ORAL EXAM CASE REVIEWER

Pneumothorax

A. DESCRIPTION
[Short Description of the disease w/c includes Clinical Manifestation, Prevalence, Incubation, Origin]
A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and
visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse. Pneumothoraces can be even further classified
as simple, tension, or open. A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax. An open pneumothorax
also is known as a "sucking" chest wound.
Primary spontaneous pneumothorax mostly occurs at 20-30 years of age. The majority of recurrence occurs within the first year, and incidence
ranges widely from 25% to 50%. The recurrence rate is highest over the first 30 days. Secondary spontaneous pneumothorax is more seen in old age
patients 60-65 years. The risk of spontaneous pneumothorax in heavy smokers is 102 times higher than in non-smokers.

Types:
● Primary spontaneous pneumothorax
● Secondary spontaneous pneumothorax
● Traumatic pneumothorax
● Tension pneumothorax
● Iatrogenic pneumothorax
● Pneumomediastinum

B. FOCUS ASSESSMENT (SIGNS AND SYMPTOMS)

SUBJECTIVE OBJECTIVE
 ● Chest pain is pleuritic, sharp, severe, and radiates to the ipsilateral
shoulder.
● Dyspnea
● Shortness of breath
● Respiratory discomfort
C. DIAGNOSTIC AND LABORATORY TESTS
DIAGNOSTIC TESTS
1. Chest Radiography/ Chest ● [Rationale]
X-Ray ○ It can help your healthcare
provider see how well your
lungs and heart are working.
Certain heart problems can
cause changes in your lungs.
Certain diseases can cause
changes in the structure of the
heart or lungs.
● [Indication]
○ Chest pain
○ Chest injury
○ Shortness of breath
○ Persistent Coughing
● [Range Values]
○ Normal
■ Hollow structures
containing mostly air,
such as the lungs,
normally appear dark. In
a normal chest X-ray, the
chest cavity is outlined on
● Shortness of breath
● Tachycardia of more than 134 beats per minute
● Hypotension
● Jugular venous distension
● Decreased tactile fremitus
● Increased respiratory rate
● Hyperresonant percussion note
● Decreased intensity of breath sounds or absent breath sounds
● Asymmetrical lung expansion
● Cyanosis
LABORATORY TEST
● [Rationale]
○ are an important routine
investigation to monitor the
acid-base balance of patients.
They may help make a
diagnosis, indicate the severity
of a condition and help to assess
treatment. ABGs provide the
following information:
■ Oxygenation
■ Adequacy of ventilation
1. Arterial blood gasses (ABG) ■ Acid-base levels
● [Indication]
○ Any severe illness which may
lead to a metabolic acidosis -
for example:
■ Cardiac failure.
■ Liver failure.
■ Renal failure.
■ Hyperglycaemic states
associated with diabetes
mellitus.
 each side by the white ■ Multiorgan failure.
bony structures that ■ Sepsis.
represent the ribs of the ■ Burns.
chest wall. ■ Poisons/toxins.
○ Abnormal ○
■ Visible visceral pleural ● [Range Values]
edge is seen as a very ○ Normal
thin, sharp white line ■ Partial pressure of oxygen
■ No lung markings are (PaO2): 75 - 100 mmHg
seen peripheral to this line ■ Partial pressure of carbon
■ Peripheral space is dioxide (PaCO2): 38 - 42
radiolucent compared to mmHg
the adjacent lung ■ Arterial blood pH of 7.38 -
■ Lung may completely 7.42
collapse ■ Oxygen saturation (SaO2):
■ Mediastinum should not 94 - 100%
shift away from the ■ Bicarbonate - (HCO3): 22 -
pneumothorax unless a 28 mEq/L
tension pneumothorax is
present (discussed
separately)
■ Subcutaneous
emphysema and
pneumomediastinum may
also be present
 ***pneumothorax present***

