hey everyone it's Sarah register nurse rn.com and in this video I'm going to be doing an inlex review over pumo thorax this video is part of an inlex review series over the respiratory system so what I'm going to be doing in this video is I'm going to be talking about the patho the different types of pneumothorax the signs and symptoms and the nursing interventions and I highly recommend that after you watch this video you also check out my video on chest tube care because chest tubes and pneumothorax go hand in hand so you can learn those nursing interventions and a card should be popping up so you can access that video after you watch this and as always over here on the side and in the description below you can access the quiz and the notes so let's get started first let's start out talking about what is a pneumothorax what is the definition of it well in a nutshell what it is is it's the collapsing of a lung due to air accumulating in the plor space which the plor space is the space between the V iseral and the paral plura and it's also called the intra plur space now before we dive into our patho signs and symptoms of nursing interventions let me go over some key points with you so you can remember and keep these in the back of your mind as we're discussing this stuff okay a pneumothorax can be partial or total um collapsing of a lung and it usually affects one lung causes of pneumothorax include it can happen spontan ously without any warning it can be caused by trauma to the chest like blunt trauma or a penetrating trauma for instance if a PA patient was in a car wreck that airbag hitting the chest can cause it or CPR or um a gunshot wound or a stabbing can cause air to go into that space other things lung disease a medical procedure like a central line placement a lot of times after a patient has a central line place like say a pick line the uh you'll need to get a chest x-ray to make sure and there is an anuma thorax and everything's good or mechanical ventilation with um positive in expiratory pressure where um barot trauma can happen and we'll really be talking about this with tension Nemo thorax and how are pneumothorax how is it diagnosed it's diagnosed usually with a chest x-ray an ultrasound or a CT scan small pneumothorax you can have small large they vary in size small ones tend to resolve on their own without treatment however if it's large and they will need treatment like a chest tube placement which will help drain that air out of the intor space or needle decompression where they stick a needle into that space and um aspirate the air and um again we'll really be hitting on that with the tension pneumothorax which is a medical emergency and that is one of the treatments for it now let's look at the path of physiology of a pneumothorax but first let's look at our lung Anatomy because it goes hand in hand okay here you have some lungs and what you see in red is the chest wall and attached to the chest wall is your paral plura and then you have in the white areas that is the intl space and then next the green is your visceral plural which attaches to the lung and what happens in this intor space you have small amounts of Cirrus fluid so as you breathe in and breathe out that fluid allows your lungs to Glide over one another without any pain and it creates a negative pressure and your lungs love negative pressure if anything is added into this space like with the pneumothorax your lungs collapse they do not like that so they thrive on negative pressure and this negative pressure acts like suction to keep your lungs inflated so in order to keep your lungs inflated you need that negative pressure now when air enters into the space it can happen again through like an object piercing through this chest wall we we would get an open numo thorax and all the air from outside is entering into this space causing pressure to push on that lung and collapse it or um a layer the visceral plora ruptures and whenever ruptures it releases Air that you're breathing in into that inor space which that is like a closed pneumothorax or barot trauma like with mechanical ventilation that can happen as well now as this air builds in this space what happens is that it decreases the ability of the lungs to recoil on that affected side so what happens is that lung gets pushed away from that chest wall and it leads to collapse and remember your lungs like negative pressure so they don't have that you're going to have some major problems now let's talk about the different types of pneumothorax what I'm going to hit on is things you need to know for your nursing lecture exam and inlex because they ask about specific um types of pneumothorax like spontaneous open uh closed or attention so let me go over those with you first let's talk about closed pneumothorax what is this this is where air leaks into to the intl space without an outside WB so the key thing with this is that your chest wall which is here in red and your plora are going to remain intact it's the opposite of what happens in an open pneumothorax which we'll go over here in a second so what can cause this one thing that can cause this is a rib fracture say that the person falls downstairs and breaks the rib you get a sharp bony prominence off of that broken rib it goes in it pierces through tears through that viscera plora of the lung so you have a tear and every time time that person breaths in and breathe out air is going to escape through that tear into this space which should not happen so what happens is that this space gets bigger and bigger as it just fills with air think about it