The client's pneumothorax persists after 4 days with a chest tube to water-seal drainage (WSD). Which does the nurse implement to facilitate resolution of the pneumothorax and prevent com-plications? (Select all that apply.)

Question

1. Removes the tubing and replaces it
2. Opens the system to remove exhaled air
3. Clamps the tubing at different intervals
4. Applies sterile gauze dressing with tape
5. Assesses client for subcutaneous emphysema
6. Checks for persistent bubbling in water chamber

Answer 1

3, 5, 6
3. To ensure that the recalcitrant pneumothorax is not occurring outside the client, the nurse assesses the client and the WSD system for air leaks. The nurse checks the connections to ensure tight seals and tapes them securely; then the nurse checks the integrity of the tubing by clamping it at different locations from the client and checks for bubbling in the water chamber simultaneously. If bubbling occurs after moving the clamps, the nurse reasons that the tubing is leaking in the region; then the nurse replaces the tubing.
5. The nurse palpates around the chest tube insertion site and the entire affected lung for crepitus, or subcutaneous emphysema, a subcutaneous collection of air.
6. The nurse observes for continual bubbling in the water chamber of the WSD sys-tem, which indicates an air leak; however, this intervention does not discriminate between a leak in the client's thorax and in the WSD system. It does warrant further investigation.
1. The nurse assesses the tubing first; if the nurse finds a break in the tubing, the nurse can replace the tubing.
2. The WSD system has an integral vent to release expired air.
4. The nurse applies a sterile petrolatum gauze dressing around the base of the chest tube to create an air-tight seal and covers the petrolatum gauze with a heavy gauze and tape dressing to prevent air leaks.