Nurse Rita is assisting in the removal of a chest tube. Which of the following instructions should she give to the patient?

Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)

Explanation

During chest tube removal, the patient should be instructed to take a deep breath and hold it (the Valsalva maneuver).
This action increases intrathoracic pressure, creating a positive pressure environment within the chest.
This positive pressure prevents atmospheric air from being sucked into the pleural space as the tube is withdrawn, which would cause a pneumothorax (collapsed lung).
Holding the breath provides a stable, high-pressure state at the exact moment of removal, ensuring the lung remains expanded.

Option A: Coughing generates a sharp, uncontrolled increase in intrathoracic pressure. This can be painful and may cause unpredictable pressure fluctuations, risking tissue injury or ineffective sealing of the tract upon removal.
Option B: Deeply exhaling lowers intrathoracic pressure, creating a negative pressure gradient relative to the atmosphere. This would actively pull air from the room into the pleural space through the chest tube site, causing a pneumothorax.
Option D: While taking a deep breath is the first step of the Valsalva maneuver, simply inhaling without holding the breath is insufficient. The act of inhalation itself involves negative intrathoracic pressure. The critical part is holding the breath to build positive pressure.

Clinical Relevance

Nursing practice connection: Use the key finding related to Procedural patient education and safety to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role during chest tube removal is to ensure patient safety by preventing complications, the most critical of which is an iatrogenic pneumothorax.
Clear, simple instructions are vital. The nurse must coach the patient to perform the Valsalva maneuver correctly at the precise moment the provider is pulling the tube.
Post-procedure assessment is crucial. The nurse must immediately assess for signs of respiratory distress (e.g., shortness of breath, decreased oxygen saturation, diminished breath sounds on the affected side) which could indicate a pneumothorax.

How to Approach the Question

First, identify the core procedure: chest tube removal.
Recall the primary risk associated with this procedure: air entering the pleural space and causing a pneumothorax.
Think about the physiology: To prevent air from entering the chest, the pressure inside the chest must be higher than the pressure outside. Normal breathing involves negative pressure on inhalation.
Evaluate the options based on their effect on intrathoracic pressure. Coughing is uncontrolled. Exhaling creates negative pressure. Inhaling is only the first step.
Conclude that holding the breath after a deep inhalation (Valsalva maneuver) is the only option that reliably and safely increases intrathoracic pressure to prevent air entry.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 2-4

Practise the full UP NHM CHO 7 Sept 2022(shift-1st)

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