Chest tubes MEd Surgical Unit

  1.     How do the patient’s vital signs reflect his current situation?  Do any of them concern you and if so, why?

For a healthy adult the normal vital signs includes RR 12-16 breaths per minute, BP 120/80, HR 60-100 beats per minute, and SpO2 95%-100%.  The vital signs presented by the patients include HR 102, BP 142/88, RR 32, and SpO2 97% on room air, chest pain (8/10). His HR, RR, and BP are higher than the normal range as well as increased chest pain. These vital signs demonstrate that the patient has tachycardia because the heart beats faster than the normal rate while at rest resulting in these symptoms.

  1.     What should be the focus of your assessment of this patient?  What specific abnormal findings might you notice?

The focus of assessment of this patient is pneumothorax and head laceration. Pneumothorax is a life-threatening condition and assessment of its cause is crucial in fostering appropriate treatment to the right type of pneumothorax. Pain in the head laceration areas, which may raise concerns of damage to the structure below the skin, bleeding, or infection (Huang, Ahmed, D'Souza & Awad, 2018).

The abnormal findings noticed include the elevated blood pressure.  Patients with pneumothorax usually have low blood pressure, which is contrary in John’s case. Although uncommon, some patients with pneumothorax present high blood pressure level. Tension pneumothorax is commonly found among individuals with high blood pressure, which is an indication that John has tension pneumothorax. A tension pneumothorax can lead to a collapse of the nearby lung completely and push the major blood vessels and the heart to one of the chest thus leading to elevated blood pressure in a patient (Huang, Ahmed, D'Souza & Awad, 2018).

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  1.     What is the priority nursing diagnosis for this patient?

 The nursing assessment will include collecting data on:

  •         Pain/anxiety
  •         Chest expansion
  •         Breath pattern

The nursing diagnosis based on the assessment data include:

  •         Acute pain related to chest pain when taking deep breaths and coughing
  •         Anxiety associated with difficulty in breathing
  •         Ineffective breathing pattern associated with respiratory problems

The nursing care planning and goals for the patient include:

  •         Ensuring the patient is relaxed to minimize anxiety to manageable level
  •         Relief pain
  •         Create a normal and effective respiratory pattern for the patient evidenced by normalized respiratory rate and ease in breathing.

Nursing Interventions

  •         Supporting the patient’s abdominal muscles and chest to make breathing and coughing less traumatic and more effective.
  •         Assist the patient to minimize anxiety or fear through helping them to take deeper and slower respirations.
  •         Inserting the chest tube to facilitate optimum fluid drainage and lung expansion.
  •         Monitoring the progress of re-expansion of lung and addressing pneumothorax (Lewis, Dirksen, Heitkemper & Bucher, 2014).
  1.     The patient is ordered Percocet (Oxycodone 5mg/Acetaminophen 325 mg) 2 tablets for pain <8/10 and morphine 4 mg IVP for pain >8/10.  Which would you administer? 

Both Percocet and morphine are pain relief medication used in emergency department.  They relief moderate to severe pain in patients. Percocet was ordered because it is an orally therapy medication while morphine IV was ordered because it is intravenous medication. I would administer Percocet because it is 1.5 times more effective than morphine in relieving pain. According to Hovda, Brutlag, Poppenga and Peterson (2016), oral administration route is regarded as the most acceptable and economical route of medication administration. I will not administer morphine IV because it is a narcotic and giving 4mg of morphine medication to John who has a higher blood pressure can cause it to drop to 50 -60 systolic and thus cause the patient become unresponsive. If morphine is given, the patient blood pressure, breathing, allergic reaction, and respiratory arrest should be monitored.

  1.     What would be important to monitor after giving this medication based on this patient’s diagnosis?

The aim of administering the medication was to relieve pain. Therefore, following the administration of these medications, the patient can be monitored for pain to determine if there is any change.

  1.     How do you know that the pain medicine was effective?

I can know that the pain medication was effective by asking the patient himself because pain is subjective.

The chest tube is inserted without difficulty and 50 mL sanguineous drainage is removed.  The chest tube is attached to low continuous suction as ordered. 

  1.     Upon connecting, you notice some bubbling in the water seal chamber of the chest tube.  What would be your next action?

Bubbling could be an indication of an air leak. I would identify the area of air leak, I will clamp the thoracic catheter next to the exit from chest. If air leak continues, I will clamp the chest tube with the physician’s order since clamping could result in tension pneumothorax.

  1.     What outcomes would you anticipate to see in the patient if the chest tube insertion has been effective?

To determine if the chest tube insertion has been effective, I would anticipate to see the patient with an effective or normal respiratory pattern.

Nursing History

Nursing history is important for any nursing professional pursuing this career. Based on VanderLinden’s (2013) assertion, “…we need to know where we were so we can figure out where we should go in the future,” affirms that learning from history helps nurses to advance their profession depending on the public interests and needs. Knowledge which an individual acquires from nursing history ensures the new nurses socialize into their profession (UVSN, 2013). Similarly, VanderLinden (2013) affirmed that the nursing history knowledge encourages different critical thinking methods among the nurses. Without a doubt, understanding this field of study is necessary and relevant to nurses participating in healthcare reform. Nursing history guarantees the public valuable perspectives on emerging transformations of nursing practice, healthcare reforms, health technologies, and gender issues experienced in the community.

