DISEASE: Pneumothorax CLINICAL MANIFESTATIONS:         Sudden, sharp pleuritic pain, referred to the shoulder Tachypnea or bradypnea Respiratory distress Asymmetrical chest movement Subcutaneous emphysema (crepitus) Jugular vein distention Tracheal deviation away from the affected side due to shift in pressure Chest pain, dyspnea, cough, chest heaviness LABS/ DIAGNOSTICS/ TESTS:  Chest x-ray (goes before CT scan because it is quicker, lungs should be black if they are working correctly)  Ultrasound  absence of lung sliding  CT scan  identifies the exact size of pneumothorax  ABG  respiratory acidosis / alkalosis because ventilation & gas exchange is whack. Hypoxemia! NURSING DIAGNOSES:      Acute pain Ineffective breathing pattern Ineffective peripheral tissue perfusion Anxiety Nutritional imbalance ETIOLOGY: Full or partial collapse of the lung caused by a collection of air in the pleural space resulting in the loss of negative intrapleural pressure. Degree of lung collapse determined by the amount of trapped air or gas. There is simple or spontaneous, traumatic, tension. Complications  recurrence, respiratory distress, myocardial infarction, cardiac distress (to try and get the oxygen out, overcompensate, demand ischemia), death ASSESSMENT: Hx:  Could be spontaneous (even in a healthy patient) Physical:  Possibly asymptomatic (with small pneumothorax)  Respiratory assessment (adventitious lung sounds, diminished in the lower lobes)  Observation of respirations and how the patient is breathing (using accessory muscles)  Vitals (high respirations, tachycardia)  Expansion of the chest, percussion of the chest  Tracheal alignment Risk factors:  Smoking, anorexia, pregnancy  Trauma, COPD, cystic fibrosis, asthma, TB, HIV, acute respiratory distress syndrome  Could happen spontaneously  As a result of medical intervention (insertion of central line for TPN) NURSING INTERVENTIONS:  Chest tube management (x-rays daily)  Deep breathing techniques  Bed rest until lung re-expansion occurs  No air travel until chest radiography is normal  Auscultate lung sounds for changes  Provide comfort measures  Use pillows for support and encourage frequent turning and position changes  Screen and assess  Antiembolism or compression devices MEDICAL MANAGEMENT:  Conservation treatment if small  Chest tube insertion to help remove excess fluid o Drainage container will lead to nothing because there is just air build up o Chest x-ray before and after insertion o Daily x-ray checks to make sure tube remains in the correct place  Thoracotomy (pop the balloon)  CPR if cardiac arrest occurs  Repair of traumatic pneumothorax MEDICATIONS:  Pain management (Opioid analgesics)  Pleurodesis (intrapleural talc, doxycycline) o For repeated pneumothorax in a patient who is not a surgical candidate  VTE prophylaxis while patient is hospitalized  Supplemental oxygen therapy  Video-assisted thorascopic surgery (for recurrent primary or secondary spontaneous pneumothorax) PATIENT EDUCATION:  Chest tube education  Education on disease process  Education on deep breathing techniques  Importance of incentive spirometer  Relaxation and stress management techniques  Promote positive coping strategies

Medical Surgical Nursing Pneumothorax - Concept Map

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