Pneumothorax

Question 1

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).

Answer 1

Pneumothorax

Question 2

___________ tubes & pneumothorax go hand in hand

Answer 2

chest tubes

Question 3

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).

Answer 3

total; spontaneous; chest; small; large; chest tube

Question 4

Attached to the chest wall is the ________ pleura

Answer 4

parietal

Question 5

Attached to the lungs is the _______________ pleura ?

Answer 5

Visceral

Question 6

What is within the intrapleural space and what does it do ?

Answer 6

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.

Question 7

In pneumothorax, the lung gets pushed away from the ____________

Answer 7

chest wall

Question 8

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 _________

Answer 8

intrapleural; pressure; chest; collapse

Question 9

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 .

Answer 9

Open pneumothorax

Question 10

This type of pneumothorax is also known as a sucking chest wound ?

Answer 10

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.

Question 11

Remember, normally you have air passing through ___________ (not the chest wall) to the lungs while breathing.

Answer 11

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.

Question 12

Nursing intervention for an open chest wound ?

Answer 12

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).

Question 13

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 ?

Answer 13

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

Question 14

What is a spontaneous pneumothorax?

Answer 14

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

Question 15

Why is a spontaneous pneumothorax known as “spontaneous”?

Answer 15

Because the pneumothorax was not caused by an injury

Question 16

Things that can increase the rupture of a bleb

Answer 16

change in air pressure, taking a sudden, deep breath, or smoking

Question 17

What are the two classifications of primary pneumothorax ?

Answer 17

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).

Question 18

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.

Answer 18

Tension pneumothorax

Question 19

The patient with tension pneumothorax will have ………………… these 3 attributes

Answer 19

The patient will have a mediastinum shift, increased intrathoracic pressure and decreased venous return.

Question 20

What is the Patho of tension pneumothorax

Answer 20

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.

Question 21

What changes with a tension pneumothorax ?

Answer 21

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.

Question 22

What are major signs & symptoms associated with tension pneumothorax ?

Answer 22

Tachycardia, Tachypnea, Hypotension and Hypoxia

As well as: Respiratory distress, jugular venous distention, tracheal deviation (LATE SIGN)

Question 23

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.

Answer 23

tension pneumothorax

Question 24

What is the treatment for tension pneumothorax?

Answer 24

needle decompression: …a needle is inserted into the intrapleural space to remove air…..performed by physician.

Question 25

S/S Pneumothorax Mnemonic COLLAPSED

Answer 25

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

Question 26

What are nursing interventions for pneumothorax ?

Answer 26

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

Question 27

Absence of breath sounds on the affected side of the lungs is a manifestation of pneumothorax. TRUE OR FALSE

Answer 27

TRUE