1.       Understand the mechanism of breathing.         

Pressure relationships in the thoracic cavity:

•             intrapulmonarypressure

•             intrapleuralpressure

•             importanceof negative pressure in intrapleural space

2.       Understand the rationale for insertion of chesttubes in specific medical-surgical conditions.

•             Thoracotomy

•             Lobectomy

•             Pneumothorax

•             Empyema

3.       Understand the rationale of a water-seal system.         

•      Preventreentry of air into the lung

4.       Understand three mechanisms to drain fluid andair from the pleural cavity.  

•             Positiveexpiratory pressure, deep breathing, and coughing

•             Gravity

•             Suction

5.       Understand four types of pleural drainagesystems.     

Pleura-evac:

•             wetsuction control chamber

•             drysuction control chamber

•             Heimlichvalves

•             pigtailcatheters

6. Understand nursing responsibilities in caring for aclient with chest tubes.

                Assessment of client

•             vitalsigns

•             lungsounds

•             clinicalsigns of complications

•             respiratorystatus

•             dressing

•             discomfort

Maintaining chest tubes and closed chest drainage:

•             ensuringthat the system is airtight.

•             assessmentof drainage in the collection container

•             assessmentof fluctuation of fluid level in the water-seal chamber of the Pleura-evac unit

•             assessmentfor intermittent bubbling in the water of the water-seal chamber

•             assessmentfor gentle bubbling in the suction control chamber

•             inspectionof the air vent

•             inspectionof the drainage tubing for kinks or loops

•             Chesttube dressing changes as per hospital protocol.