While assisting the doctor with the removal of a chest tube, the nurse should instruct the patient to?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Medical & Surgical Nursing

Medium

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

The correct instruction is for the patient to perform the Valsalva maneuver, which involves taking a deep breath, holding it, and bearing down.
This action significantly increases the pressure inside the chest cavity (intrathoracic pressure).
This positive pressure prevents atmospheric air from being sucked into the pleural space as the tube is withdrawn.
Preventing air entry is critical to avoid a recurrent pneumothorax (collapsed lung), a serious complication.

Option A: Exhaling slowly does not create sufficient or sustained positive pressure. As the patient reaches the end of exhalation, intrathoracic pressure drops, which can allow air to enter the pleural space.
Option B: While staying still is a general safety measure to prevent injury during the procedure, it has no physiological effect on intrathoracic pressure and does not protect the patient from a pneumothorax.
Option D: This is the most dangerous option. Inhaling creates negative intrathoracic pressure, which would actively suck air into the chest cavity through the wound, almost certainly causing a pneumothorax.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient instructions during chest tube removal to guide bedside assessment, documentation, and the next nursing action.
Preventing a post-procedure pneumothorax is a critical nursing responsibility and a major patient safety goal during chest tube removal.
The nurse must be prepared with a sterile, occlusive dressing (e.g., petroleum gauze) to apply immediately over the site the moment the tube is withdrawn to create an airtight seal.
Following removal, the nurse's priority is to assess the patient's respiratory status, including breath sounds, oxygen saturation, work of breathing, and any patient complaints of chest pain or shortness of breath.

How to Approach the Question

First, identify the core clinical procedure: removal of a chest tube.
Next, recall the primary risk associated with this procedure, which is the entry of air into the pleural space, causing a pneumothorax.
Analyze the underlying physics: To prevent air from being sucked into the chest, the pressure inside the chest must be greater than the atmospheric pressure outside at the moment of removal.
Evaluate each option based on its effect on intrathoracic pressure. Inhalation creates negative pressure (pulls air in). The Valsalva maneuver creates strong positive pressure (pushes air out/seals from within).
Select the option that generates the necessary positive pressure to prevent this specific complication.

Concept Tested & Keywords

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