Lecture Notes on Pleural Disorders and Chest Tubes

Introduction

• Presenter: Cathy from Level Up RN
• Topics Covered:
  • Pleural disorders
  • Chest tubes
  • Tension pneumothorax
  • Quiz included

Anatomy Review

• Pleura: Surrounds and protects each lung
• Pleural Cavity: Space between two pleural layers
• Normal Conditions: No air, blood, or fluid should accumulate

Pleural Disorders

• Pneumothorax: Air in pleural cavity
• Hemothorax: Blood in pleural cavity
• Pleural Effusion: Fluid in pleural cavity

Signs and Symptoms

• Respiratory distress
• Reduced or absent breath sounds on affected side
• Percussion:
  • Hyperresonance indicates pneumothorax
  • Dullness indicates hemothorax or pleural effusion

Diagnosis and Treatment

• Diagnosis: Chest X-ray
• Treatment: Chest tube insertion
  • Medications: Benzodiazepines (for anxiety), Opioid analgesics (for pain)

Chest Tubes

• Purpose: Drain blood, air, or fluid from pleural space

Components

1. Drainage Collection Chamber
   • Chart amount and color of drainage
   • Report excess (>100 ml/hr) to provider
2. Water Seal Chamber
   • Keep sterile fluid at 2-cm line
   • Tidaling expected; absence may indicate lung re-expansion or system obstruction
   • Continuous bubbling indicates air leak
3. Suction Control Chamber
   • Continuous bubbling expected

Nursing Care

• Confirm chest tube position with X-ray
• Occlusive dressing on insertion site
• Monitor for subcutaneous emphysema (feels like Rice Krispies)
• Clamp chest tube only if ordered
• Encourage deep breathing, coughing, incentive spirometer use
• Keep padded clamps, sterile water, and gauze at bedside
• Place tube in sterile water if disconnected
• Cover site with sterile gauze if tube is removed
• Monitor for tension pneumothorax

Tension Pneumothorax

• Air trapped in pleural cavity causing lung collapse
• Risk Factors: Occlusion of chest tube, mechanical ventilation, fractured ribs

Signs and Symptoms

• Tracheal deviation toward unaffected side
• Absent breath sounds on affected side
• Asymmetrical thorax
• Respiratory distress, tachycardia, tachypnea
• Neck vein distention, pallor, anxiety

Diagnosis and Treatment

• Diagnosis: Chest X-ray, ABGs
• Treatment:
  • Immediate large bore needle insertion
  • Chest tube placement

Quiz

1. Percussion Sound for Pneumothorax: Hyperresonance
2. Continuous Bubbling Chamber: Suction control chamber
3. Tracheal Deviation Disorder: Tension pneumothorax

Conclusion

• Review flashcards for bold red items
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