During hourly rounding assessment of the patient with a chest tube for treatment of a pneumothorax, the nurse notes the patient’s chest and neck are markedly more edematous than on previous assessment. Upon palpation, crepitus is noted. Which action does the nurse take first?

Assess chest tube for kinks and disconnections. Swelling of the chest and neck with crepitus in the patient with a chest tube for a pneumothorax indicate the patient is not receiving adequate decompression. Therefore, the nurse first ensures the patency of the chest tube and drainage system. The nurse then notifies the provider of the change in patient status. The patient may need increased suction to the chest tube drainage system or insertion of a new or additional chest tube, but these are not the initial actions.

During hourly rounding assessment of the patient with a chest tub...

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Physiological Adaptation
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Category: Physiological Adaptation
Difficulty: 4

Topics: Delegation, Prioritization and Leadership Respiratory

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