Untitled Deck

Question 1

What are indications for a chest tube?

Answer 1

• Pneumothorax
• Hemothorax
• Pleural effusion
• Empyema
• Post-thoracic surgery
• Trauma

These conditions require drainage of air or fluid from the pleural space.

Question 2

Continuous, vigorous bubbling in the water seal chamber — what does this mean?

Answer 2

➡️ Air leak in the system (NOT normal)

Continuous bubbling indicates a breach in the system that needs to be addressed.

Question 3

Nursing actions for continuous bubbling in water seal chamber?

Answer 3

• Briefly clamp near insertion site to identify leak source
• Check connections
• Tighten loose tubing
• Notify provider if leak persists

These actions help to locate and resolve the source of the leak.

Question 4

Emergency equipment at bedside for chest tube patient?

Answer 4

• Sterile water
• Occlusive dressing (petroleum gauze)
• Two padded clamps
• Sterile gloves

Having these supplies ready can help manage emergencies effectively.

Question 5

Why is milking/stripping chest tubes contraindicated?

Answer 5

➡️ Creates excessive negative pressure
➡️ Can cause tissue trauma & lung damage

These actions can lead to complications and should be avoided.

Question 6

If chest tube disconnects from drainage system, what is the priority action?

Answer 6

➡️ Place end of tube in sterile water to re-establish water seal

This action prevents air from re-entering the pleural space.

Question 7

Signs lung has re-expanded after pneumothorax?

Answer 7

• Improved breath sounds
• Symmetrical chest rise
• Decreased dyspnea
• Improved O₂ sat
• No bubbling in water seal

These indicators suggest successful lung re-expansion.

Question 8

Chest tube comes out — priority action?

Answer 8

➡️ Apply sterile occlusive dressing taped on 3 sides

This helps to prevent air from entering the pleural space.

Question 9

Difference between water seal and suction?

Answer 9

• Water seal: Passive drainage, gravity only
• Suction: Active negative pressure to help lung re-expand

Understanding the difference is crucial for proper management.

Question 10

Describe the chambers of a chest drainage system.

Answer 10

• Drainage collection: collects fluid
• Water seal: prevents air from re-entering pleural space (one-way valve)
• Suction control: regulates amount of negative pressure

Each chamber has a specific function in managing pleural drainage.

Question 11

Emergency supplies at bedside for trach patient?

Answer 11

• Obturator
• Spare trach (same size & one smaller)
• Suction equipment
• Oxygen setup
• Ambu bag

These supplies are essential for managing potential emergencies.

Question 12

Signs of infection or breakdown at stoma?

Answer 12

• Redness
• Swelling
• Warmth
• Purulent drainage
• Foul odor
• Skin erosion

Monitoring for these signs is crucial for early intervention.

Question 13

Why two providers for tie change?

Answer 13

➡️ Prevent accidental decannulation
➡️ One stabilizes trach, one changes ties

This practice enhances patient safety during the procedure.

Question 14

Priority assessment before suctioning?

Answer 14

➡️ Oxygen saturation & respiratory status

Assessing these parameters ensures patient safety during the procedure.

Question 15

Signs patient needs suctioning?

Answer 15

• Gurgling sounds
• Visible secretions
• Rhonchi
• Decreased O₂ sat
• Increased RR
• Restlessness

Recognizing these signs helps in timely intervention.

Question 16

Purpose of hyperoxygenation before suctioning?

Answer 16

➡️ Prevent hypoxia during procedure

This practice ensures adequate oxygenation while suctioning.

Question 17

Technique during catheter withdrawal?

Answer 17

➡️ Apply suction while rotating catheter
➡️ Use intermittent suction

This technique maximizes effectiveness while minimizing trauma.

Question 18

Max duration of one suction pass?

Answer 18

➡️ 10–15 seconds

Limiting suction time helps prevent hypoxia.

Question 19

How long to wait between passes?

Answer 19

➡️ 1–2 minutes

This allows for recovery of the patient between suction attempts.

Question 20

Why clear catheter between passes?

Answer 20

➡️ Prevent obstruction
➡️ Maintain effectiveness

This practice ensures the catheter remains functional.

Question 21

Should oral care be provided after suctioning?

Answer 21

➡️ YES — reduces infection risk

Oral care is an important part of post-suctioning care.

Question 22

If patient gags or vomits during suction?

Answer 22

➡️ Stop suctioning immediately

This is crucial to prevent aspiration and further complications.

Question 23

Signs suctioning was effective?

Answer 23

• Clear breath sounds
• Improved O₂ sat
• Easier breathing
• Decreased RR

These signs indicate successful removal of secretions.

Question 24

Define drainage types.

