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2 Minute EBP Challenge

Monday, March 08, 2010
Restoring Hemoglobin
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels.  This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL.  A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.

Sunday, February 28, 2010
Renal Dysfunction
Mrs. Mersa is admitted with sepsis and hypotension.  Her labs indicate:
BUN 58 mg/dl
Serum creatinine 2.1 mg/dl
Urine sodium 70 mEq/L
Urine specific gravity 1.010, with cellular casts and RBCs in the urine.
Based on these findings you would consider:

Friday, February 12, 2010
Which action first?
Which information about a patient who has just been admitted to the hospital with nausea and vomiting will require the most rapid intervention by the nurse?

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Chest Drainage

Monday, October 19, 2009

Stay up-to-date the easy way!

How would you answer this question?

Which of the following is a component of a properly functioning chest drainage system?

a. Bubbling in the water seal
b. Tidaling in the collection chamber
c. Bubbling in the suction chamber
d. Tidaling in the suction chamber

The correct answer is "c" bubbling in the suction chamber.

A chest drainage system, such as a pleurovac, is attached to a chest tube to drain fluid, blood and air from the pleural space.The chest drainage system is composed of three chambers: 1) the suction control, 2) the water seal, and 3) the collection chamber.  Many modern systems use a "dry" suction control with a dial to adjust suction instead of a water-filled chamber.

The suction chamber on a "wet" system is filled with fluid and the column of water is what controls the amount of suction that goes to the chest tube.  The water in the suction control chamber bubbles if the wall suction is adequate.  This is normal and expected.

The second chamber (water seal) acts as a one-way valve to allow air to flow out of the chest tube, but not back into the pleural space.  The water seal moves (tidals) with the patient's respiration, but bubbling in this chamber is not normal and indicates an air leak.  The chest tube, the insertion site and the collection device should all be checked to find the source of the leak.  If the leak cannot be found, the patient may have air leaking out of the lung and into the pleural space.  The physician should be notified.

The third chamber is the collection chamber that contains fluid that is removed from the patient.  This chamber will neither bubble or tidal.  Look for consistency in the drainage that is collected in the collection chamber.  Changes in color, consistency, or volume should be reported to the physician.

Learn more about chest drainage with our You Tube video .

Congratulations to Mary Ellen Genardi who won an autographed copy of my101 Tips to Improve Your Nursing Care book for answering this week's question correctly.  Congratulations Mary Ellen!   


Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President,
Ed4Nurses, Inc.

PS. This week's question came from our Med-Surg Certification Review  program.

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