Question

A client is 3 hours postoperative following a right upper lobectomy. The collection chamber of the closed pleural drainage system contains 400 ml of bloody drainage. The client's vital signs are blood pressure 100/50 mmHg, heart rate of 100 beats per minute, and respiratory rate 26 breaths per minute. There is intermittent bubbling in the water seal chamber. One hour following the initial assessment, the nurse notes that the bubbling in the water seal chamber is now constant and the client appears dyspneic. The nurse should first check __________.

1) lung sounds
2) vital signs
3) the chest tube connections
4) the amount of drainage

Answer 1

The nurse should first check the chest tube connections as constant bubbling in the water seal chamber and dyspnea suggest an air leak which could be a serious complication post lobectomy.

Step-by-step explanation:

The nurse should first check the chest tube connections if the patient is 3 hours postoperative following a right upper lobectomy, with increased bloody drainage in the closed pleural drainage system, and experiencing a constant bubbling in the water seal chamber along with dyspnea. Sudden changes in the bubbling pattern from intermittent to constant may indicate the presence of an air leak in the pleural space, which could mean disconnection or a new pneumothorax. Ensuring the integrity of the chest tube system is crucial to prevent further complications, such as lung collapse due to loss of negative pressure within the chest cavity necessary for proper lung inflation.