The nurse is caring for a client who has a pneumothorax and a water-seal chest tube drainage system to suction. Which of the following actions should the nurse take?
Explanation & Rationale
A. Clamp the chest tubes if it becomes disconnected: Clamping a chest tube is generally not recommended because it can cause a tension pneumothorax. If the tube becomes disconnected, the nurse should place the end of the tube in a sterile water container to maintain the water seal. B. Add tap water as needed to the suction control chamber: The suction control chamber is typically filled with sterile water to a prescribed level. Adding tap water is unsafe as it can introduce infection and is not recommended; only sterile water should be used. C. Maintain the drainage container below the level of the client's chest: Keeping the chest tube drainage system below the level of the chest prevents backflow of fluid or air into the pleural space, which is essential for proper drainage and patient safety. D. Empty the collection container every shift: The drainage container is not routinely emptied; it is monitored for volume and characteristics of drainage. Emptying it unnecessarily can break the sterile system and increase the risk of infection or air entry.