The nurse is assessing a patient who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the patient's respirations
How should the nurse best respond to this assessment finding?
A) Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes.
B) Inform the physician promptly that there is in imminent leak in the drainage system.
C) Encourage the patient to do deep breathing and coughing exercises.
D) Document that the chest drainage system is operating as it is intended.
Ans: D
Feedback:
Fluctuation of the water level in the water seal shows effective connection between the pleural cavity and the drainage chamber and indicates that the drainage system remains patent. No further action is needed.
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