Pneumothorax

Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

A new system needs to be obtained, however, in order to maintain a water seal until the new system arrives you will need to place the tubing 1 inch in sterile water or sterile saline to regain a water seal.

pulmonary bleb define

sac-like blister that develops on the visceral pleura that ruptures and leaks air into the pleural space.

tension pneumo ex

Pushing of trachea

Tachypnea Define:

is the medical term for rapid and shallow breathing

Cyanosis Define:

A bluish color of the skin and the mucous membranes due to insufficient oxygen in the blood.

Which statement is CORRECT about a tension pneumothorax?

A tension pneumothorax is a medical emergency and is treated with needle decompression.

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,

It is most likely to occur in patients with COPD, asthma, and cystic fibrosis.

All options are correct about primary spontaneous pneumothorax EXCEPT D. This describes SECONDARY spontaneous pneumothorax not primary.

You're providing care to a patient with a pneumothorax who has a chest tube. On assessment of the chest tube system, you note there is no fluctuation of water in the water seal chamber as the patient inhales and exhales. You check the system for kinks and find none. What is your next nursing action?

Assess patient's lung sounds to assess if the affected lung has re-expanded.

Signs & Symptoms of Pneumothorax:

Chest pain ,Cyanosis, Cyanosis ,Overt tachycardiatachypnea.Low blood pressure ,Low SpO2,Absent lung sounds on affected side,Pushing of trachea to unaffected side,Subcutaneous emphysema ,Sucking sound with open pneumothorax,Expansion of chest rise and fall unequal, Dyspnea

Dyspnea Define:

Difficult or labored breathing; shortness of breath. Dyspnea is a sign of serious disease of the airway, lungs, or heart

A patient receiving treatment for a pneumothorax calls on the call light to tell you something is wrong with their chest tube. When you arrive to the room you note that the drainage system has fallen on its side, and there is a large crack in the system. What is your next PRIORITY?

Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of sterile water and obtain a new system.

Hypotension, JVD, tracheal deviation, and tachypnea

Hypotension, JVD, tracheal deviation, and tachypnea can all be present in a tension pneumothorax. The other options are not usually present.

A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension pneumothorax. Select ALL the signs and symptoms that can present with this condition:

Hypotension, Jugular Venous Distention,Tracheal deviation, Tachypnea

A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is NOT a correct statement about this type of pneumothorax?

It is most likely to occur in patients with COPD, asthma, and cystic fibrosis

Assess patient's lung sounds to assess if the affected lung has re-expanded.

It is normal for the water seal chamber to tidal up and down as the patient breathes in and out. If there is no fluctuation of water in the water seal chamber there may be a kink in the tubing or the lung has re-expanded. Therefore, it is important to check the system for kinks and if there are none then check the patient's lung sounds to see if lung sounds are present on the affected side (hence the lung has re-expanded).

Types of Pneumothorax

Open Pneumothorax: Closed Pneumothorax:Spontaneous Pneumothorax:Tension pneumothorax:

A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment, you note there is unequal rise and fall of the chest with absent breath sounds on the left side. You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray shows a pneumothorax. What type of pneumothorax is this known as?

Open pneumothorax

Two classifications of Spontaneous Pneumothorax:

Primary spontaneous pneumothorax:Secondary spontaneous pneumothorax:

While caring for a patient with a suspected pneumothorax, you note there are several areas on the patient's skin that appear to be "bulging" out. These "bulging" areas are located on the patient's neck, face, and abdomen. On palpation on these areas, you note they feel "crunchy". When charting your findings you would refer to this finding as?

Subcutaneous emphysema

Major Signs and Symptoms of Tension Pneumothorax:

Tachycardia, Tachypnea, Hypotension and Hypoxia: Respiratory distress, jugular venous distention, tracheal deviation (LATE SIGN)

Place a sterile occlusive dressing over the chest wound and tape it on three sides

The nursing intervention would be to place a sterile occlusive dressing over the wound and tape it on 3 sides (leaving one side NOT taped). This will allow exhaled air to leave the opening but seal over the opening when inhaling (hence not letting pressure build in the intrapleural space and prevent a tension pneumothorax).

A tension pneumothorax is a medical emergency and is treated with needle decompression.