like you're blowing up a balloon as you blow into the balloon it gets bigger and bigger and so that's what's going to happen because remember your lungs like negative pressure this is adding pressure to it so it's going to cause the lung to collapse another thing another common cause of a closed pneumothorax is what's called a spontaneous pneumothorax and this is where you have a defect in the avolar wall and the visceral plora and this causes what happens is that you develop a pulmonary blood and this is like a sack like blister that develops on the visceral layer of the lungs and um what can happen is that this BLB can rupture no warning sign that's why it's really called spontaneous because there wasn't an injury that caused it it just happened without warning and that blister ruptures and it releases Air into the interp space and these blbs can develop over time patients can have multiple one multiple blbs and um they may not rupture immediately once they develop however um some things that can increase a pulmonary blood to rupture is like changes in air pressure if the patient um changes maybe altitude or something like that or there is or the patient takes a sudden deep breath or they smoke now um spontaneous pneumothorax is categorized by primary or secondary and let me go over those with you real fast um you can have a primary spontaneous pneumothorax and this tends to occur in people without lung disease they tend tend to be young less than the age of 30 and tall and thin however you can have a secondary pneumothorax and this occurs in people with lung disease like COPD asthma cystic fibrosis things like that now let's look at open pneumothorax what is this this is where there is an opening in the chest wall that causes a passage between the outside air and the interpur space so as you can see see in this illustration here you have the chest wall which is in red and you have your prodl let's say that this patient was stabbed it's a big Stab Wound and what it's done is it's allowing it's create this opening to allow inhaled and exhaled air to pass back and forth so your plur space is getting all this air in and out and as it passes in and out you could hear a sucking sound this um open Doo thorx is sometimes referred to as a sucking chest swing because what's happening is that your body is shunting air through the chest wall instead of the trachea which is what it does during normal circumstances when you don't have a big gaping wound on your chest and it will create that sucking sound and the intor pressure pressure will become equal with the outside pressure which will lead to lung collapse because remember your lungs thrive in negative pressure now inlex inlex tip thing you need to know about open pneumothorax may see it on your nursing lecture exam or the inlex okay a nursing intervention say you have a patient come in they have a big open wound they have this what are you going to do nursing intervention would be to place a sterile occlusive dressing and tape it on three sides leaving the fourth side untaped because this is going to allow exhaled air to leave the opening but seal back over it when the patient's inhaling hence it's going to be hence it's going to help prevent a tension numo thorax so what what is a tension pneumothorax a tension pneumothorax happens when an opening to the interpolar space creates a one wave valve which leads air to collect in that intol space But it cannot Escape so it just keeps building and building and building and this is a medical emergency that patient needs treatment immediately and attention in thorax can happen um as a complication of a pneumothorax such as an open or close so as you can see from this drawing here pressure is just building and building and building and as that pressure builds this leads to increased thoracic pressure and you get compression on that unaffected lung and the heart which is not good and you will get a medianum shift where your heart your trachea your esophagus and V vessels are going to shift to the unaffected side and this is going to cause major compression on your other lung and decrease Venus return because your Vena is being compressed so what's going to happen you're going to see these certain signs and symptoms in this patient and I would remember this what's going to happen is the patient's going to try to compensate because they are air hungry because they have limited amount of breathing room so they're going to become tpic they're going to try to breathe and breathe but it's not going to work they're going to be hypoxic then um they're going to have compression on that vnea which drains the blood from your body to your heart to get reoxygenated well what's going to happen is that your heart's going to become tpic you're going I mean tartic you're going to increase your heart rate because it's noticing that you're not getting blood to all those organs and tissues that you need but there's nothing to pump because of that compression on those great vessels so you're going to have Tac cardic they're going to be Tac cardic but they're going to have hypotension because it's going to reduce your cardiac output and pretty much much your patient is going into shock and the patient can also have jugular Venus distension now a late sign of um this is tracheal deviation that's going to happen L later on whenever things are really really bad so if you see that not good it's very late now one thing I want to touch on you need to watch patients who are on mechanical ventilation with pee that positive in expiratory pressure because they are at risk for developing