Pneumothorax - Nursing Lecture Overview

Introduction

• Presented by Sarah, a registered nurse from RN.com.
• Part of the respiratory system review series.
• Topics covered: Pathophysiology, types, signs & symptoms, and nursing interventions.
• Recommended to also watch the video on chest tube care.

Definition

• Pneumothorax: Collapsing of a lung due to air accumulation in the pleural space (between the visceral and parietal pleura).

Key Points

• Pneumothorax can be partial or total, usually affecting one lung.
• Causes include:
  • Spontaneous occurrences.
  • Trauma to the chest (blunt or penetrating).
  • Lung diseases or medical procedures (e.g., central line placement).
  • Mechanical ventilation can lead to barotrauma.
• Diagnosed through chest X-ray, ultrasound, or CT scan.
• Treatment options: Chest tube placement or needle decompression for large pneumothoraxes.

Pathophysiology

• Lung Anatomy:
  • Chest wall connected to parietal pleura.
  • Visceral pleura attached to lungs.
  • Intrapleural space contains serous fluid, creating negative pressure.
  • Lungs require negative pressure to remain inflated.
• Disruption: Air entry into pleural space leads to lung collapse.

Types of Pneumothorax

1. Closed Pneumothorax:

   • Air leaks without external wound.
   • Causes: Rib fracture, spontaneous defect in the alveolar wall.
   • Spontaneous pneumothorax can be primary (no lung disease) or secondary (with lung disease).

2. Open Pneumothorax:

   • Opening in chest wall, air passes between outside and pleural space.
   • Known as "sucking chest wound."
   • Nursing intervention: Apply sterile occlusive dressing taped on three sides.

3. Tension Pneumothorax:

   • Air enters pleural space but cannot escape, causing pressure buildup.
   • Medical emergency requires immediate treatment.
   • Results in compression of unaffected lung and mediastinal shift.

Signs and Symptoms

• Use mnemonic COLLAPSE:
  • C: Chest pain, Cyanosis.
  • O: Overt tachycardia & tachypnea.
  • L: Low blood pressure, Low SpO2.
  • A: Absent breath sounds on affected side.
  • P: Pushing of trachea to unaffected side.
  • S: Subcutaneous emphysema, Sucking sound.
  • E: Expansion of chest unequal, Difficulty breathing.

Nursing Interventions

• Monitor breath sounds and chest rise/fall.
• Check vital signs: BP, heart rate, respiratory rate, O2 saturation.
• Assess for subcutaneous emphysema.
• Administer oxygen as ordered.
• Position patient in Fowler's to ease breathing.
• For open pneumothorax, use sterile occlusive dressing.
• Maintain chest tube drainage system, watching for leaks.
• Ensure chest tube system functions properly and troubleshoot as needed.

Additional Considerations

• Watch for risk of tension pneumothorax in patients on mechanical ventilation.
• Needle decompression may be necessary to relieve tension.

Conclusion

• Visit RN.com for quizzes and additional resources.
• Video on chest tube care is highly recommended for in-depth understanding.