Running head: LABORATORY-LEARNING CENTERED LESSON PLAN
Laboratory-Learning Centered Lesson Plan
Module 2
Presented to
Dr. Eva Stephens, DNP, APRN, FNP-BC
THE UNIVERSITY OF TEXAS
MEDICAL BRANCH at GALVESTON
In Partial Fulfillment
Of the Requirements for the Course
GNRS 5320: Teaching Practicum
Brittney Mathis, BSN, RN
October 25, 2014
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LABORATORY-LEARNING CENTERED LESSON PLAN
Laboratory-Learning Centered Lesson Plan
I. Information
Topic: Chest tube insertion, daily care, and removal
Length of Time: 30 minutes
Format of Skill Demonstration: Laboratory
Number of Students: 20 students divided into groups of 2 or 3 to be taught each time over 30
minutes
II. Student Learning Outcomes
1. Discuss different hospital policies on insertion and care of chest tubes and where such
policies can be located within a hospital.
2. Assemble supplies for chest tube insertion and summarize the significance of each item
required.
3. Describe the steps for assisting with insertion of chest tube while caring for a patient.
4. Demonstrate the preparation of suction and underwater seal chambers for chest tube
devices.
5. Perform shift assessment on patient with chest tube and discuss the significance of the
findings.
6. Verbalize the signs and symptoms of various disease processes requiring chest tube
insertion and the complications that can arise.
II. Teaching Strategies for a Learning Centered Environment
Review pictures of different chest x-rays to help students further understand the
pathophysiology of different chest issues requiring chest tubes and to help with the
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LABORATORY-LEARNING CENTERED LESSON PLAN
understanding of placement of chest tubes. Discuss signs and symptoms and causes of
pneumothorax, hemothorax, and pleural effusions.
Allow students to handle chest tube insertion equipment, explain what each piece of
equipment does, and then allow students to practice the setup of chest tube insertion to provide
students with the ability to learn through psychomotor.
Have the student setup chest tube atrium and connect to it to suction.
Have each student preform a dressing change on the chest tube.
IV. Supplemental References
There will be a poster with pictures of x-rays displaying pneumothorax, hemothorax and
pleural effusions. There are also pictures of normal chest anatomy to discuss the placement of
chest tubes and how they help with listed processes requiring chest tubes. A picture of the poster
is in Appendix A.
Handouts to students include:
Bauman, M., & Handley, C. (2011). Chest-tube care: The more you know, the easier it gets.
American Nurse Today, 6(9). Retrieved from http://www.americannursetoday.com/chesttube-care-the-more-you-know-the-easier-it-gets/
Atrium Medical Corporation. (2010). Oasis: Dry suction water seal chest drain. Retrieved from
http://www.atriummed.com/en/chest_drainage/Documents/Oasis%20Setup%20Letter%20S
ize%20C.pdf
Atrium Medical Organization. (2009). Quick setup poster. Retrieved from
http://www.atriummed.com/en/chest_drainage/Documents/Oasis%20Quick%20Set%20Up
%20Poster%200227.pdf
V. Evaluation of Teaching Effectiveness
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LABORATORY-LEARNING CENTERED LESSON PLAN
Follow up questions with answers to be handed out to the students to fill out prior to leaving the
simulation lab. See Appendix B for questions with blanks to be handed out to the students.
1. Why would a patient need a chest tube? To drain fluid (pleural effusion), blood
(hemothorax), or air (pneumothorax) from the pleural space.
2. Patient will have an occlusive sterile dressing at insertion site.
3. What is the purpose of the water-seal? To promote one way flow out of the pleural space
4. Do you want to see fluctuation in the water seal tube? Yes, you expect to see fluctuation
with respirations
5. Fluctuations will stop when the lung has re-expanded, kink/clot in tubing, or if suction is
not working properly.
6. Why does the patient need daily Chest X-rays (CXR)? Method for evaluation of Lung reexpansion
7. Why is it important to keep the Pleur-Evac below the chest? Gravity
8. What do you do if the tubing becomes disconnected? Reconnect it!
9. What do you do if the bottles break and the water seal is lost? Do whatever you have to
do to reestablish the water seal. In an emergency you can use a cup of water.
