Republic of the Philippines

Bicol University
COLLEGE OF NURSING
Legazpi City 4500
Telefax: 052-480-0610

CRITICAL THINKING: WHAT SHOULD YOU DO?

Case Scenario
A victim of a gunshot wound to the chest sustained a penetrating injury. The emergency medical
response team applied a nonporous dressing over the victim’s sucking chest wound at the site of
the accident. On arrival at the emergency department, the victim is cyanotic, and the nurse notes
subcutaneous emphysema (crepitus) and tracheal deviation away from the affected side. What
should the nurse do?

Answer
Pneumothorax is defined as the buildup of atmospheric air in the pleural cavity, which
causes partial or full lung collapse, usually as a result of a chest injury. Most of the time, venous
return to the heart is obstructed, resulting in a life-threatening condition termed tension
pneumothorax, as in this example. This is a potential exacerbation of pneumothorax/sucking
chest wound. Pneumothorax is diagnosed using a chest x-ray, though it has also manifestations
like cyanosis, subcutaneous emphysema as palpable crepitus, tracheal deviation to the unaffected
side with tension pneumothorax, sucking sound with an open chest wound, and so on (Cipcon,
2021) The mentioned signs were shown in the scenario above.
With all of this information, the nurse should promptly release the chest wound dressing
after doing a quick examination of the client in the ER. The rationale behind is that the increase
of intrathoracic pressure in the pleural space induced by the covering of the open chest incision
generated tension pneumothorax (Silvestri, L. A., & Silvestri, A. E., 2017). According to an
article by Rod Brouhard, EMT-P (2019) on the website 'Verywell Health', the air must be
allowed to escape because if the pressure builds up too high, the person may develop
dangerously low blood pressure (shock) and would most likely die. Removing the dressing will
most likely relieve the pressure and restore balance.
 The nurse should also notify the client's health care provider, deliver oxygen as indicated,
and place the client in a Fowler's position (Cipcon, 2021). This is a medical emergency that may
necessitate needle decompression and the placement of a chest tube with a chest drainage system
(Silvestri, L. A., & Silvestri, A. E., 2017). When a nurse assists with a needle thoracentesis
procedure, he or she assists with positioning the client (preferably upright), exposing the anterior
chest, and preparing the materials requested by the physician. These are usually 14-gauge or 10-
gauge, 3.25-inch needle/catheter, alcohol swab, and gloves. Afterwards, the nurse should get the
client ready for the chest tube placement. For this, here are some of the nurse's responsibilities:
• assisting with the signing of informed consent;
• collect all necessary supplies, including lidocaine, antiseptic, sterile gloves, scalpel &
hemostat, suture materials, and of course a chest tube;
• keeping the client supine with the afflicted side's arm raised above the head; and
• sedative and pain medication administration.
• During the operation, the nurse will keep an eye on the client's heart rate since low
oxygen levels might trigger an arrhythmia.
• Since the chest tube will be in place until the lung has fully expanded (Cipcon, 2021), it's
crucial to keep an eye on the chest tube drainage system, look for signs of subcutaneous
emphysema, and report any untoward findings to the assigned physician.
Overall, if the client is cognizant, the nurse should always explain what's going on to him
or her, or to his or her support persons if the nurse isn't constantly there at bedside. In a critical
care situation, encompassed in the nurse's vital roles are providing emotional support and
addressing the client's and family's questions.

REFERENCES
Cipcon, C. J. (2021, November 6). Respiratory Disorders of the Adult Clients in CCU [Slides].

Google Slides.

https://docs.google.com/presentation/d/1MV2TWDr8UfsV1qKhyJLl3U5HiIECJYRseE-

od3WtPb4/edit#slide=id.p1
Silvestri, L. A., & Silvestri, A. E. (2017). Saunders comprehensive review for the NCLEX-RN

examination (7 edition.). St. Louis, Missouri: Elsevier.

Brouhard, R. (2019, October 17). First Aid Treatment for a Sucking Chest Wound. Verywell

Health. https://www.verywellhealth.com/how-to-treat-a-sucking-chest-wound-1298891

Name of the Student: Keisha Therese V. Bartolata Date: November 6, 2021

Year and Section: BSN-IV A