Answer 24

• Serous: clear/light yellow
• Serosanguinous: pink/light red
• Sanguinous: bright red
• Purulent: thick yellow/green

Understanding drainage types is important for assessing wound healing.

Question 25

Purpose of a **drain**?

Answer 25

* Remove fluid/air * Prevent infection * Promote healing ## Footnote Drains are essential in managing post-operative wounds.

Question 26

Suction drain vs **gravity drain** difference?

Answer 26

* Suction drain: negative pressure (JP) * Gravity drain: drains by positioning only ## Footnote Knowing the difference helps in selecting the appropriate drain type.

Question 27

How do you establish **suction** in a JP drain?

Answer 27

➡️ Compress bulb fully ➡️ Close cap while compressed ## Footnote This action creates the necessary suction for drainage.

Question 28

What is **SAS technique**?

Answer 28

Saline → Administer med → Saline ## Footnote Final flush must be at same rate as medication.

Question 29

Primary vs **secondary bag height**?

Answer 29

➡️ Secondary (IVPB) must hang higher than primary ## Footnote This ensures proper flow of medication.

Question 30

What is **backpriming**?

Answer 30

Using primary fluid to fill secondary tubing ➡️ Prevents med waste ➡️ Maintains sterility ## Footnote Backpriming is a technique to optimize medication delivery.

Question 31

If IVPB incompatible with primary fluid?

Answer 31

* Stop primary * Flush line * Administer med * Flush again * Restart compatible fluid ## Footnote This sequence ensures safe administration of medications.

Question 32

Phlebitis vs **Infiltration signs & priority action**?

Answer 32

* Phlebitis: red, warm, streaking → remove IV * Infiltration: cool, swollen, pale → stop IV & elevate ## Footnote Recognizing these signs is crucial for timely intervention.

Question 33

What access does **TPN** require?

Answer 33

➡️ Central line ## Footnote TPN is not piggybacked and is not maintenance fluid.

Question 34

How often change **TPN tubing/bag**?

Answer 34

➡️ Every 24 hours ## Footnote Regular changes are necessary to prevent infection.

Question 35

**TPN complications**?

Answer 35

* Hyperglycemia: ↑ glucose, thirst, polyuria * Infection: fever, redness, chills * Fluid overload: edema, crackles, weight gain ## Footnote Monitoring for these complications is essential for patient safety.

Question 36

Labs to monitor with **TPN**?

Answer 36

* Blood glucose * Electrolytes * BUN/Creatinine * Liver enzymes * Albumin ## Footnote Regular monitoring helps in managing TPN therapy effectively.

Question 37

How often assess **weight on TPN**?

Answer 37

➡️ Daily ## Footnote Daily assessment helps in monitoring fluid status and nutritional needs.

Question 38

Why document **I&O with TPN**?

Answer 38

➡️ Prevent fluid overload ➡️ Monitor metabolic status ## Footnote Accurate documentation is crucial for patient management.

Question 39

How does **TPN rate change**?

Answer 39

* Start slow * Increase gradually * Taper before discontinuing (prevent hypoglycemia) ## Footnote Proper rate adjustment is important to avoid complications.

Question 40

How often **central line dressing change**?

Answer 40

➡️ Every 7 days (or if soiled/loose) ## Footnote Regular dressing changes help prevent infection.

Question 41

When **flush lumens**?

Answer 41

* Before & after meds * After blood draws * Per facility protocol ## Footnote Flushing is essential for maintaining patency of the line.

Question 42

Purpose of **biopatch**?

Answer 42

➡️ Prevent infection Blue side faces up ## Footnote Biopatches are used to enhance the sterility of central lines.

Question 43

What is **CLABSI** & prevention?

Answer 43

Central Line Associated Bloodstream Infection Prevent by: * Hand hygiene * Sterile technique * Daily necessity review * Proper dressing care ## Footnote These measures are crucial for preventing infections.

Question 44

Causes of **central line occlusion**?

Answer 44

* Clot * Precipitated meds * Kinked tubing * Lipid buildup ## Footnote Identifying these causes helps in troubleshooting occlusions.

Question 45

Indications for **central line**?

Answer 45

* TPN * Vesicants * Long-term IV therapy * Hemodynamic monitoring ## Footnote Central lines are used for various critical therapies.

Question 46

If **PICC suspected dislodged**?

Answer 46

➡️ Stop infusion ➡️ Secure line ➡️ Notify provider ➡️ Do NOT advance back in ## Footnote These steps are crucial for patient safety.

Question 47

Where is a **PICC inserted** & how confirmed?

Answer 47

Inserted in basilic/cephalic vein (upper arm) Placement confirmed by X-ray ## Footnote Proper placement confirmation is essential for effective therapy.