NSG 233 - Medical-Surgical Nursing III
Exam 3
Question:
Plan of care for vented trach patients:
Answer:
care every 8hr or more as needed trach cuff pressure 20-25mm Hg assist of 2 ppl w/ trach strap obdurator @ bedside all times (keeps hole open)
Question:
Chest tube intervention for accidental disconnection from drainage system:
Answer:
Air can enter pleural space, producing a pneumothorax
- prevent by immersion of chest tube in sterile water will temporarily
reestablish a water seal and prevent collapse or restore lung function
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Question:
Excessive bubbling in the water seal compartment of the chest tube:
Answer:
leak in drainage system
Question:
Normal water level in chest drainage system
Answer:
20cm level
Question:
Steps to chest tube insertion:
Answer:
- Insertion of chest tube = consent needed before action taken
- discuss the procedure with the patient
- provide pain medication, the procedure is not pleasant
- gather all supplies needed to assist with procedure
- assist the client into position-supine
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