Question

The health care provider inserts a chest tube in a patient with a pneumothorax. When monitoring the patient after the chest tube placement, the nurse will be most concerned about?

A) 400 mL of blood in the collection chamber within one hour of inserting the chest tube.
B) Continues, moderate bubbling in the water-seal chamber.
C) Complaint of mild chest pain around the insertion site with each deep inspiration.
D) Small, local subcutaneous emphysema at the insertion site.

Answer 1

Monitoring for small, local subcutaneous emphysema is not usually a serious concern after chest tube placement. However, extensive or spreading subcutaneous emphysema could indicate persistent air leakage or misplacement of the chest tube, necessitating close monitoring and possibly urgent medical intervention.

Step-by-step explanation:

When monitoring a patient after chest tube placement for a pneumothorax, the most concerning sign would be complications that might indicate a worsening condition or an ineffective procedure. Although a small, local subcutaneous emphysema at the insertion site might initially seem alarming, it is usually not a serious concern; it can occur when air leaks into the tissue under the skin.

However, medical staff should monitor the patient closely for signs of larger amounts or spreading of subcutaneous emphysema, which could be indicative of a more serious issue such as persistent air leakage or a misplacement of the chest tube.

Pneumothorax is a condition where air enters the chest cavity, causing a lung to collapse due to negative gauge pressure which normally holds the lungs open. Chest tubes help reestablish this negative pressure and remove air from the pleural space. If subcutaneous emphysema becomes extensive, this suggests that air is not being evacuated effectively, potentially compromising respiratory function and requiring urgent medical attention.