Mr. Liu is a 28-year-old man with pneumothorax secondary to blunt chest trauma. He has three broken ribs and is being treated with a chest tube and water-seal drainage unit.  Mr. Liu reported at our ED a week ago with 3 broken ribs (left 7th-9th) after falling off his neighbor’s roof. A chest X-ray revealed that he was negative for pneumothorax. He was observed for 8 hours and discharged with instructions to return if his symptoms worsened. Yesterday, he was reaching for something on a high shelf when he experienced sharp chest pain on his left side followed by difficulty breathing

He reported to the ED within the hour, where he was diagnosed with pneumothorax secondary to blunt chest trauma, confirmed via chest X-ray. Physical examination revealed tracheal deviation to the left, air in the left side of the chest, and absent breath sounds on the left side of the chest.

At 1600 hours yesterday, Mr. Liu received a 28 F chest tube, inserted at the left 4th intercostal space, anterior axillary line.

Mr. Liu has a hydromorphone patient-controlled analgesia pump at a concentration of 2 mg/mL. He was given a loading dose of 0.4 mg, and set up with an on-demand bolus of 0.1 mg. The PCA pump has a lockout interval of 10 minutes and an hourly dose limit of 0.6 mg.

Mr. Liu’s vital signs are all within normal limits. His respirations are 18 per minute and his oxygen saturation is 94%.

Current provider’s orders are to monitor the chest tube and drainage unit every hour, to record patient vitals every hour, and to monitor Mr. Liu’s pain level and level of consciousness every hour, in addition to checking the dressing at the site of the chest tube insertion once every 2 hours.

No allergies to food, latex, or medication. No regular home medications. When he first broke his ribs, he took OTC (over the counter) ibuprofen as needed to manage the pain.

Samuel said: I just took what it said to on the bottle. The pain wasn’t all that bad until yesterday. Oh, and I used an ice pack, too.

The chest tube and water-seal drainage unit are working as expected. Chest tube to water seal, no air leak noted. No drainage. The dressing at the site of the chest tube insertion is clean with no sign of infection. No problems. Mr. Liu is currently stable, alert and oriented x4

Mr. Liu’s pain is being controlled with PCA, and he last rated his pain as a 3 out of 10.

Recommend from other nurse every hour, when you check in with Mr. Liu, you monitor his chest tube and drainage unit, monitor and record his vital signs, and check the dressing on his chest tube insertion site. It will also be important to check his respiratory status and level of consciousness.

Mr. Liu has no procedures scheduled for today, and he is not expecting any visitors.

Samuel said: Nobody wants to see me? I guess I’m just not very popular today.

Samuel said: Actually, I should probably tell you — I’m vegan. I’ve mentioned it a few times since I came in, but it seems like a good idea to tell you, too.