13. Pneumothorax

Question 1

Pneumothorax (Figures 4-15 & 4-16 and Table 4-19) is included in the exam blueprint.

Answer 1

A simple, unilateral pneumothorax is generally not life-threatening, unless it occurs in a pt with end-stage chronic lung disease.

A tension pneumothorax, however, may be life-threatening. Therefore, you must know the difference between the two types. The test makers also expect you to have an understanding of chest tube management.

Question 2

Types of Pneumothorax:

Answer 2

-Spontaneous
-Traumatic
-Open (penetrating chest trauma)
-Closed (blunt chest trauma)
-Iatrogenic (due to therapeutic or diagnostic
procedures) (figure 4-16)
-**Tension
-Air is unable to exit –>mediastinal shift
-Life threatening

Question 3

A pneumothorax with no mediastinal shift:

Answer 3

Outside air enters bc of disruption of chest wall and parietal pleura.

Lung air enters bc of disruption of visceral pleura

Question 4

Signs/symptoms of spontaneous or traumatic pneumothorax:

Answer 4

Depends on the size of the pneumothorax and depends upon the underlying lung disease (if any)
-Dyspnea, tachypnea
-Chest pain (not all cases)
-Unequal chest excursion
-tracheal deviation (if present) TOWARD the affected
side
-hypoxemia (if large)
- decreased or absent breath sounds on the affected
side
-mediastinum remains midline, no shift (see figure 4-
17)

Question 5

Signs/symptoms of tension pneumothorax:

Answer 5

Similar to a traumatic pneumothorax, EXCEPT:

-Tracheal deviation AWAY FROM the affected side 
          (figure 4-18)
-Tachycardia
-Distended neck veins
 -Mediastinal shift
 -HYPOTENSION
 -Life-threatening!

Question 6

Hemothorax

Answer 6

Usually due to trauma; presents as lung collapse, with blood in the pleural space or in the mediastinal space
-Dullness to percussion
-Absent breath sounds on the affected side
-tracheal deviation toward the unaffected side

Question 7

Treatment for a pneumothorax

Answer 7

-Pneumothorax > 20%
-Chest tube: reestablish negative pleural pressure
-Supplemental O2
-Treat pain, if needed

-Pneumothorax < 20%
-O2
-Monitor for lung reexpansion
-If there is a pneumothorax plus an underlying lung disease the pt may need a chest tube.

Question 8

**Chest Tube Assessment and Management

Answer 8

-Close assessment of the pt’s respiratory status, which should improve after chest tube insertion

-Pain assessment, treatment

-Entry site - dressing assessment

-Tubing - no dependent loops!!!

-Drainage collection chamber
-Keep lower than the chest!

-Water seal chamber
-Tidaling with deep inspiration is normal
-Air leak
-Bubbling in water seal chamber is not normal
-May be present postoperatively; if there has
not been a leak and now there is bubbling,
notify the MD.
-Avoid high airway pressures with chest tubes in
place in order to avoid an air leak.

-Suction control chamber: gauge or water level determines the amount of suction, NOT the wall suction source

-Clamp only when changing the system, with inadvertent disconnection, or with a physician order.
-Clamping cuts off the negative pressure water seal
chamber; expanded lung may re-collapse