Question

The nurse is caring for a 30 -year-old male admitted with a stab wound. While in the emergency room, a chest tube is inserted. Which of the following explains the primary rationale for insertion of chest tubes? A. The tube will allow for equalization of the lung expansion. B. Chest tubes serve as a method of draining blood and serous fluid, and assist in reinflating the lungs. C. Chest tubes relieve pain associated with a collapsed lung. D. Chest tubes assist with cardiac function by stabilizing lung expansion.

Short answer

Answer: The primary rationale for inserting chest tubes in a patient with a stab wound is to drain accumulated blood and serous fluid, which assists in reinflating the lungs.

Step-by-step solution

Analyze Option A

Option A states that the tube will allow for equalization of the lung expansion. While it is true that chest tubes facilitate lung expansion, this is not the primary rationale for their insertion in a patient with a stab wound.

Analyze Option B

Option B states that chest tubes serve as a method of draining blood and serous fluid, and assist in reinflating the lungs. This is indeed the primary rationale for inserting chest tubes in a patient with a stab wound. Blood and serous fluid can accumulate in the pleural cavity, which prevents the lungs from fully expanding. By draining this fluid, the chest tubes help reinflate the affected lung.

Analyze Option C

Option C states that chest tubes relieve pain associated with a collapsed lung. While it is true that chest tubes can help alleviate pain associated with a collapsed lung, this is not their primary purpose. Their main function is to help drain blood and serous fluid to allow the lungs to expand properly.

Analyze Option D

Option D states that chest tubes assist with cardiac function by stabilizing lung expansion. While lung expansion is important in overall cardiac function, this is not the primary rationale for inserting chest tubes in a patient with a stab wound. The main purpose is to drain accumulated blood and serous fluid to reinflate the lungs.

Choose the correct option

Based on the analysis of each option, the primary rationale for inserting chest tubes in a patient with a stab wound is given by Option B. Chest tubes serve as a method of draining blood and serous fluid and assist in reinflating the lungs.

Key concepts

Pleural Cavity Drainage

The pleural cavity is a fluid-filled space that lies between the lungs and the chest wall, acting as a lubricated surface for the lungs to expand and contract smoothly during breathing. When a patient, such as the one with a stab wound in our exercise, experiences trauma or a medical condition that leads to the accumulation of air, blood, or serous fluid in the pleural cavity, this can lead to what is known as a pneumothorax or hemothorax. This fluid build-up in the pleural cavity restricts the normal function of the lungs and can lead to difficulty in breathing or a collapsed lung.

Chest tube insertion, a medical procedure in which a tube is placed between the ribs into the pleural cavity, serves to drain this buildup of fluids or air. This facilitates respiration by allowing the lungs to re-expand properly and maintain optimal gas exchange. The drainage system is typically a closed system that prevents air from entering while letting fluid and air escape from the pleural space, thereby paving the way for lung re-expansion and healing.

Lung Expansion

Effective lung expansion is critical for proper respiration, oxygenation of the body, and overall health. When the lungs are unable to expand fully due to fluid accumulation, as in the case of our patient with a stab wound, it compromises not only respiratory function but also other systems such as the cardiovascular system.

The rationale for chest tube insertion includes restoring negative pressure within the pleural space which is critical for passive lung expansion. When the pleural space is clear of fluids or air, the lungs can expand fully, which means they can take in more oxygen and expel more carbon dioxide. This process directly impacts pulmonary efficiency and the patient's ability to breathe without assistance. Without adequate lung expansion, patients may experience shortness of breath, decreased oxygen levels in the blood, and potential respiratory failure.

NCLEX-PN Exam Preparation

The National Council Licensure Examination for Practical Nurses (NCLEX-PN) is designed to test the knowledge, skills, and abilities essential for safe and effective practice as an entry-level vocational or practical nurse. Preparing for the NCLEX-PN involves a thorough study of various medical and surgical nursing interventions, including understanding the rationale behind procedures such as chest tube insertion.

When preparing for questions related to pleural interventions on the NCLEX-PN, it's crucial to grasp the concept of pleural cavity drainage and original lung expansion, as illustrated in the exercise solution. Understanding the pathophysiology behind chest trauma, the resulting complications such as pneumothorax, and the subsequent interventions like chest tube placement can be vital for both patient care and exam success. Future nurses are expected to differentiate between various conditions and rationalize the most appropriate nursing intervention for each scenario. A strong foundation in these concepts will not only aid in passing the licensure exam but also equip nurses with the necessary knowledge to deliver competent care to their patients.