Pneumothorax

Introduction:

The pleural sac surrounding the lung normally contains a small amount of fluid to
prevent friction as the lungs expand and relax during the respiratory cycle. When air
is allowed to enter the pleural space between the lung and the chest wall, a pnuemo-
thorax develops. This air pocket takes up space that is normally occupied by lung
tissue, causing an area of the lung to partially collapse. If there is a penetrating chest
wound, the patient may have an open pneumothorax, also known as a sucking
chest wound (for the sound it makes during breathing). A closed pneumothorax
may be caused by blunt trauma, post-central line insertion, or post-thoracentesis.
Spontaneous pneumothorax may be secondary to another disease or occur on its
own. As the air accumulates, there may be a partial or complete collapse of the
lung—the more air that accumulates, the greater the area of collapse. If there is a
large enough amount of air trapped between the pleural layers, the tension within
the area increases. This increase in tension results in pushing the mediastinum
toward the unaffected lung, causing it to partially collapse and compromising
venous return to the heart. This is a tension pneumothorax.

PROGNOSIS
Prognosis will vary depending on causes and size of pneumothorax. Any pneumo-
thorax that enlarges or progresses to a tension pneumothorax is a greater risk for
the patient. Tension pneumothorax presents a life-threatening situation. A small
area of pneumothorax may be monitored without intervention while a larger area
requires treatment for resolution of the problem.

SIGNS AND SYMPTOMS

• Sharp chest pain, made worse by activity, moving, coughing, and breathing
• Shortness of breath due to inability to fully expand the lungs during inspiration
• Absent breath sounds over the affected area due to presence of air between
lungs and chest wall
• Subcutaneous emphysema (presence of air in the tissue beneath the skin)—
a crackling feeling beneath the skin on palpation over the area
• Tachycardia (increased heart rate) and tachypnea (increased respiratory rate)
as body attempts to meet needs
• Mediastinal shift and tracheal deviation toward the unaffected side with ten-
sion pneumothorax

TREATMENT
Once identified, a pneumothorax can be treated and completely resolved. A ten-
sion pneumothorax can become a life-threatening condition. Careful monitoring
and early intervention is critical for these patients. A small area may resolve with-
out intervention, but the patient will still be monitored until resolution.
• Bedrest.
• Supplemental oxygen if needed.
• Chest tube connected to suction to re-expand lung if needed.
• Administer analgesic if needed:
• morphine

NURSING DIAGNOSES
• Acute pain
• Ineffective breathing
• Impaired gas exchange

NURSING INTERVENTION
• Place patient in high Fowler’s or semi-Fowler’s position to ease respiratory
effort.
• Monitor drainage of the chest tube for amount and characteristics of output.
Note changes.
• Monitor respirations for rate, effort, use of accessory muscles, skin color, and
breath sounds.
• Teach turning, coughing, and deep-breathing exercises.
• Explain to the patient:
• Disease process.
• Importance of coughing and deep breathing.
• Monitor vital signs for changes.