2. Ultrasonography/ Ultrasound ● [Rationale] 2. Hemoglobin Blood Test ● [Rationale]

○ Ultrasound has a higher ○ A hemoglobin test measures
sensitivity than the traditional the levels of hemoglobin in
upright anteroposterior chest your blood. Hemoglobin is a
radiography (CXR) for the protein in your red blood
detection of pneumothorax. cells' that carries oxygen from
Small occult pneumothoraces your lungs to the rest of your
may be missed on CXR body.
during a busy trauma ● [Indication]
scenario, and CXR may not ○ Weakness
always be feasible in critically ○ Fatigue
ill patients. Sonographic ○ Shortness of breath
signs, including ‘lung ○ Dizziness
sliding’, ‘B-lines’ or ‘comet ● [Range Values]
tail artifacts’, ‘A-lines’, and ○ Normal
‘the lung point sign’ can help ■ Hgb: 11.7-17.4 g/dL
in the diagnosis of a ○ Abnormal
pneumothorax. ■ Decreased, indicating
● [Indication] blood loss
○ The most common clinical
indication was to assess a
pleural effusion, but other
indications included
assessment of diaphragmatic
function, pleural thickening,
and chest wall masses.
● [Range Values]
○ Normal
■ The normal lung interface
with pleura shows lung
sliding with z-lines,
which appear as vertical
comet tails running down
from the pleural surface.
 ***B-lines/ comet tail***
○ Abnormal
■ Bilateral absence of
B-lines/comet tail
artifacts from the pleura
with loss of the lung pulse
and sliding, and
subsequent discovery of a
lung point in a typical
location

3. CT Scan ● [Rationale]
○ CT is considered the gold
standard in the diagnosis of
pneumothorax. Thoracic
ultrasound has more
sensitivity than a supine chest
radiograph for the
identification of
pneumothorax after blunt
trauma. The other advantage
of ultrasound is that it can be
used at point-of-care.
● [Indication]
○ signs or symptoms of chest
disease
■ Cough
 ■ Trauma
■ Pulmonary Embolism
■ Tumor
■ Empyema
■ Shortness of breath
■ Chest pain
■ Fever
● [Range Values]
○ Normal
■ The lungs and airways
are normal. No pleural
effusion or thickening.
Heart size is normal. No
pericardial effusion. The
mediastinum structures
have normal
configurations. The chest
wall is unremarkable.
○ Abnormal
■ Bullous disease is
present, and a loculated
pneumothorax may
appear similar.

D. RISK FACTORS

Most Common
1. Chest Trauma
2. Rib Fracture
3. Car Accident
4. Gun Shot
5. Stab Wounds
6. Chest Surgery
7. Thoracentesis

Risk factors for Primary spontaneous pneumothorax Diseases associated with Secondary spontaneous pneumothorax
● Smoking ● COPD
● Tall thin body habitus in an otherwise healthy person ● Asthma
● Pregnancy ● HIV with pneumocystis pneumonia
● Marfan syndrome ● Necrotizing pneumonia
● Familial pneumothorax ● Tuberculosis
● Sarcoidosis
● Cystic fibrosis
● Bronchogenic carcinoma
● Idiopathic pulmonary fibrosis
● Severe ARDS
● Langerhans cell histiocytosis
● Inhalational drug use like cocaine or marijuana

Causes of Traumatic pneumothorax Causes of Tension pneumothorax

● Penetrating or blunt trauma ● Penetrating or blunt trauma

● Rib fracture ● Barotrauma due to positive pressure ventilation
● Diving or flying ● Percutaneous tracheostomy
● Conversion of spontaneous pneumothorax to tension
● Open pneumothorax when occlusive dressing work as one way
valve

Causes of Iatrogenic pneumothorax Causes of Pneumomediastinum

● Pleural biopsy ● Asthma
● Transbronchial lung biopsy ● Parturition
● Transthoracic pulmonary nodule biopsy ● Emesis
● Central venous catheter insertion
 ● Tracheostomy ● Severe cough
● Intercostal nerve block ● Traumatic disruption of oropharyngeal or esophageal mucosa
● Positive pressure ventilation

E. PATHOPHYSIOLOGY
 PATHOPHYSIOLOGIC PROCESS The pathophysiology of pneumothorax include:
1. Chest injuries ● Negative pressure. The negative pressure
2. Atmospheric air positive pressure enters pleural is required to maintain lung inflation.
space ● Breach. When either pleura is breached, air
3. Collapse of lungs enters the pleural space.
4. Decrease total lung capacity, vital capacity, lung ● Collapse. When positive pressure has
volume, lung compliance entered the pleural space, the lung or a
portion of it collapses.
A pneumothorax occurs when air collects in the
pleural space around the lung. A hemothorax occurs
when blood collects in the pleural space around the
lung. A tension pneumothorax occurs when the
pressure is so great that it puts pressure on the heart
and major blood vessels – therefore decreasing
cardiac output – this is a medical emergency. This
pressure makes the lung unable to expand, therefore
it causes the lung to collapse.

