Pathophysiology Of Pneumothorax

PATHOPHYSIOLOGY Of PNEUMOTHORAX A. Description 1. Pneumothorax is the accumulation of air in the pleural space, which results in partial or com-

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

Chest Cavity is open to outside Air from the lung enters the pleural space, pushing the lung away from the chest. plete lung collapse. 2. Types include: a.Tension pneumothorax: Air can enter the pleural space but cannot leave it.

phagus. c.Spontaneous pneumothorax: air enters the pleural space when airfilled blebs (blisters) on the lung surface rupture. B. Etiology 1. Tension pneumothorax results from unknown 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

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C. Pathophysiologic processes and manifestations 1. 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 occurring during inhalation) b.Increased respiratory rate c.Dyspnea d.Visible asymmetry of the chest, which results from rib fracture e.Hyperresonant lung sounds f. Decreased breath sounds over the area of pneumothorax g.Trachea deviating to the injured side h.Neck vain distention (resulting from greater amount of pressure in the thorax) i. Palpable subcutaneous emphysema (as air leaves the chest cavity and remains in the subcutaneous space) j. Shifting of mediastinal structures to unaffected side of the chest (caused by large pneumothorax) k.Hypoxemia (seen on ABG) and clinical signs of shock, such as low blood pressure and tachycardia (caused by large pneumothorax) 3. In tension pneumothorax, the onset of symptoms is sudden and painful. D. Overview of nursing interventions 1. 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 semiFowlers 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.