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Nursing QUESTION #9306
Question 1
In the care of a patient with chest drain (intercostal tube drainage), which of the following observations requires immediate nursing action?
  • Fluctuation (tidaling) in the water-seal chamber
  • Continuous bubbling in the water-seal chamber✔️
  • Absence of drainage for the first 2 hours
  • Drainage of 50 mL of serous fluid in 4 hours
Correct Answer Explanation

Understanding chest drain assessment:

FindingInterpretationAction
Fluctuation (tidaling)Normal — reflects respiratory pressure changesNo action needed
Continuous bubbling in water-sealAir leak — from lung or at connection siteImmediate action — check connections, notify physician
No tidalingLung fully expanded OR tube kinked/blockedAssess tube position, X-ray
Sudden large drainagePossible hemorrhage (>200 mL/hr)Notify physician immediately

Continuous bubbling indicates a persistent air leak — could be bronchopleural fistula or disconnection at the tubing. The system should never be clamped without a physician's order — risk of tension pneumothorax.