The pressure gradient inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is negative when compared to atmospheric
pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between parietal and visceral pleurae. Lungs have a tendency
to collapse due to elastic recoil. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit
equilibrium is achieved, or the rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases.
Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath.

F. NURSING DIAGNOSES (BY PRIORITY - 5)

1. Acute pain related to chest injury as evidenced by chest pain
2. Ineffective airway clearance related to airway obstruction secondary to pneumothorax
3. Ineffective breathing pattern related to decreased lung expansion as evidenced by shortness of breath
4. Impaired gas exchange related to altered oxygen supply
5. Risk for Trauma related to collapsed lung and chest tube placement

G. NURSING CARE PLAN (3 PRIORITY PROBLEM)

NCP 1 (ACTUAL PROBLEM)

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Acute pain Any blunt or SHORT TERM NIC: Pain Management NOC: Pain Level
> Verbalization of related to chest penetrating injury After 30 After 30 minutes of
pain in the chest injury as to your chest can minutes of INDEPENDENT nursing intervention,
> 8/10 score in the cause lung collapse. nursing the patient is able to:
evidenced by
pain scale Some injuries may intervention, the Assess characteristics of Information about the pain ● MET. The patient
chest pain happen during patient will be pain, location, pain scale. helps in analyzing for optimal experiences a
Objective physical assaults or able to: observe and report the pain interventions for the reduction in pain
> Report of Chest car crashes, while ● The patient changes in pain as patient and a lower score
 pain others may experiences appropriate. on the pain scale.
> Changes in BP, inadvertently occur a reduction ● MET. The patient
pulse, and during medical in pain and These methods can be taught will be able to
Provide diversional activities
respiratory rate procedures. The a lower reduce and provide comfort by understand and
● Imagery
> Guarding position increased air score on the altering psychological demonstrate
● Meditation
of the affected area pressure from pain scale. responses to pain relaxation
> Restlessness continuous air ● The patient techniques
> Report of chest pain accumulation can will be able Nurses can provide assistance ● MET. The patient
Provide comfort measures and
also cause pain for to in patient comfort by proper will have stable
non-pharmacologic pain
the patient understand positioning, pillow support vital signs
management.
and and temperature management
demonstrate
relaxation Provide quiet and calm To avoid stimuli and reduce LONG TERM
techniques environment anxiety to the patient After 8 hours of
● The patient nursing intervention,
will have DEPENDENT the patient is able to
stable vital ● MET. The patient
signs Administer pharmacological Pain can be managed by using reports a
pain relief as prescribed by the medications such as opioid satisfactory pain
physician analgesics and NSAIDs level with a 0/10
LONG TERM score in pain scale
After 8 hours of Assist in the patient ● MET. The patient
nursing Administer oxygen as respiration to maintain will be able to
intervention, the prescribed by the physician adequate oxygenation to the maintain stable
patient will be body vital signs
able to
● The patient
reports a
COLLABORATIVE
satisfactory
pain level to open the chest wall
with 0/10 surgically. The chest wall is
score in pain Prepare the patient for opened surgically to remove
scale Thoracotomy
the blood or air trapped in
● The patient the pleural space
will be able
to maintain
stable vital
signs
 NCP 2 (RISK DIAGNOSIS)

