Pneumothorax Flashcards
the collapsing of a lung due to air accumulating in the pleural space (the space between the visceral and parietal pleura which is also called the intrapleural space).
Pneumothorax
___________ tubes & pneumothorax go hand in hand
chest tubes
Key Points to Remember about Pneumothorax:
It can be a partial or __________ collapse of the lung (mainly affects one lung).
Causes include but not limited to: ____________ (without warning), trauma to the _________ (blunt or penetrating), lung disease, medical procedures (central line placement, mechanical ventilation).
It is diagnosed with a chest x-ray, ultrasound, or CT scan.
A ____________pneumothorax usually resolves on its own.
A __________ pneumothorax usually requires treatment like a ___________ to remove air from intrapleural space or needle aspiration (as with a tension pneumothorax).
total; spontaneous; chest; small; large; chest tube
Attached to the chest wall is the ________ pleura
parietal
Attached to the lungs is the _______________ pleura ?
Visceral
What is within the intrapleural space and what does it do ?
Small amounts of serous fluid are between the parietal and visceral pleura. In a pneumothorax, this is where the air collects that causes the lung to collapse.
The intrapleural space allows the visceral and parietal pleura to glide over one another during inhalation and exhalation which creates a negative pressure. The negative pressure acts like suction to keep the lungs inflated.
In pneumothorax, the lung gets pushed away from the ____________
chest wall
Therefore, if air enters the____________ space it causes a buildup of ____________ (remember under normal condition the lungs like negative pressure) which decreases the ability of the lungs to recoil and pushes the lung away from the ___________ which leads to _________
intrapleural; pressure; chest; collapse
What kind of pneumothorax is this ?
an opening in the chest wall (from a gun shot, stabbing etc.) that causes a passage between outside air and the intrapleural space. This allows air to pass back and forth during inspiration and expiration. Therefore, the body will shunt air through the chest wall opening instead of the trachea .
Open pneumothorax
This type of pneumothorax is also known as a sucking chest wound ?
Open pneumothorax ………….
Remember, normally you have air passing through trachea (not the chest wall) to the lungs while breathing. Because of this you may hear a “sucking sound” This type of pneumothorax is also known as a sucking chest wound.
Remember, normally you have air passing through ___________ (not the chest wall) to the lungs while breathing.
trachea
In an open pneumothorax, you may hear a “sucking sound” because of the air passing through the chest wall. This type of pneumothorax is also known as a sucking chest wound.
Nursing intervention for an open chest wound ?
place a sterile occlusive dressing over the opening and tape it on 3 sides (leaving the 4th side free from tape). This prevents the wound from being occluded. This type of dressing will allow exhaled air to leave the opening but seal over the opening when inhaling (hence preventing a tension pneumothorax).
This is when air leaks into the intrapleural space without any outside wound. (hence the chest wall and pleural stay intact)
What can cause this ?
Closed Pneumothorax
Example of what can cause this: a rib fracture where the sharp, bony part of the bone punctures the lung causing air to be released into the intrapleural space. Another common cause of closed pneumothorax is called spontaneous pneumothorax
What is a spontaneous pneumothorax?
a defect in the alveolar wall and visceral pleura where air enters into the intrapleural space. An example: pulmonary bleb (sac-like blister that develops on the visceral pleura that ruptures and leaks air into the pleural space). This causes pressure to build up in the intrapleural space and causes the lung to collapse. It known as a “spontaneous” pneumothorax because the pneumothorax was NOT caused by an injury.
Patients can have multiple pulmonary blebs and they don’t have to rupture immediately. Exact cause of rupture is not totally understood but things that can increase the rupture of a bleb include: change in air pressure, taking a sudden, deep breath, or smoking
Why is a spontaneous pneumothorax known as “spontaneous”?
Because the pneumothorax was not caused by an injury
Things that can increase the rupture of a bleb
change in air pressure, taking a sudden, deep breath, or smoking
What are the two classifications of primary pneumothorax ?
Primary spontaneous pneumothorax: occurs in people without lung disease and they tend to be young <30 years of age and tall and thin.
Secondary spontaneous pneumothorax: occurs in people with lung disease (copd, asthma, cytic fibrosis).
This is complication of a pneumothorax (can happen with open or closed pneumothorax). This is a medical emergency. It happens when the opening to the intrapleural space creates a one-way valve…where air collects into the space but never leaves. This causes major compression on the lungs and heart.
Tension pneumothorax
The patient with tension pneumothorax will have ………………… these 3 attributes
The patient will have a mediastinum shift, increased intrathoracic pressure and decreased venous return.
What is the Patho of tension pneumothorax
Patho of tension pneumothorax: AIR CANNOT ESCAPE the intrapleural space -> there is shift of the mediastinum as pressure builds in the space -> patient tries to compensate by increasing breathing (tachypnea) to maintain oxygen level but this doesn’t work, patient will have hypoxia -> there will be compression on the vena cava (remember the vena cava normally drains blood to the heart but it can’t now) ->suppose to draining blood back to the heart…the heart then has nothing to pump…hence decreased cardiac output
Anatomy changes with a tension pneumothorax: mediastinal shift causes heart, trachea, esophagus, and vessels to shift to the UNAFFECTED side and this will compress the unaffected lung and venous vessels.
What changes with a tension pneumothorax ?
ANATOMY changes with a tension pneumothorax: mediastinal shift causes heart, trachea, esophagus, and vessels to shift to the UNAFFECTED side and this will compress the unaffected lung and venous vessels.
What are major signs & symptoms associated with tension pneumothorax ?
Tachycardia, Tachypnea, Hypotension and Hypoxia
As well as: Respiratory distress, jugular venous distention, tracheal deviation (LATE SIGN)
If a patient is on mechanical ventilation w/ PEEP (positive end-expiratory pressure) they are at risk for a _______________ due to barotrauma which causes buildup of pressure in the intrapleural space from rupture of the visceral pleura.
tension pneumothorax
What is the treatment for tension pneumothorax?
needle decompression: …a needle is inserted into the intrapleural space to remove air…..performed by physician.
S/S Pneumothorax Mnemonic COLLAPSED
Chest pain (sharp and sudden and worst on inspiration), Cyanosis
Overt tachycardia and tachypnea
Low blood pressure
Low SpO2
Absent lung sounds on affected side
Pushing of trachea to unaffected side (tension pneumo.)
Subcutaneous emphysema (escaping carbon dioxide collecting in the skin…crunchy bulges on the skin), Sucking sound with open pneumothorax
Expansion of chest rise and fall unequal
Dyspnea
What are nursing interventions for pneumothorax ?
Monitor breath sounds (equal sounds on both sides), equal rise and fall of the chest, vital signs (HR, blood pressure, oxygen saturation), and patient effort of breathing, subq emphysema (can be found on the face, abdomen, armpits, neck (affects breathing), administering oxygen as ordered
Maintain chest tube drainage system if placed by physician:
Assessing for air leaks in the system, keep it secure
Troubleshooting if drain comes out or system breaks
Water seal chamber: may have intermittent bubbling as air is drained from the pleural space. The water seal chamber fluctuates as the patient breathes in and out. If it stops fluctuating there may be a kink somewhere or the lung has re-expanded. NOT normal to have excessive bubbling in the water seal chamber (air leak somewhere).
Keep HOB of the bed elevated…Fowler’s position
Absence of breath sounds on the affected side of the lungs is a manifestation of pneumothorax. TRUE OR FALSE
TRUE
