Pneumothorax and Hemothorax

Objective data

- Unequal chest expansion (unaffected side of chest will expand while affected side may appear to diminish in size or remain stationary) - Tachycardia -Hypotension -Dyspnea -Cyanosis

Nursing Care

-Assess lung sounds, color, cap refill -Promote lung expansion by encouraging deep breathing and proper positioning - PCA or epidural block is commonly used for pain management

Tension pneumo can be relieved by a

28 French needle 2nd intercostal space

Nursing care includes

Admin O2 Auscultate and VS q 4 hrs Document vent settings hourly Position in High fowlers

Subjective data

Anxiety pleuritic pain

Risk factors

Blunt chest trauma penetrating chest wounds closed/occluded chest tube older adult clients dt normal lung changes (decreased lung elasticity and thickening alveoli) COPD

Diagnostic procedures

CXray Thoracentesis

Complications include decreased --- --- and --- ----.

Decreased CO and Respiratory failure - the amount of blood pumped by heart decreased as intrathoracic pressure rises, hypotension follows.

Encourage immunizations for ---- and ----.

Influenza and pneumonia.

Surgical interventions include Chest tube insertion. They are inserted into the --- space to drain or re-establish a ---- pressure which will facilitate --- --- and restore ---- pressure.

Inserted into the pleural space to drain or re-establish a negative pressure which will facilitate lung expansion and restore intrapleural pressure.

Sedatives used include benzodiazepines, used to decrease anxiety

Lorazepam (Ativan) Monitor VS (hypotension and resp distress) Amnesiac effect Monitor for paradoxical effects (euphoria, rage)

Opioid agonist for pain.

Morphine Sulfate and Fentanyl. Act on the mu and kappa receptors. Can cause: resp depression, euphoria, sedation, and decrease in GI motility Nursing considerations: use cautiously in pt with asthma or emphysema. - assess pain q 4 hr -initial fentanyl patch takes several hours to work, SA med may be administered for breakthrough - Watch for hypotension/bradycardia - Encourage fluid intake and activity

A pneumothorax is the presence of --- in the --- --- that causes the lungs to collapse

Presence of air in the pleural space

Trapped air in a tension pneumo can cause pressure on the --- and --- which ---- blood vessels and limits ----- return leading to a decrease in ---- ---. Death can result.

Pressure on the heart and lungs, constricting blood vessels and limits venous return leading to a decrease in CO.

Objective data

Signs of respiratory distress (tachypnea, tachycardia) reduced or absent breath sounds on affected side asymmetrical chest wall movement

Spontaneous pneumo can occur when there has been no trauma. A small --- on the lung ---- and --- enters the pleural space.

Small bleb on the lung ruptures and air enters the pleural space.

Objective data for air accumulating in the SubQ tissue

SubQ emphysema

Notify patient to report the following to the provider

URI Fever Cough Difficulty breathing Sharp Chest pain

What should the nurse tell the patient prior to thoracentesis procedure?

Will feel discomfort when local anesthetic is injected. When needle is inserted in the lung, some pressure may be felt but no pain A large bore needle will be used.

A hemothorax is an accumulation of

blood in the pleural space

With a tension pneumo patient is at risk for

decreased CO

Objective data for hemothorax

dull percussion

A tension pneumo occurs when air enters the pleural space during ---- through a --- --- valve and is not able to exit upon expiration.

during inspiration through a one-way valve

Objective data for pneumo

hyperresonance on percussion due to trapped air

Flail chest is the

inability of the injured side of the chest to expand adequately upon inhalation and contract upon exhalation. One side of the chest is typically effected

Recovery from a pneumo and hemo may be

lengthy

This can be a result of a tension pneumo.

mediastinal shift

Flail chest occurs when several ribs usually on

one side of the chest sustain multiple fractures, resulting in significant limitation to chest wall expansion

Objective data for tension pneumo

tracheal deviation to the unaffected side