The only correct statement about a tension pneumothorax is option B. Option A is wrong because this condition happens when an opening to the intrapleural space creates a ONE-way (not two-way) valve which causes pressure to build up in the space leading to shifting of the mediastinum. Option C is wrong because tracheal deviation is a LATE (not early) sign of a tension pneumothorax. Option D is wrong because not only can an open pneumothorax cause a tension pneumothorax but a closed or spontaneous pneumothroax can as well.

A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during your assessment requires immediate nursing intervention?

The patient has slight tracheal deviation to the right side.

When a Tension pneumothorax: causes major compression on the lungs and heart. What happens to the patient?

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

Pathophysiology of Pneumothorax

The visceral pleura (attaches to the lungs) and parietal pleura (attaches to the chest wall) are separated by a small amount of serous fluid and this space is called the intrapleural space. In a pneumothorax, this is where the air collects that causes the lung to collapse

What happens to the lungs and heart with a Tension pneumothorax:

This causes major compression on the lungs and heart.

Open pneumothorax

This description is of an open pneumothorax. An open pneumothorax happens when there is an opening in the chest wall ( from a gun shot, stabbing etc.) that creates a passage between the outside air and intrapleural space. This allow air to pass back and forth during inspiration and expiration. The body will shunt air through the opening in the chest well instead of the trachea (if the opening on the chest is large enough) which will create a "sucking" sound.

Subcutaneous emphysema

This known as subcutaneous emphysema or subcutaneous crepitation.

Which of the following is a LATE sign of the development of a tension pneumothorax?

Tracheal deviation

Tracheal deviation

With a tension pneumothorax, you will quickly see hypotension, tachycardia, and dyspnea as the mediastinum shifts from the extra pressure in the intrapleural space on the affected side. A late sign of a tension pneumothorax is that the trachea will eventually shift to the unaffected side.

Tension pneumothorax Is:

a complication of a pneumothorax (can happen with open or closed pneumothorax). This is a medical emergency.

Spontaneous Pneumothorax:

a defect in the alveolar wall and visceral pleura where air enters into the intrapleural space.

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.

Open Pneumothorax:

an opening in the chest wall (from a gun shot, stabbing etc.) This allows air to pass back and forth during inspiration and expiration.

Known as a "Spontaneous" Pneumothorax why

because the pneumothorax was NOT caused by an injury.

Subcutaneous emphysema is:

escaping carbon dioxide collecting in the skin...crunchy bulges on the skin

Definition of pneumothorax

is a collapsed lung. A pneumothorax occurs when air leaks into the space between your lung and chest wall. This air pushes on the outside of your lung and makes it collapse. In most cases, only a portion of the lung collapses.

Spontaneous Pneumothorax Example: :

is a pulmonary bleb. This causes pressure to build up in the intrapleural space and causes the lung to collapse

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.

Treatment for tension pneumothorax:

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

Vena Cava

normally drains blood back to the heart

Secondary spontaneous pneumothorax:

occurs in people with lung disease (copd, asthma, cytic fibrosis).

Primary spontaneous pneumothorax:

occurs in people without lung disease and they tend to be young <30 years of age and tall and thin.

Patho of a tension pneumothorax how will it effect patient:

patient will have hypoxia -> there will be compression on the vena cava (cannot drain blood to the heart now) the heart then has nothing to pump...hence decreased cardiac output

Describe Chest pain with a Pneumothorax:

sharp and sudden and worst on inspiration

What happens to the intrapleural space with a Open Pneumothorax:

that causes a passage between outside air and the intrapleural space.

What happens to the patient with a Open Pneumothorax:

the body will shunt air through the chest wall opening instead of the trachea

Closed Pneumothorax:

when air leaks into the intrapleural space without any outside wound (hence the chest wall and pleural stay intact).

What happens to the intrapleural space with a Tension pneumothorax:

when the opening to the intrapleural space creates a one-way valve...where air collects into the space but never leaves.

Barotrauma Define

which causes buildup of pressure in the intrapleural space from rupture of the visceral pleura

Why is a patient at risk for a tension pneumothorax on mechanical ventilation w/ PEEP

•If a patient is on mechanical ventilation w/ PEEP (positive end-expiratory pressure) they are at risk for a tension pneumothorax due to.