— 生理適應 · MEDIUM · MCQ —
護理師照顧一位放置胸管的病人，發現水封瓶中有持續性的冒泡（constant bubbling）。這暗示什麼？
A nurse is caring for a client with a chest tube. The nurse notices constant bubbling in the water seal chamber. What does this suggest?
- ANormal lung expansion正常肺部擴張
- BAir leak in the system✓ 正解系統漏氣
- CThe chest tube is obstructed胸管阻塞
- DThe lung has fully re-expanded肺部已完全擴張
— Explanation · 中文詳解 —
胸管引流系統中的水封瓶（Water seal chamber）若有持續性冒泡，代表空氣持續進入系統。正常情況下，若病人為氣胸，冒泡應隨呼吸週期出現；若肺部已擴張，則僅在深呼吸或咳嗽時偶有冒泡。持續性冒泡暗示系統漏氣（Air leak），護理師應依序檢查胸管接頭是否鬆脫，以及傷口敷料是否密合，若排除外部漏氣，則需評估是否為肺部持續漏氣。
Constant bubbling in the water seal chamber indicates an air leak within the chest tube system, as normal drainage typically presents with intermittent bubbling synchronized with respiration. The nurse should immediately inspect all connections for looseness and check the insertion site dressing for integrity to identify the source of the leak.