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Ineffective Ineffective airway SHORT TERM NIC: Airway Management NOC: Airway
> Patient verbalizes airway clearance clearance occurs After 30 Patency
difficulty of related to airway when an artificial minutes to 1 INDEPENDENT SHORT TERM
breathing and airway is used hour of nursing After 30 minutes to 1
obstruction The position maximizes
shortness of breath because normal intervention, the hour of nursing
secondary to mucociliary patient will be Elevate the position of the inhalations, making the patient intervention, the
Objective pneumothorax. A transport able to: patient (Fowler’s Position) more comfortable which patient is able to:
> High Respiratory pneumothorax mechanisms are ● Verbalize decreases work of breathing. ● MET. Verbalize
Rate >20 can either be bypassed and decrease in decrease in
> Tachycardia >100 impaired. difficulty of It can detect changes in the difficulty of
spontaneous or
> Labored breathing Monitor oxygen saturation oxygen level in the blood, breathing
secondary to levels alerting healthcare providers
Respirations ● Improved ● MET. Improved
another existing for low levels of oxygen.
> Low SpO2 airway airway clearance
Saturation <95% condition. clearance and oxygenation
Penetrating chest Encourage patient for bed rest
> Breath sounds are and Reducing oxygen use and by applying
trauma allows air and to limit their activities.
absent on the oxygenation demand may help to alleviate pharmacological
Provide rest periods between
affected side to enter the by applying symptoms. and non
care activities.
> Hyperressonance in pleural space pharmacolo pharmacological
the thorax gical and interventions
with the dependent portion
non Apply dressing in 3 sides
open, it allows blood and air
pharmacolo adhered to the chest LONG TERM
to escape the wound.
gical After 8 hours of
intervention to introduce a catheter into the nursing intervention,
s pleural space, thus producing the patient will be able
Perform needle
a pathway for the air to escape to:
decompression on the patient
LONG TERM and relieving the built-up ● MET. Display
After 8 hours of pressure. improved oxygen
nursing exchange via
intervention, the DEPENDENT laboratory results
patient will be ABG
able to: ● MET. Maintain
Assist in the patient
● Display oxygen saturation
Administer oxygen as respiration to maintain
improved of <95%
prescribed by the physician adequate oxygenation to the
oxygen ● MET. Maintain
body
exchange patency of
 via Provide medications, as Reduces airway resistance for patient’s airway
laboratory prescribed by the physician, the patient
results ABG
● Maintain To allow draining of the
oxygen pleural spaces of air, blood or
saturation of Insert chest tube as prescribed fluid, allowing expansion of
<95% by the physician the lungs and restoration of
● Maintain negative pressure in the
patency of thoracic cavity.
patient’s
airway COLLABORATIVE

Monitor laboratory values Further monitor patient’s

such as arterial blood gases oxygenation

NCP 3 (READINESS/DISCHARGE DIAG)

