مريض عنده أنبوب صدري لاسترواح صدري منذ يومين. الممرضة تلاحظ فقاعات متقطعة في حجرة السدّ المائي تظهر مع الزفير والكحة فقط، والماء يرتفع وينزل مع التنفس. ما التفسير؟

A client has had a chest tube for a pneumothorax for 2 days. The nurse sees intermittent bubbling in the water-seal chamber only on exhalation and coughing, and the water level rises and falls with breathing. What does this mean?

1. The lung has fully re-expanded, and the tube can be removed today
2. There is a system air leak, and the tube must be clamped at once
3. It is expected; air is still leaving the pleural space
4. The tube is blocked and needs milking and stripping to clear it

Answer: C) It is expected; air is still leaving the pleural space. Intermittent bubbling on exhalation and coughing in a pneumothorax means residual air is escaping, which is expected. A leak causes continuous bubbling, a blockage stops tidaling, and full re-expansion shows as bubbling stopping with X-ray confirmation. Clamping can cause a tension pneumothorax.