C.L. is a 45-year-old man who presents to his healthcare provider with difficulty breathing, which has progressively worsened over the past couple of weeks. He has a history of hypertension. He is currently taking furosemide and lisinopril.
Has had some shortness of breath for the past couple of weeks. At first, it was just with activity, but it has gotten worse and is present at rest.
Started smoking at age 18 years and has smoked one pack per day for the past 37 years
Adds he has cut down on his smoking the past week and is only smoking one-half pack of cigarettes per day
Blood pressure 140/88, pulse 90, temperature98.7°F, respirations 22
O₂ saturation 90% on room air
Respirations labored, frequent productive cough with yellow sputum
Breath sounds reveal distant breath sounds in right lower lobe, clear in all other lobes
Dullness to percussion of right lower lung lobe
Chest radiography reveals a 2.5-cm lesion and pleural effusion in the right lower lung
What is a pleural effusion? What type of effusion do you suspect C.L. has and why?
The health care provider performs a thoracentesis to alleviate C.L.’s dyspnea and to have the fluid analyzed for diagnostic purposes. What is the procedure for a thoracentesis? What tests and monitoring are done after the procedure?
Case Study Progress
The results of the thoracentesis revealed malignant cells in the pleural fluid. C.L. then has computed tomography (CT) scans of the chest, brain, and bone to evaluate the exact location and size of the lung mass and check for any mediastinal or lymph node involvement and metastatic disease. The results of the CT scan show only the 2.5-cm lesion in the lower lobe of the right lung with no evidence of mediastinal or lymph node involvement and metastasis. C.L. undergoes a thoracotomy with a right lower lobectomy. After this surgery, he is admitted to the surgical step-down unit with a chest tube.
What is the purpose of the chest tube?
Describe how you will maintain C. L.’s chest tube drainage system.
What would you do if the chest tube drainage system breaks?
When will the chest tube be removed? Describe the procedure for chest tube removal.