pneumothorax this video is part of an Inc Lex review series over the respiratory system so what I want to

be doing in this video is I'm going to be talking about the path oh 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 long due to
air accumulating in the pore space which the floor space is the space between the visceral and the
parotid pleura and it's also called the intrapleural space now before we dive into our pathos 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 spontaneously without any warning it can be caused by trauma to the chest like blunt trauma or
a penetrating trauma for instance if a patient was in a car wreck that airbag hitting the chest can cause it
or CPR or 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 in place
like saying a PICC line the you'll need to get a chest x-ray to make sure and there isn't a pneumothorax
and everything's good or mechanical ventilation we with a positive end expiratory pressure where a
barotrauma can happen and we'll really be talking about this with tension pneumothorax and how our
pneumothorax how's it diagnosed it's diagnosed usually with a chest x-ray and 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 Interflora space or needle decompression where they stick a needle
into that space and um aspirate the air and 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 pathophysiology of a pneumothorax so 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 Prato pleura and then you have in the white area that is the inter porous space and then
next the green is your visceral pleura which attaches to the lung and what happens in this Interflora
space you have small amounts of serous 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 I
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 will we
would get an open pneumothorax and all the air from out is entering into this space causing pressure to
push on that lung and collapse it or layer the visceral pleura ruptures and whenever it ruptures it
releases air that you're breathing in into that Interflora space which that is like a closed pneumothorax
or Barrow 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 want to hit on is things you need to know for your
nursing lecture exam and in clicks because they ask about specific and types of pneumothorax like
spontaneous open 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 leads into the interspace without an outside wound so the
key thing with this is that your chest wall which is here in red and your pleura 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 visceral pleura of the lungs so you have a tear and every time that person breathes 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 laughs 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 alveolar wall and the
visceral pleura and this causes what happens is that you develop a pulmonary bled and this is like a sack
like blister that developed on the visceral layer of the lungs and what can happen is that this web 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 intra
porous space and these bloods can develop over time patients can have multiple one multiple blabs and
they may not rupture immediately once they develop however some things that can increase a
pulmonary blood to rupture is like changes in air pressure if the patient and changes maybe altitude or
something like that or there is where the patient takes a sudden deep breath or they smoke now and
spontaneous pneumothorax is categorized by primary or secondary and let me go over those with you
real fast I'm you can have a primary spontaneous pneumothorax and this tends to occur in people
without lung disease they 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 intra pleural space so as
you can see in this illustration here you have the chest wall which is in red you have your product for
let's say that this patient was stabbed it's a big stab wound and what it's done is it's allowing its create
this open to allow inhale the exhaled air to pass back and forth so your pleura space is getting all this air
in and out and as it passes in and out you can hear a sucking sound this open to my works is sometimes
referred to as a sucking chest wound 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 interim pore
pressure pressure will become equal with the outside pressure which will lead to lung collapse because
remember your lungs thrive and negative pressure now in clips in clicks Tim thing you need to know
about open pneumothorax may see it on your nursing lecture exams or the NCLEX okay a nurse in your
dimension so 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 untape because this is going to a while exhaled air to leave the opening but seal
back over it when the patient's inhaling hence it's going to be tense it's going to help prevent a tension
pneumothorax so what is a tension pneumothorax a tension pneumothorax happens when it opening to
the inter polar space creates a one-way valve which leads air to collect in that interpolar 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 what the works can happen as a complication of a
pneumothorax such as an open or closed 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 increase thoracic pressure
and you get compression on the unaffected lung and the heart which is not good and you will get a
mediastinum shift where your heart your trachea your esophagus and best vessels are going to shift to
the unaffected side and this is going to cause major compression on your other lung and decrease
venous return because your vena cava 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 tacca panic they're going to try to breathe and
breathe butit's not going to work they're going to be hypoxic then and they're going to have
compression on that vena cava which drains the blood from your body to your heart to get reoxygenate
'add well what's going to happen is that your heart's going to become tachypnic you're going to I mean
tachycardic 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 tachycardic they're going to be tachycardic but they're going
to have hypotension because it's going to reduce your cardiac output and pretty much your patient is
going into shock and the patient can also have jugular venous distention now a late sign of this is
tracheal deviation that's going to happen late 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 peep that positive end expiratory pressure because they are at risk for
developing this due to what's called barotrauma which over time all that extra pressure on that lungs is
going to lead a lead to buildup of air in the Interflora space from rupture of the visceral pleura now if
this happens they will need treatment that the physician will do will be needle decompression well
needle in and aspirate that extra air that has built and help 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 remember the mnemonic collapsed because the pneumothorax is a
collapsed lung so 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 o4 avert tachycardia and tachypnea 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 l4 low blood pressure the other l4 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 collapsed lung you're not going to hear breath sounds on that side that has a
collapse on compared to the other side so you'd want to compare the sides see how they're sounding
next P for pushing of the trachea to the unaffected side remember that was in a tension pneumothorax
but remember if your patient has a pneumothorax or a chest tube they are at risk for a tension
pneumothorax so if you see that and it could be developing into that but remember that's a late sign
next s4 sub-q emphysema this is where a carbon dioxide 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 sub-q emphysema another s4

