A nurse is caring for a patient with a chest tube and drainage system. The patient reports continuous bubbling in the water-seal chamber. Which of the following statements should the nurse make?

Choice A rationale:

Keeping the drainage system above the chest level is incorrect because the drainage system should be placed below the chest level to facilitate proper drainage of fluids and air.

Choice B rationale:

Clamping the tubing for an extended period to prevent leaks is incorrect. Chest tubes should never be clamped for an extended period as it can lead to a dangerous buildup of pressure within the pleural space and impair proper drainage.

Choice C rationale:

Ensuring adequate and stable water levels in the water-seal and suction-control chambers is correct. Maintaining appropriate water levels is essential for maintaining the proper functioning of the chest tube system, ensuring that it can effectively remove air and fluid from the pleural space.

Choice D rationale:

Milking or stripping the tubing regularly to enhance drainage is incorrect. This practice is outdated and can cause damage to the chest tube, leading to potential complications. The tubing should not be manipulated in this manner.

Choice E rationale:

Keeping the tubing free of kinks, loops, or dependent areas is correct. Any kinks, loops, or dependent areas can obstruct the flow of fluids and air within the chest tube system, impairing its functionality.

Choice A rationale:

The nurse should suspect tension pneumothorax in the patient with a chest tube who shows sudden decreased drainage, pink frothy sputum, and crackles on auscultation. Tension pneumothorax is a life-threatening condition where air accumulates in the pleural space, leading to increased pressure on the affected lung and heart. Immediate intervention, such as chest tube insertion on the affected side, is crucial to relieve the pressure and improve ventilation.

Choice B rationale:

Subcutaneous emphysema does not present with decreased drainage or pink frothy sputum. It is characterized by air trapped under the skin, causing a crackling sensation on palpation. Monitoring respiratory status and elevating the head of the bed are appropriate interventions for subcutaneous emphysema but not in this scenario.

Choice C rationale:

Re-expansion pulmonary edema is a rare complication that occurs after rapid lung re-expansion. It does not typically manifest with pink frothy sputum and crackles. Administering diuretics may be appropriate, but it is not the primary intervention in this situation.

Choice D rationale:

Infection does not explain the sudden decrease in drainage and pink frothy sputum. Although obtaining cultures from the chest tube site is important to assess for infection, it is not the most appropriate intervention at this moment. The priority is to address the potential tension pneumothorax.