Pneumothorax - NCLEX Review

What is Pneumothorax?

• Definition: The collapse of a lung due to air accumulating in the pleural space (space between the visceral and parietal pleura).
• Effects: Can be partial or total collapse, usually affects one lung.

Causes of Pneumothorax

• Spontaneous: Occurs without warning.
• Trauma: Blunt or penetrating trauma (e.g., car accidents, CPR, gunshot wounds).
• Lung Disease: Complications from diseases.
• Medical Procedures: Complications from procedures like central line placement.
• Mechanical Ventilation: Positive end-expiratory pressure (PEEP) can lead to barotrauma.

Diagnosis

• Methods: Chest X-ray, ultrasound, CT scan.
• Treatment: Small pneumothoraxes may resolve on their own; larger ones require a chest tube or needle decompression.

Pathophysiology

• Anatomy Review: Lungs, pleural space, negative pressure necessary for lung inflation.
• Types: Air can enter via the chest wall (open pneumothorax) or from within the lung (closed pneumothorax).

Types of Pneumothorax

1. Closed Pneumothorax:
   • Air leaks into the pleural space without external wound.
   • Causes: Rib fracture, spontaneous pneumothorax.
   • Spontaneous Pneumothorax: Defect in alveolar wall or visceral pleura, can be primary or secondary.
2. Open Pneumothorax:
   • Opening in the chest wall allows air passage into the pleural space.
   • Known as "sucking chest wound."
3. Tension Pneumothorax:
   • Air enters the pleural space and cannot escape, increasing pressure.
   • Causes: Complication of other types, medical emergency.
   • Effects: Mediastinal shift, compression of heart and other lung.

Signs and Symptoms

• Mnemonics: COLLAPSE
  • C: Chest Pain
  • O: Overt Tachycardia and Tachypnea
  • L: Low Blood Pressure
  • L: Low SpO2
  • A: Absent breath sounds on affected side
  • P: Pushing of trachea to unaffected side (tension pneumothorax)
  • S: Subcutaneous Emphysema
  • S: Sucking Sound (open pneumothorax)
  • E: Expansion of chest wall is unequal
• Late Sign: Tracheal deviation.

Nursing Interventions

• Monitor breath sounds, chest rise, vital signs (BP, HR, RR, SpO2).
• Administer oxygen as ordered.
• Position patient in Fowler's position.
• Open Pneumothorax: Use sterile occlusive dressing, tape on three sides.
• Chest Tube Management: Assess for leaks, ensure proper function, troubleshoot.
  • Intermittent bubbling in water seal chamber indicates air escape.
  • No fluctuation may indicate a kink or re-expanded lung.

Additional Resources

• Recommended to watch related videos on chest tube care.
• Quiz and notes available on the registered nurse RN website.