Pneumothorax Flashcards
what is pneumothorax?
partial collapse to complete collapse of the lung due to accumulation of air or gas in the pleural space
types of pneumothorax
-spontaneous (primary (no cause), secondary (underlying condition))
-traumatic (close, open, iatrogenic)
-tension (can be life-threatening)
risk factors for primary, spontaneous
-smoking
-tall, thin body build
-anorexia nervosa
-marfan syndrome
-familial pneumothorax
risk factors for tension pneumothorax
-mechanical ventilation, especially with high levels of positive end-expiratory pressure (PEEP)
-complication of traumatic pneumothorax
risk factors for secondary pneumothorax (spontaneous)
-chronic obstructive pulmonary disease
-asthma
-cystic fibrosis
-HIV with PCP
-necrotizing pneumonia
-TB
-pulmonary malignancy
-severe acute respiratory syndrome
-ARDS
-endometriosis
history of someone with pneumothorax
-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
physical findings
-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
assessment findings for simple pneumothorax
-tracheal alignment»_space; midline
-expansion of chest»_space; decreased
-breath sounds»_space; diminished or absent
-percussion of chest»_space; normal sounds or hyperresonant on affected side
assessment findings for tension pneumothorax
-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
complications of pneumothorax
-air leaks (lung will not reinflate need surgery)
-infection
-tension pneumothorax
tension pneumothorax
-increase in intrathoracic pressure
-decreased stroke volume
-decreased cardiac output –> cardiac arrest
are tension pneumothoraxes emergent?
yes, require emergent intervention
what intervention is used for tension pneumothorax
needle decompression (aspiration) as the 2nd intercostal space (temp fix until chest tube)
patient-centered care
-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
medical management pneumothorax
-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)
goal of medical management of pneumothorax
evacuate air (or fluid) from the pleural space
what does bubbling water in chamber mean in chest tube?
there’s a leak
Nursing Considerations: Pre-procedure chest tube insertion
-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
Nursing Considerations: Intra-procedure chest tube insertion
-surgical asepsis
-continually monitor VS & patient response
-assist with procedure
-anticipate needs of the patient and surgeon
-set suction to 20mmHg
what do you need at bedside for chest tube insertion?
sterile H2O
-reinforcing tape
-sterile hemostats
-sterile dressings
Nursing Considerations: post chest tube insertion
-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
where should chest tube placement be?
below chest level
chest tube safety measures
-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
nursing considerations for chest tube removal
-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