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The nursing history is valuable in the modern society. This study allows the nurses to collect, preserve, research, and disseminates the nursing history and shares the findings with various stakeholders including nursing history researchers, nursing organizations, government, individual nurses, and healthcare agencies (Serrant, 2017). They share the duty to incorporate the nursing history into professional awareness and nursing education; therefore, supporting the nursing historical research. Today, the nursing history research has helped to illuminate the diversity and complexity within the nursing profession. This is because nursing encompasses diverse identities, roles, and practices which need continuous historical inquiry; hence, transform the modern changes in the health industry. The current work in the study of nursing history provides new directions required for analyzing practices and making the dimensions visible in shaping care. Therefore, nursing history knowledge helps the users to identify the way to shape and promote health and patient care.

RFID Tracking Technology

Radio-frequency identification (RFID) is an important identification system which has gained prominence in the modern world. This wireless technology can unambiguously and automatically identify products or people without line of sight. It extracts a unique identifier from the RFID tags or microelectronic tags on the object (Knezevic, Delic, & Cegnar, 2015). The RFID technology has been utilized by many organizations to track the movement of commercial products, pets, people, and corporate assets with the help of a strategically placed reader. In fact, even governments have adopted this system to monitor the movement of different groups or individuals. According to Ajami and Rajabzadeh (2013), this technology utilizes radio waves to track the individuals or goods. Interestingly, it consists of different components including an antenna, an RFID reader, and an RFID tag. Since the RFID has electromagnetic fields, it finds it easy to automatically track and identify tags on objects (Ajami & Rajabzadeh, 2013). This is because these tags have electronically stored data which can be transmitted to the interrogator or the RFID reader.

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The RFID technology has successfully been used in manufacturing, healthcare, transportation, agriculture, supply chain, and services (Knezevic et al., 2015). The system should be integrated with electronic health records, hospital information systems, and clinical decision support systems to help overcome diagnosis and medical errors. The RFID technology serves three purposes including inventory management, tracking, and validation which affirm its ability to improve productivity and yield cost savings. In medicine, for instance, the RFID technology improves medical safety because it eliminates surgical sponge count protocols (Coustasse, Tomblin, & Slack, 2013). Besides, it enhances patient safety by reducing medical errors, improves diagnostic services, and increases the pharmaceutical quality services. Although this technology has proved beneficial, the companies must beware of the security risks associated with RFID including eavesdropping, profiling, inventory jamming, and denial of service attacks (Knezevic, 2015). Without a doubt, this technology is susceptible to interface with wiretaps, interceptions, forgery, and fraud. These are security threats and concerns which can never be underestimated.

Nursing Scholar

  1.     How can you promote the image of the nurse as a scholar?

Nurses are indisputable healthcare professionals with a lot of skills and knowledge. Nonetheless, the public rarely values the competence and skills these professionals have acquired through innovation and education (Ten Hoeve, Jansen, & Roodbol, 2013). Since the nurses have self-created their public image and professional identity, their work environment, public image, education, work values, and cultural and social values. To this effect, nurses need to intensify their efforts to communicate to the public about their professionalism. This can be pursued through YouTube and social media; therefore, making them visible. The nurses should utilize strategic positions including nurse educators, case managers, and clinical nurse specialists to maximize their professionalism. This will demonstrate to the public that their work is beyond medical care.

The nursing scholars’ future programs focus on establishing a diverse cadre of Ph.D. prepared nurses who have to affirm their commitment to long-term leadership careers. Such programs would help the nurses to advance science and discovery using research. Therefore, strengthening nursing education can transform the image of nurses. Scholarships will help redefine the nursing profession because today’s work environment is dynamic (Conard & Pape, 2014). Therefore, scholarships provide the best opportunity to transform nursing into a respectful profession through the use of Boyer’s Model of Scholarship.

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  1.     What are the potential consequences of changing the image of the nurse from caregiver to a scholar?

Transforming the images of nurses from caregivers to scholars will enable these professionals to become exemplary nurse leaders who can change healthcare throughout the country. This will ensure these nurses inspire the next generation and build the health culture in the society. Since the scholarship will incorporate overlapping and interrelated domains, such as teaching, application, integration, and discovery, nurses will improve their roles in academia and practice (Conard & Pape, 2014). Therefore, nursing will get the opportunity to participate in policy formulation and development.


  1. Conard, P.L. and Pape, T.T. (2014). Roles and Responsibilities of the Nursing Scholar. Pediatric Nursing, 40(2), 87-90.
  2. Ten Hoeve, Y., Jansen, G., and Roodbol, P. (2013). The Nursing Profession: Public Image, Self-Concept, and Professional Identity. A Discussion Paper. Journal of Advanced Nursing, 70(2), 295-309. Doi: 10.1111/jan.12177.