James Carter Chest Tube

University:
University of Alabama
Course:
NUR 326 | Pharmacology Nursing Practice
Academic year:

2024
Views:

0

Pages:

29
Author:

Tavany Rivera

Instructor Simulation Instructions Ensure students are in full uniform for the simulation experience Take attendance Ask each student for their Simulation ticket-if the student does not have a simulation ticket they can not participate in the simulation case (therefore they will not get credit for this lab). Review the objectives of the simulation case with the students Discuss what is expected of them for the simulation (see the questions/assessments that each student was supposed to look up (located in review following to your simulation experience on their simulation ticket located in box 2 and 3) Review the medication templates with them (have each one read one out) Have the students do the pre-test (collect the pre-test afterwards) Review the pre-test answers Discuss the scenario with the students and what is expected of them Give the students the verbal report template Split the group up into 2 groups Assign the roles to the group (i.e. Primary Rn, 2nd RN, medication nurse, physician, treatment nurse etc.). Once group one finishes they will give a report to group 2 using the verbal template. Once in the simulation room your role is to monitor their activity and ensure they are meeting the goals of the simulation and taking notes on what to talk about in the debrief. (Use the performance checklist) After the simulation case ends, take your students to the assigned room for debriefing. Use debriefing and reflection guide to do your debrief as well as bring up things you saw during the simulation Have the students do the post test (collect the post test afterwards) Have the students complete the Simulation objectives questionnaire (this goes to the lead instructor for the student file) Have the students complete the evaluation forms (this comes back to the simulation.lab manager) Session: #2 James Carter Scenarios: Chest Tube Insertion Name: Date: Instructor: Objectives: 1. Understand the Indications for Chest Tube Insertion: Nursing students will be able to identify the primary reasons for chest tube placement (e.g., pneumothorax, hemothorax, pleural effusion) and contraindications. 2. Assist in Preparing for Chest Tube Insertion:Nursing students will demonstrate how to prepare necessary supplies, assist in client positioning, and maintaining sterility during the procedure. 3. Monitor and Assess Clients with Chest Tubes: Students will learn how to monitor chest tube drainage, check for air leaks, and recognize early signs of complications like infection or dislodgement. 4. Manage Chest Tube Functionality and Drainage Systems: Students will demonstrate proficiency in managing the chest tube drainage system, ensuring patency, and troubleshooting common problems. 5. Recognize and Address Complications: Students will be able to identify and respond to potential complications related to chest tubes, such as tension pneumothorax, infection, or accidental tube removal. 6. Assist with Safe Removal of Chest Tubes: Nursing students will understand their role in supporting healthcare providers during chest tube removal, including client Please review the following PRIOR to your simulation experience: Review indications for Chest tube insertion Review Focused respiratory assessment Review setup of chest tube suctioning Review common complications of chest tube insertion Review Chest tube removal process Review care and maintenance of chest tube including troubleshooting for air leaks, dislodgement, and lung reexpansion Review the following medications and create medication templates: Hydromorphone, Fentanyl Citrate, Lidocaine hydrochloride, Lorazepam, Cefazolin Session: #2 James Carter Scenarios: Chest Tube Insertion Questions to Answer Prior to Simulation Session (Attach answers to this ticket for admission to simulation session. Without this ticket and completed questions you will not be allowed to participate in the scheduled scenarios) 1. What are the early signs and symptoms of inadequate oxygenation? 2. What are the side effects of Hydromorphone? 3. What are the antagonists to opioid medications? 4. Describe how to assess ABCs (airway, breathing, circulation) when the patient is not breathing effectively. 