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Ineffective When there is SHORT TERM NIC: Respiratory Monitoring NOC: Ventilation
> Patient verbalizes breathing pattern communication After 30 SHORT TERM
difficulty of related to between the alveoli minutes to 1 INDEPENDENT After 30 minutes to 1
breathing and and the pleural hour of nursing hour of nursing
decreased lung The position maximizes
shortness of breath space, air fills this intervention, the intervention, the
expansion as space changing the patient will be Elevate the position of the inhalations, making the patient patient is able to:
Objective evidenced by gradient, lung able to: patient (Fowler’s Position) more comfortable which ● MET. Have
> High shortness of collapse unit ● Have decreases work of breathing. improved
Respiratory breath equilibrium is improved breathing patterns
Rate >20 achieved, or the breathing It can detect changes in the with decreased
> Tachycardia rupture is sealed. patterns Monitor oxygen saturation oxygen level in the blood, shortness of
>100 Pneumothorax with levels alerting healthcare providers breath, as
> Labored enlarges, and the decreased for low levels of oxygen. evidenced by the
Respirations lung gets smaller shortness of lack of tachypnea
Encourage patient for bed rest
> Low SpO2 due to this vital breathes, as Reducing oxygen use and ● MET. Have stable
and to limit their activities.
Saturation capacity, and evidenced demand may help to alleviate vital signs
Provide rest periods between
<95% oxygen partial by the lack symptoms. > Respiratory Rate
care activities.
pressure decreases. of Deep breathing exercise > Oxygen Saturation
Educate patient about proper
A collapsed lung tachypnea improve ventilation and > Pulse Rate
breathing techniques
reduces lung ● Have stable maintain health status
capacity, impairs vital signs LONG TERM
respiration, and > Respiratory After 8 hours of
accessory muscle is Rate nursing intervention,
used, therefore > Oxygen DEPENDENT the patient is able to:
there is the Saturation
presence of > Pulse Rate Assist in the patient ● MET. Maintain
shortness of breath Administer oxygen as respiration to maintain stable vital signs
LONG TERM prescribed by the physician adequate oxygenation to the ● MET. Maintain
After 8 hours of body oxygen saturation
nursing of <95%
Medications such as
intervention, the ● MET, Patient
bronchodilators,
patient will be verbalizes no
corticosteroids,
able to: shortness of
mucolytics/expectorants,
● Maintain Provide medications, as breath, the
antibiotics/anti-inflammatory
stable vital prescribed by the physician, difficulty of
agents relaxes smooth
signs breathing
respiratory musculature,
● Maintain
reduce airway edema, and
oxygen
mobilize secretions.
saturation of
<95%
● Patient
verbalizes COLLABORATIVE
no shortness
of breath, Chest x-ray and CT scan
difficulty of monitor prognosis and the
breathing Prepare patient for diagnostic
condition of the patient to
procedures
provide appropriate
interventions
H. NURSING MANAGEMENT/INTERVENTION
● Assess characteristics of pain, location, pain scale. observe and report the changes in pain as appropriate.
○ Information about the pain helps in analyzing for optimal pain interventions for the patient
● Assess the Tracheal alignment, Expansion of the chest, Breath sounds, Percussion of the chest.
○ used to identify ventilation problems and airway obstruction in the patient
● Provide diversional activities : Imagery,Meditation
○ These methods can be taught reduce and provide comfort by altering psychological responses to pain
● Provide comfort measures and non-pharmacologic pain management.
○ Nurses can provide assistance in patient comfort by proper positioning, pillow support and temperature management
● Provide quiet and calm environment
○ To avoid stimuli and reduce anxiety to the patient
● Administer pharmacological pain relief as prescribed by the physician
○ Pain can be managed by using medications such as opioid analgesics and NSAIDs
○ Reduces airway resistance for the patient
○ Assist in the patient respiration to maintain adequate oxygenation to the body
● Administer oxygen as prescribed by the physician
○ Assist in the patient respiration to maintain adequate oxygenation to the body
● Elevate the position of the patient (Fowler’s Position)
○ The position maximizes inhalations, making the patient more comfortable which decreases work of breathing.
● Monitor oxygen saturation levels
○ It can detect changes in the oxygen level in the blood, alerting healthcare providers for low levels of oxygen.
● Encourage patient for bed rest and to limit their activities. Provide rest periods between care activities.
○ Reducing oxygen use and demand may help to alleviate symptoms.
● Apply dressing in 3 sides adhered to the chest
○ with the dependent portion open, it allows blood and air to escape the wound.
● Perform needle decompression on the patient
○ to introduce a catheter into the pleural space, thus producing a pathway for the air to escape and relieving the built-up pressure.
● Monitor laboratory values such as arterial blood gases
○ Further monitor patient’s oxygenation
● Educate patient about proper breathing techniques
○ Assist in the patient respiration to maintain adequate oxygenation to the body
I. MEDICAL/SURGICAL MANAGEMENT

MEDICAL MANAGEMENT SURGICAL MANAGEMENT

1. Chest tube A small chest tube is inserted near the 1. Thoracotomy If more than 1500 ml of blood is
second intercostal space to drain the aspirated initially by thoracentesis, the
fluid and air. For patients with rule is to open the chest wall
jeopardized gas exchange, chest tube surgically. The chest wall is opened
insertion may be necessary to achieve surgically to remove the blood or air
lung re-expansion. The priority is to trapped in the pleural space.
maintain the airway, breathing, and
circulation. The most important
interventions focus on reinflating the
lung by evacuating the pleural air.
Patients with a primary spontaneous
pneumothorax that is small with
minimal symptoms may have
spontaneous sealing and lung
re-expansion.

