The nurse is reviewing medication orders for a patient with pulmonary hypertension.
Which medication order would the nurse querry

Choice A rationale

Pursed-lip breathing is a technique used to slow down the breathing rate and facilitate a more complete exhalation, primarily beneficial for patients with obstructive lung diseases like COPD. It does not provide the positive intrathoracic pressure necessary to prevent air from entering the pleural space during a chest tube removal.

Choice B rationale

Lying flat and breathing deeply does not create the necessary positive pressure within the pleural cavity. This action would not prevent air from being sucked into the chest cavity, leading to a potential pneumothorax. The patient needs to increase intrathoracic pressure to seal the site.

Choice C rationale

The Valsalva maneuver, which involves taking a deep breath, holding it, and bearing down, increases intrathoracic pressure. This positive pressure helps to prevent air from rushing back into the pleural space when the chest tube is removed, thus minimizing the risk of a tension pneumothorax.

Choice D rationale

Rapid breathing, or hyperventilation, would decrease intrathoracic pressure and could potentially cause more air to be drawn into the pleural space upon removal of the chest tube. This action could lead to a tension pneumothorax. *.

Choice A rationale

This is an expected finding. Following a thoracotomy, a certain amount of drainage is anticipated from the chest tube as a result of inflammation and bleeding from the surgical site. A drainage volume of 50 mL is considered normal in the immediate postoperative period and should be monitored closely. However, if the drainage exceeds 100 mL/hour, it could indicate hemorrhage and requires immediate notification of the healthcare provider.

Choice B rationale

This is a correct principle of chest tube management. The drainage system must be kept below the level of the patient's chest to prevent fluid from flowing back into the pleural cavity. The principle of gravity ensures that air and fluid from the pleural space continue to drain into the collection chamber, which is essential for re-expanding the lung and maintaining negative intrapleural pressure.

Choice C rationale

This is an essential component of chest tube care. An occlusive dressing is applied over the chest tube insertion site to prevent air from entering the pleural space from the outside. This dressing ensures that the closed drainage system remains airtight and prevents a pneumothorax, which could cause the lung to collapse again. The dressing must be kept intact and taped on all sides.

Choice D rationale

Excessive bubbling in the water seal chamber is an unexpected finding. The water seal chamber should normally have gentle tidaling (fluctuations) with respirations, indicating changes in intrapleural pressure. Constant, vigorous bubbling suggests a significant air leak, which could be from the insertion site, tubing, or within the chest, indicating a persistent pneumothorax or a problem with the system. It needs to be investigated.

Choice E rationale

Vigorous bubbling in the suction control chamber is an incorrect finding. The suction control chamber should have gentle, continuous bubbling to indicate that the appropriate level of suction is being applied. Vigorous or turbulent bubbling is inefficient, causes the water to evaporate quickly, and does not increase the amount of suction applied to the chest. It simply indicates excessive airflow