10. If the chest tube is connected to suction, gentle continuous bubbling is expected.
11. Continuous, Vigorous/Excessive bubbling = Air Leak in the system
12. Pneumothorax – expect intermittent bubbling. Bubbles in the water-seal chamber after
the initial insertion of the tube or when air is being removed are a normal finding.
Constant bubbles in the water-seal chamber after initial insertion period indicate an air
leak in the system.
13. Call MD if the drainage is >100 ml/hr or if drainage is BRIGHT red
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LABORATORY-LEARNING CENTERED LESSON PLAN
14. Do not “milk” or “strip” a chest tube without an MD order.
15. NEVER clamp a chest tube! This could promote a tension pneumothorax.
16. When the doctor removes the chest tube the patient will need to take a deep breath and
hold or valsalva and a petroleum dressing with 4x4 gauze will be placed over the site.
17. If chest tube gets pulled out, QUICKLY apply sterile Vaseline gauze taped on 3 sides.
VI. Check for learning during class
In order to check for learning during simulation with hands on nursing care tasks, I would
ask questions and watch students demonstrate different activities, such as, chest tube dressing
changes, drainage marking on chest tube container, and assessing for air leaks in chest tubes. By
students being able to answer questions while demonstrating a task allows for learning through
psychomotor activities.
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LABORATORY-LEARNING CENTERED LESSON PLAN
References
Atrium Medical Corporation. (2010). Oasis: Dry suction water seal chest drain. Retrieved from
http://www.atriummed.com/en/chest_drainage/Documents/Oasis%20Setup%20Letter%20S
ize%20C.pdf
Atrium Medical Organization. (2009). Quick setup poster. Retrieved from
http://www.atriummed.com/en/chest_drainage/Documents/Oasis%20Quick%20Set%20Up
%20Poster%200227.pdf
Bauman, M., & Handley, C. (2011). Chest-tube care: The more you know, the easier it gets.
American Nurse Today, 6(9). Retrieved from http://www.americannursetoday.com/chesttube-care-the-more-you-know-the-easier-it-gets/
Fink, L. D. (2003). Creating significant learning experiences: An integrated approach to
designing college courses. San Francisco, Calif: Jossey-Bass.
Global Medical Education Project. (2012, June 15). Labelled chest x-ray. Retrieved from
https://gmep.org/media/11009
MedlinePlus Medical Encyclopedia. (2013, July 20). Collapsed lung. Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000087.htm
Pellico, L. H. (2013). Nursing management: Patients with chest and lower respiratory tract
disorders. In Focus on adult health medical-surgical nursing (pp. 312-322). China: Wolters
Kluwer: Lippincott Williams & Wilkins.
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LABORATORY-LEARNING CENTERED LESSON PLAN
Appendix A
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LABORATORY-LEARNING CENTERED LESSON PLAN
Appenix B
Chest Tubes
Name: ______________________________
1. Why would a patient need a chest tube?
____________________________________________________
2. Patient will have an _________________ dressing at insertion site.
3. What is the purpose of the water-seal?
_____________________________________________________
4. Do you want to see fluctuation in the water seal tube?
_________________________________________
5. Fluctuations will _________ when the lung has re-expanded, kink/clot in tubing, or if suction
is not working properly.
6. Why does the patient need daily Chest X-rays (CXR)?
___________________________________________
7. Why is it important to keep the Pleur-Evac below the chest?
_____________________________________
8. What do you do if the tubing becomes disconnected?
___________________________________________
9. What do you do if the bottles break and the water seal is lost?
____________________________________
10. If the chest tube is connected to suction, gentle continuous __________ is expected.
11. Continuous, Vigorous/Excessive bubbling = ____________ in the system
12. Pneumothorax – expect intermittent __________
13. Call MD if the drainage is ________ ml/hr or if drainage is BRIGHT red
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LABORATORY-LEARNING CENTERED LESSON PLAN
14. Do not ___________________ a chest tube without an MD order.
15. NEVER clamp a chest tube! This could promote a _________ pneumothorax.
16. When the doctor removes the chest tube the patient will need to take a _______________
and hold or valsalva and a petroleum dressing with 4x4 gauze will be placed over the site.
17. If chest tube gets pulled out, QUICKLY apply ____________________ taped on 3 sides.
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