5. What are the priority nursing interventions for the management of a patient with a pneumothorax? Pre-Simulation Questions James Carter-Answer Key 1. What are the most common indications for chest tube insertion? A. Chronic lung disease B. Respiratory distress C. Mild cases of shortness of breath D. pneumothorax, hemothorax, pleural effusion, and empyema 2. Which equipment is essential to prepare for chest tube Insertion? A. Chest tube and a pair of sterile gloves B. Chest tube tray, sterile gloves, gown, local anesthetic, chest tube, drainage system, and sterile dressing materials C. Drainage system and sterile gauze D. Oxygen mask and an IV set 3. What is the nurse's role in assisting with chest tube insertion? A. Observing the procedure, taking notes B. Positioning the client after the tube is inserted C. Maintaining a sterile field, ensuring the necessary equipment is available, positioning the client, and providing client support D. The nurse does not need to worry about the chest tube insertion process 4. What are the signs of a malfunctioning chest tube? A. No drainage in the canister B. No pain at the insertion site C. Intermittent bubbling in the water chamber D. Continuous bubbling in the water seal chamber 5. What are the most common complications associated with chest tubes? A. Infection, dislodgement, bleeding, air leaks, and tension pneumothorax B. Spleen or Liver rupture C. Intercostal nerve Neuralgia D. A large amount of bright red drainage Pre-Simulation Questions James Carter-Answer Key 6. When should a chest tube be considered for removal? A. When the lung has re-expanded and drainage has decreased with no evidence of air leaks. B. After 24 hours C. Once the cilent no longer requires oxygen therapy D. When fluid drainage stops, regardless of lung re-expansion Pre-Simulation Questions James Carter 1. What are the most common indications for chest tube insertion? A. Chronic lung disease B. Respiratory distress C. Mild cases of shortness of breath D. pneumothorax, hemothorax, pleural effusion, and empyema 2. Which equipment is essential to prepare for chest tube insertion? A. Chest tube and a pair of sterile gloves B. Chest tube tray, sterile gloves, gown, local anesthetic, chest tube, drainage system, and sterile dressing materials C. Drainage system and sterile gauze D. Oxygen mask and an IV set 3. What is the nurse's role in assisting with chest tube insertion? A. Observing the procedure, taking notes B. Positioning the client after the tube is inserted C. Maintaining a sterile field, ensuring the necessary equipment is available, positioning the client, and providing client support D. The nurse does not need to worry about the chest tube insertion process 4. What are the signs of a malfunctioning chest tube? A. No drainage in the canister B. No pain at the insertion site C. Intermittent bubbling in the water chamber D. Continuous bubbling in the water seal chamber 5. What are the most common complications associated with chest tubes? A. Infection, dislodgement, bleeding, air leaks, and tension pneumothorax B. Spleen or Liver rupture C. Intercostal nerve Neuralgia D. A large amount of bright red drainage Pre-Simulation Questions James Carter 6. When should a chest tube be considered for removal? A. When the lung has re-expanded and drainage has decreased with no evidence of air leaks. B. After 24 hours C. Once the client no longer requires oxygen therapy D. When fluid drainage stops, regardless of lung re-expansion Provider Orders Carter, James MRN: 1000119496 DOB 08/25/1979 Physician: M. Horvath MD Order Signature Acti on Day/Time Provider Orders Signature Verified By/Initials JD Action Mon 1). Admit to medical-surgical unit M Horvath, MD 04:00 2). Code status: Full code 3). Diet: Nothing by mouth 4). Allergles: Morphine Sulfate 5). Activity: Bedrest 6). Maintain indwelling urinary catheter to gravity 7). Chest tube to -20 mm Hg water seal 8). Titrate oxygen to maintain oxygen saturation level at or above 93% 9). Midazolam 2.5 mg/hr, IV continuous Infusion. For patient comfort and sedation; may titrate drip every 15 min in increments of 1 mg/hr to maximum dose of 4 mg/hr 10). Record Intake and output every 8 hours Provider Orders Carter, James MRN: 1000119496 DOB 08/25/1979 Physician: M. Horvath MD 11). Normal saline IV continuous infusion at 80 mL/hr M Horvath, MD 12). Fluld bolus 250 ml normal saline over 15 minutes if blood pressure below 88 systolic; notify physician 13). Monday moming labs: Complete blood call count with differential, basic metabolic panel, arterial blood gases, INR, PT, PTT 14). Chest x-ray at 1300 15.) 1). Acstaminophen 650 mg by mouth every 6 hours for fever greater than 101.0 F (38.3 C); not to exceed 4 g total acetaminophen dose every 24 hours 16.) HydroMorphone 1 mg IV q 2H PRN for pain score of 5-7 17.) Fentanyl 100 mog IV q2H PRN Pain score of 8-10 18). Notify for temperature greater then 101.0 F (38.3 C) or any signs of bleeding Lab Results Carter, James MRN: 1000119496 DOB: 08/25/1979 Provider: Dr. Cooper CBC Test Result Reference Range Hgb 11.1 g/dL 14-18 g/dL HCT 34% 42%-52% WBC 12,300/mm3 5000 to 10,000/mm3 Neutrophils 8364/mm3 2500 to 8000/mm3 Lymphocytes 2583/mm3 1000 to 4000/mm3 Monocytes 733/mm3 100 to 700/mm3 Eosinophils 492/mm3 50 to 500/mm3 Basophils 123/mm3 25 to 100/mm3 Platelet Count 135,000/mm3 150,000 to 400,000/mm3 RBC 4.4 4.7 to 6.1

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