— 生理適應 · MEDIUM · MCQ —
胸管水封瓶持續出現氣泡（continuous bubbling），護理師優先行動為何？
A client with a chest tube begins to have continuous bubbling in the water seal chamber. What is the nurse's priority action?
- ACall the physician immediately立即通知醫師
- BClamp the chest tube夾住胸管
- CIncrease the suction pressure增加抽吸壓力
- DCheck for air leaks in the tubing connections✓ 正解檢查管路連接處是否有漏氣
— Explanation · 中文詳解 —
胸管系統中，水封瓶（Water seal chamber）若出現持續冒泡，代表胸腔或系統管路有空氣洩漏（Air leak）。處理原則遵循「優先順序（Priority）」，先從病人端向系統端檢查管路連結處是否鬆脫或密合不良。若確認管路無漏氣，則需評估病人是否有氣胸惡化。絕對不可盲目夾管，以免造成張力性氣胸。
Continuous bubbling in the water seal chamber indicates an air leak within the drainage system or the patient's pleural space. The nurse's priority is to check the tubing connections for loose fittings or disconnections to restore system integrity. Clamping the chest tube is contraindicated as it may lead to a tension pneumothorax.