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Difficulty: MediumReduction of Risk Potential

A 62-year-old client has a chest tube connected to a closed water-seal drainage system for the treatment of a right-sided spontaneous pneumothorax. Which assessment findings indicate a developing physiological complication or system malfunction that requires immediate intervention? Select all that apply.

  1. Tracheal deviation toward the left side of the neckAnswer
  2. Continuous, vigorous bubbling in the water-seal chamberAnswer
  3. C
    The water level in the water-seal chamber rises during inspiration and falls during expiration
  4. Asymmetric chest expansion with absent breath sounds on the right sideAnswer
  5. E
    The client is resting in a semi-Fowler's position with the drainage collection system positioned upright on the floor
  6. F
    A collection of 15 mL of pale serous fluid in the drainage chamber over the last four hours

Answer

The findings that require immediate intervention are tracheal deviation toward the left side, continuous vigorous bubbling in the water-seal chamber, and asymmetric chest expansion with absent breath sounds on the right side.
The correct choices represent acute physiological deterioration (tension pneumothorax, worsening lung collapse) or a system failure (continuous air leak). Immediate intervention is required to restore respiratory hemodynamics and ensure the patency of the closed drainage system.

Step-by-Step Solution

1
Analyze the client's baseline condition
The client has a right-sided pneumothorax requiring closed-chest drainage to restore negative intrapleural pressure.
Establishing the baseline is necessary to differentiate expected therapeutic outcomes from pathological changes.
2
Evaluate respiratory and systemic assessment findings
Tracheal deviation to the left and absent breath sounds on the right are identified as signs of a tension pneumothorax.
These findings indicate dangerously high intrathoracic pressure compromising ventilation and venous return, requiring immediate life-saving intervention.
3
Assess the chest drainage system mechanics
Continuous bubbling in the water-seal chamber is identified as an abnormal finding.
While intermittent bubbling during exhalation is normal in a resolving pneumothorax, continuous bubbling indicates a persistent and pathological air leak in the system or pleural space.
4
Differentiate normal from abnormal findings
Tidaling, positioning the system below the chest, and minimal serous output are recognized as expected and correct.
Recognizing expected findings prevents unnecessary and potentially harmful interruptions to safe, standard care.

Key Concept

Chest Tube Complication Recognition and Risk Reduction
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Topics

Reduction of Risk Potential

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