15:02

sucking sound and remember that was in

15:04

the open pneumothorax where you have

15:06

that passage through the chest wall that

15:10

is allowing air to go in and out of the

15:12

lungs through the opening of the chest

15:14

efore expand expansion of the chest will

15:18

be an equal so wherever you have the

15:21

collapse line remember it's not

15:22

inflating and deflating fully like

15:24

compared to the healthy lung on the

15:25
other side so you'll have unequal chest

15:27

rise and fall

15:28

and then D for dis Mia of course they're

15:31

going to have difficulty breathing

15:32

because they only probably have one lung

15:35

that's working appropriately now let's

15:36

look at the nursing interventions what

15:38

are you going to do for this patient as

15:40

the nurse who have it who has a

15:41

pneumothorax and you're going to of

15:43

course be monitoring the breath sounds

15:45

what do they sound like on this side

15:47

compared to the other side and you're

15:49

going to be watching the rise and the

15:51

fall of the chest

15:52

you'll be monitoring their bottle songs

15:54

especially their blood pressure their

15:56
heart rate the respiratory rate and

15:58

their oxygen saturation assessing for

16:01

that sub-q emphysema a ministry oxygen

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as ordered by the physician and its best

16:08

whenever a patient has a respiratory

16:10

issue to keep them in the head of the

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bed and Fowler's position to decrease

16:15

that effort of breathing and remember

16:18

whenever we talked about open

16:20

pneumothorax what you're going to do

16:21

with the dressing by using a sterile

16:24

cluesive dressing placing it over the

16:25

opening taping it on three sides and

16:27

leaving one side untaped so it'll allow

16:31

the air to escape and prevent a tension

16:33

pneumothorax and then another biggie is

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maintaining that chest tube drainage

16:38
system if it is placed by the position

16:41

and that's why I really recommend that

16:42

you watch that video on chest tubes

16:45

because it will really help you

16:46

understand how to care for them but let

16:48

me go over some highlights with you a

16:50

patient with the pneumothorax you would

16:52

want to make sure while you're

16:53

maintaining the drain that you're

16:55

assessing for leaks in the system the

16:57

test two drains drain system and make

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sure it's working appropriately how to

17:02

troubleshoot it a lot of NCLEX questions

17:05

and nursing exam questions like to ask

17:07

you well the drain came out what are you

17:09

going to do or the systems broken what

17:11

do you

17:11
to do because this stuff does happen in

17:13

real life and they want you to be

17:14

prepared for it next with a pneumothorax

17:18

just from where we've talked about the

17:20

anatomy and physiology of it we're

17:23

removing the chest tube is removing air

17:26

from the inter polar space so you may

17:29

have intermittent bubbling and that

17:30

water seal chamber as the air is

17:33

escaping but excessive bubbling in the

17:36

water soul chamber represents a leak

17:39

somewhere in your system so you want to

17:41

investigate and figure out where it is

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also as the patient breathes in and

17:45

breathe out the water seal chain chamber

17:48

will fluctuate up and down however a lot

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of questions like to ask you you've

17:54
noticed that it's quit fluctuating up

17:56

and down in the water soul chamber what

17:58

could it be

17:58

I'm either it's a kink somewhere in the

18:00

system or that lung has re-expanded so

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you want to assess those breath sounds

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and see what it sounds like ok so that

18:07

is about pneumothorax now go to my

18:09

website register nurse Orion comm and

18:11

take the free review quiz and be sure to

18:13

check out the other videos in this

18:14

series and thank you so much for

18:16

watching and please consider subscribing

18:17

to this YouTube channel

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