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    Chapter 27: Lower Respiratory Problems Pleural Effusion With Thoracentesis and Chest Tube

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    Sherree Hayes
    C.L. presents with difficulty breathing and is found to have a pleural effusion and lung lesion. A thoracentesis reveals malignant cells. Further scans show a lung mass but no metastases. He undergoes lobectomy and is admitted with a chest tube. Chest tubes drain fluid and air and allow lung reexpansion. The tube will be removed once drainage stops and the lung is fully expanded, using lidocaine, having the patient hold their breath, and applying a dressing to prevent pneumothorax.

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    Chapter 27: Lower Respiratory Problems Pleural Effusion With Thoracentesis and Chest Tube

    Uploaded by

    Sherree Hayes
    123 views3 pages
    C.L. presents with difficulty breathing and is found to have a pleural effusion and lung lesion. A thoracentesis reveals malignant cells. Further scans show a lung mass but no metastases. He undergoes lobectomy and is admitted with a chest tube. Chest tubes drain fluid and air and allow lung reexpansion. The tube will be removed once drainage stops and the lung is fully expanded, using lidocaine, having the patient hold their breath, and applying a dressing to prevent pneumothorax.

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    study guide for medsurg

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    Pleural Effusion

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    C.L. presents with difficulty breathing and is found to have a pleural effusion and lung lesion. A thoracentesis reveals malignant cells. Further scans show a lung mass but no metastases. He undergoes lobectomy and is admitted with a chest tube. Chest tubes drain fluid and air and allow lung reexpansion. The tube will be removed once drainage stops and the lung is fully expanded, using lidocaine, having the patient hold their breath, and applying a dressing to prevent pneumothorax.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    123 views3 pages

    Chapter 27: Lower Respiratory Problems Pleural Effusion With Thoracentesis and Chest Tube

    Uploaded by

    Sherree Hayes
    C.L. presents with difficulty breathing and is found to have a pleural effusion and lung lesion. A thoracentesis reveals malignant cells. Further scans show a lung mass but no metastases. He undergoes lobectomy and is admitted with a chest tube. Chest tubes drain fluid and air and allow lung reexpansion. The tube will be removed once drainage stops and the lung is fully expanded, using lidocaine, having the patient hold their breath, and applying a dressing to prevent pneumothorax.

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    © All Rights Reserved
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    of 3

    Chapter 27: Lower Respiratory Problems

    Pleural Effusion with Thoracentesis and Chest Tube

    Patient Profile
    C.L. is a 55-year-old man who presents to his healthcare provider with difficulty breathing,
    which has progressively worsened over the past couple of weeks. He has a history of
    hypertension. He is currently taking furosemide and lisinopril.

    Subjective Data
    • Has had some shortness of breath for the past couple of weeks. At first, it was just with
    activity, but it has gotten worse and is present at rest.
    • Started smoking at age 18 years and has smoked one pack per day for the past 37 years
    • Adds he has cut down on his smoking the past week and is only smoking one-half pack
    of cigarettes per day

    Objective Data
    • Physical Examination
    • Blood pressure 140/88, pulse 90, temperature98.7°F, respirations 22
    • O₂ saturation 90% on room air
    • Respirations labored, frequent productive cough with yellow sputum
    • Breath sounds reveal distant breath sounds in right lower lobe, clear in all other lobes
    • Dullness to percussion of right lower lung lobe

    Diagnostic Studies
    • Chest radiography reveals a 2.5-cm lesion and pleural effusion in the right lower lung

    Question 1
    What is a pleural effusion? What type of effusion do you suspect C.L. has and why?

    ANS: A pleural effusion is an abnormal collection of fluid in the pleural space, which is the
    space between the parietal and visceral layers of the membrane that surrounds the lungs.
    Normally, only 5 to 15 mL of fluid is in the pleural space. C.L. likely has an exudative effusion
    that is related to the presence of the 2.5-cm lesion in the right lower lung.

    RATIONALE:A pleural effusion is an abnormal collection of fluid in the pleural space, which
    is the space between the parietal and visceral layers of the membrane that surrounds the lungs.
    The fluid hinders the lungs from working properly. Causes vary, however a few pathophysiology
    examples from this chapter that may cause a pleural effusion include pneumonia, tuberculosis,
    cancer, and infections.

    Question 2
    The health care provider performs a thoracentesis to alleviate C.L.’s dyspnea and to have the
    fluid analyzed for diagnostic purposes. What is the procedure for a thoracentesis? What tests and
    monitoring are done after the procedure?
    ANS: A thoracentesis involves insertion of a needle into the intercostal space. The placement of
    the needle is confirmed by radiography and percussion of dullness at the location. Fluid is then
    aspirated with a needle or allowed to drain into a sterile container. After removing the fluid
    (usually not more than 1200 mL of pleural fluid is removed at one time to avoid hypotension,
    hypoxemia, or pulmonary edema), the needle is removed, and a bandage is applied. The patient
    is then sent for radiography to detect a possible pneumothorax. The patient’s vital signs,
    including pulse oximetry and respiratory status, should be monitored during and after the
    procedure. Respiratory distress and diminished or absent breath sounds on the side of the
    thoracentesis could indicate a pneumothorax.

