If a nurse is assisting a physician in removing a Chest Tube, what appropriate instructions will the nurse give to the patient?

Appeared in: Uttarakhand CHO - 2021

Explanation

The primary goal during chest tube removal is to prevent air from entering the pleural space, which could cause the lung to collapse (pneumothorax).
The Valsalva maneuver involves taking a deep breath and bearing down (forced exhalation against a closed glottis).
This action significantly increases the pressure within the chest (intrathoracic pressure).
When the intrathoracic pressure is higher than atmospheric pressure, it prevents air from being sucked into the chest cavity as the tube is withdrawn.

Option A: While remaining still and calm is helpful for the safe execution of the procedure, it is a general instruction and does not actively prevent the primary complication of air entry into the pleural space.
Option B: Breathing in (inspiration) creates negative pressure in the chest, which would actively suck air into the pleural space as the tube is removed, directly causing a pneumothorax. Quick breathing can cause unpredictable pressure changes.
Option C: Simply exhaling does increase intrathoracic pressure, but it may not be sufficient or sustained enough to prevent air entry, as the glottis may not be fully closed. The Valsalva maneuver is a more forceful and reliable method.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing care and patient instructions during chest tube removal to guide bedside assessment, documentation, and the next nursing action.
The primary nursing responsibility during chest tube removal is patient safety, which hinges on preventing a iatrogenic pneumothorax.
Immediately after the tube is removed, the nurse must apply a sterile, occlusive (airtight) dressing, typically petroleum gauze, to seal the site and prevent air leakage.
Post-procedure, the nurse must diligently monitor the patient's respiratory status, including breath sounds, oxygen saturation, and respiratory rate, and check the site for subcutaneous emphysema (air trapped under the skin), which would indicate an air leak.

How to Approach the Question

First, identify the core procedure: chest tube removal.
Recall the main risk associated with this procedure, which is the entry of air into the pleural space, causing a pneumothorax.
Analyze the physiological effect of each option on intrathoracic (chest) pressure.
Inspiration (breathing in) creates negative pressure, which would pull air in. This is dangerous. Eliminate options involving inhalation.
Expiration (breathing out) creates positive pressure, which pushes air out. This is protective.
Compare the remaining options. The Valsalva maneuver (bearing down while holding breath) creates the highest and most sustained positive intrathoracic pressure, making it the most effective method to prevent air entry.

Concept Tested & Keywords

Concept Tested: Nursing care and patient instructions during chest tube removal.
Stem keywords: nurse, assisting, physician, removing, Chest Tube, instructions, patient
Lead-in keywords: appropriate instructions

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E6 Nursing Fundamentals Potter Perry 12e Part 5 pp. 2-4, 36-38

Practise the full Uttarakhand CHO - 2021

Attempt every question from this paper in a timed mock, then review the full solution for each one.