2. Maintain a closed chest
drainage system
Be sure to tape all connections, and
secure the tube carefully at the
insertion site with adhesive bandages.
Regulate suction according to the
chest tube system directions;
generally, suction does not exceed 20
to 25 cm H2O negative pressure.
2. VATS Video-assisted thoracoscopic surgery
(VATS) is a minimally invasive
surgical technique used to diagnose
and treat problems in your chest.
During a VATS procedure, a tiny
camera (thoracoscope) and surgical
instruments are inserted into your
chest through one or more small
incisions in your chest wall.

3. Monitor a chest tube unit for These could indicate an air leak, but
any kinks or bubbling do not clamp a chest tube without a
physician’s order because clamping
may lead to tension pneumothorax.

4. Autotransfusion Autotransfusion involves taking the

patient’s own blood that has been
drained from the chest, filtering it, and
then transfusing it back into the
 vascular system.

5. Antibiotics Antibiotics are usually prescribed to

combat infection from contamination.

6. Oxygen Therapy The patient with possible tension

pneumothorax should immediately be
given a high concentration of
supplemental oxygen to treat the
hypoxemia.

J. DRUG ANALYSIS
1. Doxycycline (Vibramycin, Vibra-Tabs, Doryx)
2. STERITALC
3. Morphine (Astramorph, Infumorph 200, MS Contin, Oramorph SR)
Drug Classification Examples (Generic Name) Indication Mechanism Of Action Contraindications Nursing Responsibilities

Brand Names: ● Doxycycline Infection Protein synthesis is essential ● Hypersensitivity 1. Advise patient to swallow the drug
● Vibramycin Capsules To reduce the for the survival and to the drug or with a full glass of water (240mL)
● Vibra-Tabs development of functioning of cells, any of its Rationale: To ensure passage of drug into
drug-resistant bacteria and including bacteria. components, the stomache and prevents esophageal
● Doryx
maintain the effectiveness Doxycycline inhibits and any of the ulceration
● Adoxa of doxycycline capsules bacterial protein synthesis by tetracyclines.
and other antibacterial allosterically binding to the ● Pregnancy or 2. Monitor for patient’s
[Drug Class 1] drugs, doxycycline 30S prokaryotic ribosomal breastfeeding hypersensitivity/ adverse reactions
Tetracyclines capsules should be used subunit. The drug blocks the due to to the drug
only to treat or prevent association charged teratogenicity Rationale: To identify the risks associated
infections that are proven aminoacyl-tRNA (aa-tRNA) with the drug to the prevention of
and permanent
or strongly suspected to with the ribosomal A site, worsening of the patient’s condition and
be caused by susceptible which is the acceptor site on
teeth their symptoms
bacteria. When culture the mRNA-ribosome discoloration
and susceptibility complex. Doxycycline after in utero 3. Avoid exposure to areas with
information are available, ultimately impedes the exposure ultraviolet lights or sunlight
they should be considered elongation phase of protein ● Children under Rationale: This is to prevent or reduce the
in selecting or modifying synthesis and halts the the age of 12 risks of having a phototoxic reaction.
 antibacterial therapy. In production of essential due to teeth
the absence of such data, proteins or bacterial survival discoloration
local epidemiology and and functioning. ● Allergy to
susceptibility patterns tetracycline
may contribute to the Doxycycline mediates
antibiotics
empiric selection of anti-inflammatory actions by
therapy. preventing
● Use with
calcium-dependent penicillin or
microtubular assembly and isotretinoin
lymphocytic proliferation, ● Liver disease
thereby inhibiting leukocyte due to rare
movement during fatal
inflammation. It also inhibits hepatotoxicity
nitric oxide synthase, which ● History of
is an enzyme that produces yeast
nitric oxide, an inflammatory infections
signaling molecule.
● Recent colitis
caused by
antibiotic use
● Kidney disease
diarrhea from
C. Dificile
● History of
lupus
(autoimmune)
● Porphyria (a
blood disease)
● Myasthenia
gravis

