# Situation: A 24-year-old tall, thin man who smokes arrives with sudden right-sided chest pain and breathlessness. He has no known lung disease and no history of injury. A chest X-ray shows a large right pneumothorax, and a chest tube is planned. The chest tube is connected to a wet-suction drainage system at −20 cmH2O. On day 2, bubbling in the water-seal chamber, which had occurred only when he coughed, becomes continuous. His oxygen saturation, respiratory rate, and blood pressure are unchanged. What should the nurse do FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630217  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 24-year-old tall, thin man who smokes arrives with sudden right-sided chest pain and breathlessness. He has no known lung disease and no history of injury. A chest X-ray shows a large right pneumothorax, and a chest tube is planned.

The chest tube is connected to a wet-suction drainage system at −20 cmH2O. On day 2, bubbling in the water-seal chamber, which had occurred only when he coughed, becomes continuous. His oxygen saturation, respiratory rate, and blood pressure are unchanged. What should the nurse do FIRST?

## 보기

1. Inspect connections from the dressing to the unit **✔ 정답**
2. Milk the tubing toward the drainage unit to clear it
3. Turn down the wall suction until the bubbling stops
4. Clamp the chest tube close to the chest for 1 hour

**정답: 1**

## 해설

Continuous bubbling in the water-seal chamber means an air leak, either from the client or from the system. With the client stable, the nurse checks the system from the insertion site down to the unit for a loose connection, then notifies the physician if the leak is not from the system.

## 심화 해설

What continuous bubbling means
In a chest drainage system, the water-seal chamber acts as a one-way valve. Intermittent bubbling when the client coughs or exhales is expected while air is still leaving the pleural space. When bubbling becomes continuous, it signals an air leak, which may come from the client (an ongoing leak from the lung) or from the system (a loose connection or a dislodged tube). With the client stable, the nurse first checks the system from the dressing down to the drainage unit to find and fix a leak in the equipment.

How to locate the leak
The nurse inspects the insertion site and dressing for a dislodged tube or an exposed eyelet, then follows the tubing to each connection, making sure each is tight and taped per policy. If the policy allows, brief, momentary clamping at successive points along the tubing, starting near the chest, helps locate the leak: if bubbling stops when the tube is clamped near the chest, the leak is from the client; if it continues, the leak is in the system below the clamp. Clamps are released immediately. If the leak is from the client or cannot be found, the nurse notifies the physician.

| Chamber | Normal finding | Abnormal finding |
| --- | --- | --- |
| Water seal | Tidaling; intermittent bubbling with coughing or exhaling while air is still draining | Continuous bubbling: air leak |
| Suction control (wet) | Gentle, continuous bubbling while suction is on | No bubbling: suction off or inadequate; vigorous bubbling only adds evaporation |
| Collection | Drainage amount and color recorded | Sudden large increase or bright red drainage |

Why the other actions are wrong
Milking or stripping the tubing is not routine practice and does nothing for an air leak; it may generate high negative pressure. Turning down wall suction affects bubbling in the suction-control chamber, not the water seal, so it does not fix a leak. Watch out! Clamping the chest tube for an hour is dangerous: if air is still leaking from the lung, it cannot escape and can accumulate under pressure, producing a tension pneumothorax. Clamping is brief and done only when ordered or allowed by policy, such as when locating a leak or changing the unit.

Why the stable vital signs matter
The stem says his oxygen saturation, respiratory rate, and blood pressure are unchanged. This tells the nurse that there is time for systematic troubleshooting rather than emergency action. If he became acutely breathless or hypotensive, the priority would shift to immediate assessment and calling for help.

Exam takeaway
Key point! Continuous bubbling in the water seal = air leak. In a stable client, first check the system from the client downward. Never clamp for prolonged periods, and do not confuse the water-seal and suction-control chambers.

## 임상 시나리오

Continuous Water-Seal BubblingTroubleshooting a chest tube air leak
Continuous bubbling in the water-seal chamber means an air leak from the client or from the system.

With stable vital signs, inspect the dressing and insertion site, then every connection down to the unit. If allowed, brief clamping along the tube helps tell a client leak from a system leak.

Wall suction controls bubbling in the suction-control chamber, not the water seal. Notify the physician if the leak is from the client or cannot be found.

CautionDo not clamp the chest tube for prolonged periods; trapped air can cause a tension pneumothorax. Release any test clamp at once.

## 핵심 개념

- **Water-seal chamber** — The chest drainage chamber that lets air leave the pleural space but prevents it from returning.
- **Air leak** — Continuous escape of air into the drainage system from the lung or from a loose connection.
- **Tidaling** — Rise and fall of water in the water-seal chamber with breathing, showing a patent system.
- **Suction-control chamber** — The chamber whose water level sets suction in a wet-suction system; it bubbles gently when suction is on.
- **Tension pneumothorax** — A life-threatening buildup of pleural air under pressure that shifts the mediastinum.

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