PATHOPHYSIOLOGYOf

PNEUMOTHORAX

A. Description1. Pneumothorax is the accumulation of

air in the pleural space, which results in partial or complete lung collapse.

2. Types include:a.Tension pneumothorax: Air can

enter the pleural space but can-not leave it.

b.Secondary pneumothorax: Air enters the pleural space as a re-sult of injury to the chest wall, respiratory structures, or esophagus.

c. Spontaneous pneumothorax: air enters the pleural space when airfilled blebs (blisters) on the lung surface rupture.

B. Etiology1. Tension pneumothorax results from un-

known causes.2. Secondary pneumothorax is caused by

injury to the chest wall resulting from trauma (such as crushing injuries0 or from punctures (such as stab wounds or gunshot wounds).

3. Spontaneous pneumothorax is caused by a ruptured bleb and is seen more commonly on smokers.

Air from the lung enters the pleural space, pushing the lung away from the chest.

Chest Cavity is open to outside air

C. Pathophysiologic processes and manifestations1. Severity of symptoms depends on the

size of the injury and amount of lung tissue left intact.

2. Symptoms can include:a.Pleuritic pain (a sharp pain oc-

curring during inhalation)b.Increased respiratory ratec. Dyspnead.Visible asymmetry of the chest,

which results from rib fracturee.Hyperresonant lung soundsf. Decreased breath sounds over

the area of pneumothoraxg.Trachea deviating to the injured

sideh.Neck vain distention (resulting

from greater amount of pres-sure in the thorax)

i. Palpable subcutaneous emphy-sema (as air leaves the chest cavity and remains in the sub-cutaneous space)

j. Shifting of mediastinal struc-tures to unaffected side of the chest (caused by large pneu-mothorax)

k.Hypoxemia (seen on ABG) and clinical signs of shock, such as low blood pressure and tachy-cardia (caused by large pneu-mothorax)

3. In tension pneumothorax, the onset of symptoms is sudden and painful.

D. Overview of nursing interventions1. Monitor vital signs, checking for signs of

shock (e.g., low blood pressure and tachycardia).

2. Observe the patient’s respirations (rate and depth); breathing pattern changes may indicate a worsening condition.

3. Position the patient in a semi-Fowlers position.

4. Monitor oximetry.5. Administer oxygen if necessary.6. Administer analgesics as prescribed.7. For a patient with chest tubes:

a.Maintain sterile dressing at chest tube insertion site.

b.Maintain patency and integrity of the closed chest drainage system and suction as ordered.

c. Evaluate amount of fluid and breath sounds to determine progress of closed chest drainage.

d.Assess for sign and symptoms of wound infection.

e.Assess for fear and anxiety and institute appropriate measures for alleviation and relief.