Question

Which of the following is a normal finding for the client with a chest tube? a. New pockets of air are palpated under the skin b. Bubbling is present in the water seal chamber c. Drainage from the chest tube increases each day d. The water level in the water seal chamber oscillates with the client’s respirations

Short answer

The normal finding for a client with a chest tube is option (d) The water level in the water seal chamber oscillates with the client's respirations.

Step-by-step solution

Understanding Normal Chest Tube Function

A chest tube is inserted to remove air, fluids, or pus from the intrathoracic space. It is important to understand how a normally functioning chest tube system behaves. Typically, the water seal chamber helps prevent air from re-entering the pleural space and allows monitoring of intrapleural pressures. Oscillation of the water level within the water seal chamber typically reflects normal pressure changes during respiration. Continuous bubbling in the chamber indicates an air leak, while increasing drainage or subcutaneous emphysema can be a sign of complications.

Identifying Normal Findings

The normal findings in a functioning chest tube may include fluctuation (tidaling) of the water level in the water seal chamber with inspirations and expiration due to the changes in intrathoracic pressure. This is a normal finding that indicates the chest tube is intact and the intrathoracic pressures are varying with respiration.

Ruling Out Abnormal Findings

New pockets of air under the skin (which would be palpated as crepitus), continuous bubbling in the water seal chamber (which might indicate a persistent air leak), and increasing drainage each day (which could suggest ongoing bleeding or other issues) are generally considered abnormal findings.

Selecting the Correct Answer

Based on the understanding of normal and abnormal chest tube functioning, we can eliminate options (a), (b), and (c) as they describe abnormal conditions. Option (d), 'The water level in the water seal chamber oscillates with the client’s respirations,' is the only choice that describes a normal finding for a patient with a chest tube.

Key concepts

Intrathoracic Pressure

Understanding intrathoracic pressure is crucial when considering the mechanics of breathing and chest tube function. Intrathoracic pressure refers to the pressure within the pleural cavity, which is the space between the lungs and the chest wall. During normal breathing, this pressure fluctuates with inspiration and expiration.

When a person inhales, the diaphragm and intercostal muscles contract, expanding the chest and decreasing the intrathoracic pressure. This creates a negative pressure that draws air into the lungs. Conversely, during exhalation, these muscles relax, the chest cavity decreases in size, increasing the intrathoracic pressure, and air is expelled from the lungs.

In the context of chest tube monitoring, it's important to remember that a properly functioning chest tube can cause the water level in the water seal chamber to rise and fall with these pressure changes—which is a normal, expected finding.

Water Seal Chamber

The water seal chamber plays a vital role in chest tube drainage systems. Its primary function is to prevent air from re-entering the pleural space while allowing trapped air and fluid from the chest to be expelled.

How the Water Seal Chamber Works

During inhalation, as the intrathoracic pressure decreases, the water level in the chamber may drop slightly. During exhalation, the pressure rises, and the water level returns to its baseline. This fluctuation, or tidaling, indicates a patent airway and chest tube system. Observing the water seal chamber can provide clinicians with valuable information about a patient's respiratory status and reveal if there are any issues with the chest tube system.

However, it's important to differentiate normal tidaling from continuous bubbling, which could signify a persistent air leak—a potentially serious problem. Understanding these dynamics helps in recognizing normal versus abnormal findings related to chest tube function.

NCLEX-RN Examination

The NCLEX-RN examination is a standardized test that nursing graduates must pass to obtain licensure as registered nurses. This exam assesses a test-taker's ability to apply knowledge, skills, and abilities essential for safe and effective practice as a newly licensed, entry-level nurse.

Topics covered in the NCLEX-RN include a wide array of health conditions, treatments, and interventions. Among the competencies tested are ones regarding the management of clients requiring specialized procedures such as chest tube insertion. For the examination, it's essential to know not only the procedure's mechanics but also how to interpret the chest tube drainage system's normal and abnormal findings.

Questions about chest tubes on the NCLEX-RN might ask candidates to identify normal versus abnormal findings, as with the exercise example regarding water seal chamber oscillations. Candidates need to use critical thinking and apply their understanding of intrathoracic pressure and chest tube mechanics to answer correctly.