STERITALC ● Talc for intrapleural Pneumothorax Talc instilled into the pleural ● Hypersensitivit 1. Monitor for patient’s
administration ● STERITALC is cavity is thought to result in y of the drug hypersensitivity/ adverse reactions
indicated in adults an inflammatory reaction. and any of its to the drug
[Drug Class 2] to decrease the This reaction promotes components Rationale: To identify the risks associated
Sclerosing Agents recurrence of adherence to the visceral and ● Contraindicate with the drug to the prevention of
pneumothorax. parietal pleura to prevent d for use in worsening of the patient’s condition and
reaccumulation of pleural air pregnant their symptoms
 Malignant Pleural or fluid. women
Effusion 2. Monitor vital signs of the patient
● STERITALC is esp. Respiratory rate and sounds
indicated to Rationale: Assess the baseline data to
decrease the identify any deviation in the condition of
recurrence of the patient
malignant pleural
effusions in 3. Monitor patient’s chest tube
symptomatic medical appliance while
patients following administering medication
maximal drainage Rationale: Important in assessing patient’s
of the pleural stability during intervention
effusion.

Brand Names: ● Morphine Sulfate Infumorph is a Opioid drugs, typified by ● Hypersensitivit 1. Monitor vital signs of the patient
● Astramorph prescription medicine morphine, produce their y to the drug or esp. Respiratory rate and blood
● Infumorph used to treat the pharmacological actions, any of its pressure
symptoms of Acute Pain including analgesia, by components Rationale: Assess the baseline data to
200
and Chronic Severe Pain. acting on receptors located ● Respiratory identify any deviation in the condition of
● MS Contin Infumorph may be used on neuronal cell membranes. depression in the patient
● Oramorph alone or with other The presynaptic action of the absence of
SR medications. opioids to inhibit resuscitative 2. Reassess pain after administration
neurotransmitter release is equipment of the drug
[Drug Class 3] considered to be their major ● Acute or severe Rationale: to determine the efficacy of the
Opioid Analgesics effect in the nervous system. bronchial medication, which can be adjusted
asthma or according to patient need as ordered by the
hypercarbia. physician
● Paralytic ileus.
3. Advise patient to call for
assistance/ assist patient when
ambulating
Rationale: To minimize the risk of falls

4. Advise patient to turn, cough, and

breathe deeply when in prolonged
bedrest
Rationale: Prevention for atelectasis

5. Monitor for patient’s

 hypersensitivity/ adverse reactions
to the drug
Rationale: To identify the risks associated
with the drug to the prevention of
worsening of the patient’s condition and
their symptoms

References:
● https://radiopaedia.org/articles/pneumothorax#:~:text=Radiographic%20features,-Plain%20radiograph&text=A%20pneumothorax%20is%2C%20when%20loo
ked,seen%20peripheral%20to%20this%20line
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299161/
● https://pmj.bmj.com/content/86/1011/8
● https://academic.oup.com/bjaed/article/15/6/299/356262
● https://patient.info/doctor/arterial-blood-gases-indications-and-interpretation#nav-1
● https://medlineplus.gov/lab-tests/hemoglobin-test/#:~:text=A%20hemoglobin%20test%20is%20often,complete%20blood%20count%20(CBC).
● https://www.ncbi.nlm.nih.gov/books/NBK441866/
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563704/
● robholland.com/Nursing/Drug_Guide/data/monographframes/D077.html
● https://fadavispt.mhmedical.com/content.aspx?bookid=1873&sectionid=139009250#:~:text=Monitor%20signs%20of%20hypersensitivity%20reactions,immedi
ately%20if%20these%20reactions%20occur.
● https://medlineplus.gov/druginfo/meds/a682063.html
● https://go.drugbank.com/drugs/DB00254
● https://www.rxlist.com/doryx-drug.htm#:~:text=Mechanism%20Of%20Action,positive%20and%20Gram%2Dnegative%20bacteria.
● https://www.ncbi.nlm.nih.gov/books/NBK556088/
● https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51518/all/morphine
● http://shadwige.sites.truman.edu/cardiac-medications/hemodynamic-medications/morphine-sulfate/#:~:text=Nursing%20Implications%3A&text=Monitor%20p
atient's%20respiratory%20rate%20prior,light%20signal%20close%20to%20patient.
● https://www.ncbi.nlm.nih.gov/books/NBK526115/
● https://go.drugbank.com/drugs/DB00295
● https://www.rxlist.com/infumorph-drug.htm#description
● https://www.rxlist.com/adoxa-drug.htm#description
● https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Chest_drain_management/
●