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