Pneumothorax

Question 1

what is pneumothorax?

Answer 1

partial collapse to complete collapse of the lung due to accumulation of air or gas in the pleural space

Question 2

types of pneumothorax

Answer 2

-spontaneous (primary (no cause), secondary (underlying condition))
-traumatic (close, open, iatrogenic)
-tension (can be life-threatening)

Question 3

risk factors for primary, spontaneous

Answer 3

-smoking
-tall, thin body build
-anorexia nervosa
-marfan syndrome
-familial pneumothorax

Question 4

risk factors for tension pneumothorax

Answer 4

-mechanical ventilation, especially with high levels of positive end-expiratory pressure (PEEP)
-complication of traumatic pneumothorax

Question 5

risk factors for secondary pneumothorax (spontaneous)

Answer 5

-chronic obstructive pulmonary disease
-asthma
-cystic fibrosis
-HIV with PCP
-necrotizing pneumonia
-TB
-pulmonary malignancy
-severe acute respiratory syndrome
-ARDS
-endometriosis

Question 6

history of someone with pneumothorax

Answer 6

-possibly asymptomatic (with small pneumothorax)
-sudden, sharp, pleuritic pain, referred pain to shoulder
-pain that worries with chest movement, breathing and coughing
-dyspnea
-cough
-chest heaviness

Question 7

physical findings

Answer 7

-tachypnea/bradypnea
-respiratory distress (possible respiratory arrest)
-tachycardia
-pulsus paradoxus
-asymmetrical chest wall movement (decreased chest excursion on the affected side)
-overexpansion and rigidity on the affected side
-SQ emphysema
-decreased or absent breath sounds on the affected side
-decreased breath sounds on the affected side
-decreased tactile remits over the affected side
-absent ego phony and bronchony on the affected side

Question 8

assessment findings for simple pneumothorax

Answer 8

-tracheal alignment&raquo_space; midline
-expansion of chest&raquo_space; decreased
-breath sounds&raquo_space; diminished or absent
-percussion of chest&raquo_space; normal sounds or hyperresonant on affected side

Question 9

assessment findings for tension pneumothorax

Answer 9

-distended jugular veins
-pallor
-anxiety
-tracheal deviation away from affected side
-weak, rapid pulse
-hypotension
-tachypnea
-cyanosis
-absent breath sounds on the affected side
-decreased cardiac output
-chest pain
-cardiac arrest

Question 10

complications of pneumothorax

Answer 10

-air leaks (lung will not reinflate need surgery)
-infection
-tension pneumothorax

Question 11

tension pneumothorax

Answer 11

-increase in intrathoracic pressure
-decreased stroke volume
-decreased cardiac output –> cardiac arrest

Question 12

are tension pneumothoraxes emergent?

Answer 12

yes, require emergent intervention

Question 13

what intervention is used for tension pneumothorax

Answer 13

needle decompression (aspiration) as the 2nd intercostal space (temp fix until chest tube)

Question 14

patient-centered care

Answer 14

-monitor vital signs including SaO2
-administer oxygen therapy
-auscultate heart and lung sounds every 4 hours
-check ABGs, CBC, and chest x-ray results
-Position the client to maximize ventilation (high-Fowler’s position)
-provide emotional support to the patient and family
-maintain chest tube system and monitor drainage

Question 15

medical management pneumothorax

Answer 15

-diagnosis confirmed by x-ray or Ct scan
-medical management varies depending upon cause and severity: observation, needle decompression (aspiration), closed drainage system (chest tube)

Question 16

goal of medical management of pneumothorax

Answer 16

evacuate air (or fluid) from the pleural space

Question 17

what does bubbling water in chamber mean in chest tube?

Answer 17

there’s a leak

Question 18

Nursing Considerations: Pre-procedure chest tube insertion

Answer 18

-verify correct procedure, correct patient, correct site (time out)
-ensure consent is signed
-determine allergies
-position patient for procedure
-provide patient education
-review labs
-comfort measures
-monitor vital signs
-provide supplemental oxygen

Question 19

Nursing Considerations: Intra-procedure chest tube insertion

Answer 19

-surgical asepsis
-continually monitor VS & patient response
-assist with procedure
-anticipate needs of the patient and surgeon
-set suction to 20mmHg

Question 20

what do you need at bedside for chest tube insertion?

Answer 20

sterile H2O
-reinforcing tape
-sterile hemostats
-sterile dressings

Question 21

Nursing Considerations: post chest tube insertion

Answer 21

-monitor vitals, breath sounds, respiratory efforts, & SaO2
-coughing/deep breathing
-comfort measures
-monitor chest tube placement and function (drainage & system integrity)

-preventing complications: drainage tidaling, air leak, infection risk, dislodgment of chest tube

Question 22

where should chest tube placement be?

Answer 22

below chest level

Question 23

chest tube safety measures

Answer 23

-keep hemostats, bottle of sterile water & occlusive dressing at beside
-do not clamp, strip, or milk tubing
-if the tubing separates, instruct the patient to exhale as much as possible and to cough to remove as much as possible from the pleural space
-if the chest tube drainage system is compromised, immerse the end of the chest tube in servile water to provide a temporary water seal
-if a chest tube is accidentally removes, dress the area with dry, sterile gauze

Question 24

nursing considerations for chest tube removal

Answer 24

-provide pain medication prior to removal
-instruct the patient to preform vagal maneuver or take a deep breath and hold it down during removal
-apply airtight sterile petroleum jelly gauze dressing, secure in place with heavyweight stretch tape
-obtain chest x-ray as prescribed
-monitor for excessive wound drainage, findings of infection, or recurrent pneumothorax