as a result of air being drained from the chest. A water seal chamber is a one-way valve that allows air to exit through the chest. This prevents the air from returning back to the client. The flow of air from the leak into the pleural space can inhibit lung expansion. Continuous bubbling in the water seal chamber indicates an air leak and needs prompt attention. It is important to notify the provider so the leak can be evaluated.

Test Taking Tip

Remember that with a pneumothorax, intermittent bubbling is okay. But continuous or vigorous bubbling indicates an air leak and the provider should be notified.

Video Rationale