— 降低風險 · MEDIUM · MCQ —
護理師照護一位使用胸腔引流管的病人，哪項發現顯示肺部已重新擴張？
A nurse is caring for a client who has a chest tube connected to a closed-chest drainage system. Which finding indicates that the lung has re-expanded?
- AFluctuation of the fluid level in the water seal chamber水封瓶內液面的波動
- BAbsence of fluctuation in the water seal chamber✓ 正解水封瓶內液面無波動
- CIncreased drainage output in the collection chamber收集瓶內引流輸出量增加
- DContinuous bubbling in the water seal chamber水封瓶內持續冒泡
— Explanation · 中文詳解 —
胸管水封瓶（water seal chamber）內的液面波動隨呼吸起伏，代表肺部尚未完全癒合或擴張。當肺部完全擴張，胸腔壓力穩定，波動便會停止（tidaling stops）。A 是空氣洩漏，A 是正常生理表現，C 代表持續出血，三者均非肺擴張指標。
In a chest tube system, fluctuation (tidaling) of the fluid level in the water seal chamber with respiration indicates that the lung has not yet fully healed or expanded. Once the lung has fully expanded and intrathoracic pressure has stabilized, the tidaling ceases. Option D indicates an air leak, A is an expected physiologic finding, and C reflects ongoing hemorrhage; none of these indicates lung re-expansion.
✦ 台美臨床差異
美國護理師常執行胸管拔除操作（視各州法規），台灣通常由胸腔外科醫師執行拔管。