A nurse is caring for a client who has an open abdominal wound and a negative-pressure wound therapy (NPWT) device. Which of the following actions should the nurse take?

Rationale

A. Empty the drainage collection chamber when full: Maintaining an appropriate level of drainage ensures the system functions effectively and reduces the risk of infection or complications. The collection chamber must be replaced when the drainage volume reaches the maximum limit or when specified by policy, ensuring the system remains closed.

B. Ensure bubbling is present in the water-seal chamber: Continuous bubbling in the water-seal chamber is abnormal and may indicate an air leak. Intermittent bubbling with respirations is expected, but constant bubbling requires assessment and correction rather than being a desired finding.

C. Milk the chest tube at least three times per day: Milking or stripping the chest tube is generally discouraged because it can create high negative pressures, potentially injuring lung tissue. Modern recommendations advise gentle manipulation only if necessary and as per provider guidance.

D. Clamp the chest tube when transferring the client from bed to chair: Clamping the chest tube can cause a tension pneumothorax and is unsafe unless specifically ordered for a diagnostic procedure. The tube should remain patent during movement to allow continued drainage and prevent complications.

Rationale

A. "Your provider wants you to take this medication.": This response focuses on the provider’s wishes rather than the client’s concerns and may make the client feel dismissed. It does not support shared decision-making or encourage the client to express what is worrying them about treatment. Such a statement can create resistance instead of promoting understanding.

B. "Would you like to discuss other treatment options with your provider?": This response acknowledges the client’s autonomy and validates their concerns about monitoring. It opens the door to exploring alternatives, such as DOACs, which require less monitoring, while still keeping the provider involved.

C. "Why don't you want to undergo monitoring?": Asking “why” can feel accusatory or confrontational, which may make the client defensive. Although understanding the reason is important, this phrasing is not therapeutic and can shut down communication. A more open and neutral statement would be needed to explore the client's concerns effectively.

D. "Regular monitoring is not difficult and will ensure that you remain healthy.": This response minimizes the client’s feelings and assumes they will find the monitoring easy. It offers reassurance without addressing the client’s specific concerns or allowing them to express their viewpoint. It does not promote meaningful dialogue about their hesitation.