對於放置胸管的病人，下列哪些護理措施是適當的？（選所有適合的）

核心概念：胸腔引流管（Chest Tube）的護理原則。 為何正確答案對： A. 胸腔引流系統（Drainage System）必須低於病人胸腔水平，以利用重力原理引流胸腔內的積液或積氣，防止引流液逆流回胸腔，造成感染或加劇病情。 C. 水封瓶（Water Seal Chamber）的特徵是應有波動（Tidal Fluctuations），表示引流管與胸腔連通且呼吸時胸腔內壓力變化。若無波動，可能表示管路阻塞、病人呼吸淺或肺部已復張。 E. 所有胸管與引流系統之間的連接處（Connections）都必須用膠帶（Tape）牢固密封，以確保系統的密閉性，防止空氣從連接處進入胸腔，導致張力性氣胸（Tension Pneumothorax）。 為何其他選項錯： B. 過長的引流管應盤繞（Coil）在床邊，而非床面上，以避免管路受壓或扭結，阻礙引流。將其隨意盤繞在床面上可能導致意外拔除或阻塞。 D. 夾閉（Clamping）胸管是絕對禁止的，除非是為了評估特定情況（如檢查管路是否阻塞，且需在醫師指示下短時間進行）。行走時夾管會導致胸腔內氣體或液體無法排出，迅速形成張力性氣胸，危及生命。 臨床思路（Safety/Physiological Adaptation）：胸管護理的關鍵在於維持引流系統的密閉性與引流效率。任何可能導致空氣逆流或引流受阻的情況都需嚴格避免。病人安全與維持呼吸功能是最高考量。

Core concept: nursing principles for chest tube care. Why the correct answers are right: A. The chest drainage system must be kept below the level of the client's chest in order to use gravity to drain pleural fluid or air, and to prevent backflow of drainage into the chest, which could cause infection or worsen the condition. C. The water seal chamber should normally show tidal fluctuations, indicating that the tube is patent and that the intrathoracic pressure changes with respiration. Absence of fluctuations may indicate obstruction, shallow breathing, or lung re-expansion. E. All connections between the chest tube and the drainage system must be securely sealed with tape to maintain a closed system and prevent air from entering the pleural space at the connections, which could lead to a tension pneumothorax. Why the other options are wrong: B. Excess tubing should be coiled at the bedside, not on top of the bed, to prevent kinking or compression that would obstruct drainage. Coiling it loosely on top of the bed may lead to accidental dislodgement or obstruction. D. Clamping the chest tube is absolutely contraindicated except in specific assessment situations (such as checking for obstruction, and only briefly under physician orders). Clamping during ambulation would prevent intrathoracic air or fluid from escaping, rapidly producing a life-threatening tension pneumothorax. Clinical reasoning (Safety/Physiological Adaptation): the key to chest tube care is maintaining a closed system and effective drainage. Any situation that may allow air to flow back or obstruct drainage must be strictly avoided. Patient safety and preservation of respiratory function are the highest priorities.