The nurse assesses a patient’s chest tube drainage 2 hours following thoracic surgery. The total drainage in the system is 200 mL. The nurse knows that:

Question

a. the drainage amount is only significant if the patient is hemodynamically unstable

b. reassess in 30 minutes

c. normal

d. excessive

Answer 1

Hi there! I would say the answer is (a). The drainage amount is only significant if the patient is hemodynamically unstable. In nursing school you are taught that > 75 mL/hr drainage means you call the HCP. In this scenario, though, the patient is 2 hours post-op. This means you can expect a little more drainage than you would several hours post-op. If your patient is really hemodynamically unstable, though, it is possible that any amount of fluid removed from the body can cause serious problems (like shock). (NOTE: the answer is almost never "reassess in x minutes!" This option is too passive for nurses!). Hope this helps!