    RATIONALE: Removing the excess fluid allows the lungs to expand appropriately and relieves
    such symptoms as dyspnea and cough. Chest pain may be lessened after drainage. The biggest
    complication from performing a thoracentesis is accidentally inserting the needle into the lung
    and collapsing the lung, causing a pneumothorax.

    Question 3
    Case Study Progress
    The results of the thoracentesis revealed malignant cells in the pleural fluid. C.L. then has
    computed tomography (CT) scans of the chest, brain, and bone to evaluate the exact location and
    size of the lung mass and check for any mediastinal or lymph node involvement and metastatic
    disease. The results of the CT scan show only the 2.5-cm lesion in the lower lobe of the right
    lung with no evidence of mediastinal or lymph node involvement and metastasis. C.L. undergoes
    a thoracotomy with a right lower lobectomy. After this surgery, he is admitted to the surgical
    step-down unit with a chest tube.
    What is the purpose of the chest tube?

    ANS: Chest tubes are inserted into the pleural space postoperatively to drain air and fluid and to
    allow the lung to re-expand.

    RATIONALE: A thoracotomy and lobectomy impair the lungs ability to inflate and deflate
    appropriately. The chest tube helps to reinflate the lung and drains excess fluid until the body can
    heal the lung.

    Question 4
    Describe how you will maintain C. L.’s chest tube drainage system.

    ANS: Some important guidelines for maintaining a chest tube drainage system are to
    Keep the drainage system upright and below the chest level to maintain a water seal and to
    prevent drainage from spilling over into the different collection chambers (makes it difficult to
    measure the amount of drainage)

    Tighten, tape, or band all the connections between the chest tube and drainage collection system
    Keep all tubing loosely coiled below the chest level to promote drainage
    Observe for fluctuations (tidaling) and bubbling in the water-seal chamber. If no tidaling is
    observed, the drainage system is blocked, the system is attached to suction, or the lung is
    reexpanded. If bubbling increases, there may be an air leak in either the drainage system or a
    leak from the patient.

    RATIONALE: Safety issues when caring for a patient who has a chest tube include ensuring the
    chest tube is working efficiently, is draining appropriately, and monitors for possible
    complications such as dislodging the chest tube from the patient’s insertion site. Safety
    precautions are imperative so that the patient does not have any negative outcomes.

    Question 5
    What would you do if the chest tube drainage system breaks?

    ANS: If the drainage system breaks, place the distal end of the chest tubing connection in a
    sterile water container at a 2-cm level as an emergency water seal until a new chest drainage
    system can be set up.

    RATIONALE: The pleural space. This is accomplished by maintaining a seal using sterile water
    thus helping prevent infection. The nurse should support the patient should they experience
    worsening symptoms such as hypoxemia, tachypnea, and possible cardiac and respiratory failure
    (tension pneumothorax) during the chest tube equipment failure.

    Question 6
    When will the chest tube be removed? Describe the procedure for chest tube removal.

    ANS: Chest tubes are removed when the lung has reexpanded and there is no further drainage.
    The suction on the chest tube is usually discontinued, and the chest tube is on gravity drainage
    for at least 24 hours to see how the patient tolerates it before the tube is removed. Removing the
    chest tube is performed by a physician or advanced-practice nurse. Because there is some pain
    with the removal of the chest tube, the patient should be given some pain medication at least 15
    minutes before removal. Removal of the chest tube involves cutting the suture that is holding the
    chest tube in place and having the patient hold their breath or perform the Valsalva maneuver
    while the chest tube is removed. After the tube has been removed, the insertion site should be
    immediately covered with a sterile airtight petroleum jelly gauze dressing to prevent air from
    entering the pleural space. When the dressing is in place, the patient can be instructed to breathe
    again. Chest radiography then performed to evaluate for a pneumothorax or reaccumulation of
    fluid. Assess the patient for respiratory distress and monitor the dressing for drainage. Reinforce
    the dressing if necessary but do not remove it.

    RATIONALE: The patient is weaned off the suction connected to the chest tube to better gauge
    how the patient will tolerate the discontinuation of the chest tube. The Valsalva maneuver is
    done during removal so that air is not accidentally reintroduced into the pleural space. The
    patient should continue to be monitored to assess whether the discontinuation of the chest tube is
    tolerated.

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