— 生理適應 · MEDIUM · SATA —
護理師照顧一位放置胸管的病人，哪些發現顯示胸管運作正常？（選所有適合的）
A nurse is caring for a client with a chest tube. Which findings suggest the chest tube is functioning correctly? (Select all that apply.)
- AContinuous bubbling in the water seal chamber水封瓶內持續冒泡
- BFluctuation of water in the water seal tube during respiration✓ 正解呼吸時水封管內水位波動
- CAbsence of drainage in the collection chamber收集瓶內無引流液
- DTidaling observed in the water seal chamber✓ 正解水封瓶內觀察到潮動現象
- ESterile occlusive dressing remains intact✓ 正解無菌封閉敷料保持完整
— Explanation · 中文詳解 —
胸管正常運作時，水封瓶內的水柱隨呼吸上下波動（稱為潮動 Tidaling），若無波動需懷疑阻塞或肺部膨脹。水封瓶內持續冒泡（Continuous bubbling）通常代表系統有漏氣。敷料需保持密閉以預防氣胸。排水量正常與否需視臨床狀況而定，而非絕對指標。
Proper chest tube function is indicated by tidaling, where the water level fluctuates with respiration, showing the system is patent. Fluctuation confirms lung expansion, while an intact sterile occlusive dressing maintains the pleural seal. Continuous bubbling suggests an air leak, which is abnormal.
✦ 台美臨床差異
美國胸管護理強調系統密閉度檢查，台灣常輔以胸部 X 光確認引流管位置與肺擴張狀況。