The nurse prepares to administer 500 mL of normal saline to infuse at 175 mL/hr for a client who is vomiting. The IV tubing has a drop factor of 15 gtt/mL. How many gtt/min will the client receive? Round to a whole number.

Step 1: Convert weight from pounds to kilograms
Weight (kg) = 165 ÷ 2.2
Weight = 75 kg

Step 2: Calculate the ordered dose in mcg/min
Dose (mcg/min) = 4 mcg/kg/min × 75 kg
Dose = 300 mcg/min

Step 3: Convert mcg/min to mg/hr
300 mcg/min × 60 min/hr = 18,000 mcg/hr
18,000 mcg/hr ÷ 1,000 mcg/mg = 18 mg/hr

Step 4: Determine concentration of IV solution
400 mg in 250 mL
Concentration = 400 ÷ 250 = 1.6 mg/mL

Step 5: Calculate mL/hr
mL/hr = 18 mg/hr ÷ 1.6 mg/mL
mL/hr = 11.25 mL/hr

Step 6: Round to the nearest tenth
11.25 = 11.3 mL/hr

Final Answer: 11.3 mL/hr

Rationale:

A. Mild to moderate chest pain with deep inspiration is expected after chest tube insertion due to pleural irritation or tissue trauma. Pain should be managed with analgesics, but it does not require immediate provider notification unless accompanied by respiratory distress, hypotension, or other signs of complication.

B. Subcutaneous emphysema (air under the skin, often felt as crepitus) indicates air leaking from the pleural space into surrounding tissue. This may signal tube displacement, a worsening pneumothorax, or a new pleural leak, all of which require urgent provider notification. Severe cases can compromise the airway.

C. The water seal chamber should only bubble intermittently during exhalation or coughing. Continuous or constant bubbling indicates an air leak, suggesting tube malfunction or pleural space compromise. This can prevent proper lung re-expansion and requires prompt provider evaluation.

D. Chest tube eyelets should remain entirely within the pleural cavity. If they are visible, the tube is malpositioned, which can prevent drainage and worsen the pneumothorax or cause tissue damage. This is an urgent finding requiring immediate attention.

E. This is expected behavior for a properly functioning chest tube. Intermittent bubbling with exhalation or coughing shows that the tube is patent and air is being expelled from the pleural space. It does not require provider notification.