this due to what's called barot trauma which um over time all that pre extra pressure on that lungs is going to lead up lead to buildup of air in the inl space from rupture of the visceral plora now if this happens they will need treatment that the physician will do will be needle decompression well they'll insert a needle in and aspirate that extra air that has built and helped relieve all that tension that is going on now let's look at the major signs and symptoms that a patient could have when they have a pneumothorax and to help you remember it um remember the pneumonic collapse because a pneumothorax is a collapse lung so um each letter will correlate with the sign and symptom Okay C for chest pain patient may complain of chest pain all of a sudden that is sharp and could be worse on inspiration also another C for cyanosis just where they're not getting oxygenated good you can see blue around the lips the skin tone could turn a bluish color next o for avert tacac cardia and tpen that is where the body is trying to compensate for that low oxygen level that's going on the heart's trying to pump faster to get blood to the body because it has low oxygen level and the body's causing the respiratory system to increase in respiration so you can take more oxygen in L for low blood pressure the other L for low spo2 if you have them on an spo2 monitor you may notice that it would be less than 90% a for absent breath sounds on the affected side if they have a collapse lung you're not going to hear breath sounds on that side that has a collapse lung compared to the other side so you'd want to compare the sides see um how they're sounding next p for pushing of the trachea to the unaffected side remember that was in attention pneumothorax but remember if your patient has a Neo thorax or a chest tube they are at risk for attention pneumothorax so if you see that um it could be developing into that but remember that's a late sign next s for subq osma this is where um carbon do oxide can escape into the skin so you may see these little bulging areas maybe in the face the neck the lung I mean the abdomen and whenever you feel it it's like a crunchy feeling to it and this is known as subq osma another s for sucking sound and remember that was in the open pneumothorax where you have that Passage through the chest wall that is allowing air to go in and out of the lungs through that opening of the chest e for expand expansion of the chest will be unequal so wherever you have the collapse lung remember it's not inflating and deflating fully like compared to the healthy lung on the other side so you'll have unequal chest rise and fall and then D for dmia of course they're going to have difficulty breathing because they only probably have one lung that's working appropriately now let's look at the nursing interventions what are you going to do for this patient as the nurse who have who has a pneumothorax um you're going to of course be monitoring the breath sounds um what do they sound like on this side compared to the other side and you're going to be watching The Rise and the fall of the chest you're going to be monitoring their Vital Signs especially their blood pressure their heart rate their respiratory rate and their oxygen saturation uh assessing for that subq osma administering oxygen as ordered by The Physician um it's best whenever a patient has a respiratory issue to keep them in uh the head of the bed in Fowler's position to decrease that effort of breathing and remember whenever we talked about open pneumothorax what you're going to do with the dressing by um using a sterile clusive dressing placing it over the opening taping it on three sides and leaving one side untape so um it'll allow the air to escape and prevent attention pneumothorax and then another biggie is maintaining that chest tube drainage system if it is placed by The Physician and that's why I really recommend that you watch that video on chest tubes because it'll really help you understand how to care for them but let me go over some highlights with you um a patient with a pneumothorax you would want to make sure while you're maintaining the drain that you're assessing for leaks in the system the chest two drain drain system and make sure it's working appropriately how to troubleshoot it a lot of inlex questions and nursing exam questions like to ask you well the drain came out what are you going to do or the system's broken what do you want to do because this stuff does happen in real life and they want you to be prepared for it next um with a numo thorax just from where we've talked about the anatomy and phys the pathopysiology of it we're removing the chest tube is removing air from the interpolar space so you may have intermittent bubbling in that water seal chamber as the air is escaping but excessive bubbling in the water s chamber represents a leak somewhere in your system so you want to investigate it and figure out where it is also as the patient breathes in and breathes out the water SE seal Cham chamber will fluctuate up and down however um a lot of questions like to ask you you've noticed that it's quit fluctuating up and down in the water sell chamber what could it be um either it's a kink somewhere in the system or that lung has re-expanded so you want to assess those breath sounds and see what it sounds like okay so that is about pneumothorax now go to my website register nurse rn.com and take the free review quiz and be sure to check out the other videos in this series and thank you so much for watching and please consider subscribing to this YouTube channel