Pneumothorax

Prepared by:
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Topic contents:
Introduction of pneumothorax
Types of pneumothorax
Definition of pneumothorax
Pathophysiology of pneumothorax
Etiology of pneumothorax
Clinical manifestations of client that
having pneumothorax
Investigations that was carried out
to client with pneumothorax

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Continue..
Treatment for client with
pneumothorax
Nursing diagnosis for client with
pneumothorax
Health education to client with
pneumothorax
Introduction of hemothorax
Definition of hemothorax
Clinical manifestations of hemothorax

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 Introduction

Ú Lung expansion occurs when the pleural

lining maintain negative pressure in the
pleural space.
Ú When the continuity of this system lost,
the lungs collapse resulting in
pneumothorax.
Ú A pneumothorax may be open or closed.

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 Cont..
Ú Closed pneumothorax:
• Air may escape into pleural space from a puncture
or tear in an internal respiratory structure s/a
bronchus, bronchioles or alveoli
• Also can caused by fracture ribs.

Ú Open pneumothorax:
• Air may enter the pleural space directly through a
hole in the chest wall and diaphragm.
• one form of traumatic pneumothorax.

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 Definition
Ú Pneumothorax is the presence of air in
the pleural space that prohibits complete
lung expansion.
(Black & Hawks, 2004)

Ú Pneumothorax occurs when the parietal

or visceral pleural is breached and the
pleural space is exposed to positive
atmospheric pressure.
(Smeltzer etc, 2008)

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 Types of pneumothorax
i) Simple
ii) Traumatic
iii) Tension

i) Simple
- Or spontaneous pneumothorax
- Idiophatic (no cause can be found-primary)
- Result of other illness in lungs s/a COPD, TB or
Ca (secondary)
- Can occur in healthy person d/t rupture of blebs
that allow air to enter pleural space.

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 Cont..
ii) Traumatic pneumothorax:
- occurs when air escape from a laceration in the
lung itself and enters the pleural space or enter the
pleural space through a wound in the chest wall.
- may result from:
- Blunt trauma (ribs #)
- Penetration chest/ abdominal trauma (stab wound/
gunshots)
- Diaphragmatic tears (RTA)
- Diagnostic procedures ( thoracocentesis)
- Barotrauma (mechanical ventilation)
- Surgery (chest sx)

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 Cont..
- Traumatic pneumothorax that resulted from major
injury to the chest usually accompanied by
hemothorax (blood in the pleural space)
- Hemopneumothorax: both blood and air are found
the pleural cavity.
- Open traumatic pneumothorax can cause:
- sucking chest wound
- mediastinal flutter/ swing.

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Mediastinal flutter/ swing

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 Cont..

iii) Tension pneumothorax:

- Develops when air is trapped in the pleural space
during inspiration and cannot escape during
expiration.
- With each breath, tension (+ve pressure) is
increased within the affected pleural space.
- This causes lungs to collapse and mediastinal
shift.

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Pathophysiology
Ú Idiophatic, trauma to the chest or air
trap in the pleural space.

Ú Cause negative pressure in the

pleural cavity drop/reduce.

Ú During inhalation and expiration,

more air trapped in the pleural space

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 Cont..

Ú Positive pressure increase caused altered

lung expansion.

Ú This can leads to lung collapse and pain.

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 Etiology

i) Simple pneumothorax
- unknown
- smoking primary
- inheridity
- destroyed alveolus
- lung disease secondary
(COPD, ARDS, Asthma, etc)

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 Cont..
ii) Traumatic pneumothorax
- blunt trauma
- penetrating trauma/ punctured wound
- Iatrogenic pneumothorax

iii) Tension pneumothorax

- lung injury
- damage of venous return to the lungs

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 Clinical manifestations
i) Simple pneumothorax
- abrupt onset
- pleuritic chest pain
- dypsnea, SOB
- decreased breath sound
- hyperresonant percussion at
affected side

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ii) Traumatic pneumothorax
- pain
- dypsnea
- tachypnea, tachycardia
- absent breath sound in effected area
- air movement through an open wound

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iii) Tension pneumothorax
- hypotension, shock
- distended neck vein
- severe dypsnea
- tachypnea, tachycardia
- absent breath sound on effected area

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 Investigations
i) Chest Xray: ensure the location of
effected area

i) Blood test: FBC, ABG (for transfusion

if needed, to ensure oxygen saturation)

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 Medical managements

1. Depends on its cause and severity.

2. The goals of treatment
- to evacuate the air or blood from
the pleural cavity

Variety of treatments:
i) Thoracocentesis
ii) Insertion of chest tube
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 i) Thoracocentesis

i) Needle aspiration
ii) Goals: i) Decompressed pleural cavity.
ii) Reexpand the lung
iii) Maximum fluid can be drain out from
pleural cavity is 1200-1500mls each
procedures.
iv) Emergency: if client have a cardiovascular
injury 2dary to chest or penetration trauma
is suspected.
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Needle aspiration Thoracocentesis

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 ii) Insertion of chest tube

i) Small chest tube (28 French) is inserted

in the intercostal space to drain the
excessive fluid or blood.

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ii) Large caliber (36 French or larger) chest
tube are used to drain intrathoracic
accumulation of blood which then
connected to the drainage system.

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 Complications

1) Lung collapse 2) Cardiac arrest

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Nursing Diagnosis

i) Acute pain related to disease process.

ii) Anxiety related to procedure.
iii) Ineffective airway clearance related to
increased secretion and to decreased
cough effectiveness due to pain.
iv) Impaired physical mobility related to
pain, restricted positioning and chest
tube.

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Acute pain related to disease
process.

Goals: The client will be more

comfortable as evidence by
verbalizing that discomfort is
reduced and moving in bed with
less pain.

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interventions

1) Assess client’s level of pain

using a self-reported
measurement tools.
R- use of a consistent, valid tool
promotes communication and
evaluation of pain intervention
effectiveness.

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 Cont..

2) Administer pain medication as

ordered.
R- decreased pain sensation

3) Observe for side effects of

medication used.
R- side effect are monitored

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Cont..

4) Position client to his/ her’s

comfortable position such as
Fowler’s or cardiac position
R- to reduce pain sensation

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Cont..

5) Instruct client to use breathing

exercise and relaxation techniques
R- to reduce carbon dioxide
accumulation in the alveoli and to
reduce respiratory rate

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 Cont..

6) Advice client to avoid factors that can

exacerbate his/ her condition such as
sudden movement, coughing without
splint the affected area
R- to relieve pain

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Cont..

7) Give reassurance
R- to alleviate anxiety and to
reduce pain sensation.

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Health education
Ú Medication
Ú Pain reduction techniques
Ú Changing lifestyle
Ú Signs and symptoms of
complication after procedure.
Ú Follow up

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Heamothorax
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Topic contents:

Introduction of heamothorax
Definition of heamothorax
Clinical manifestations of client that
having heamothorax
Investigation for hemothorax
Management for client with
hemothorax

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 Introduction

ØMay be present in clients with chest

injuries.

ØA small amount of blood (<300mls) in the

pleural space may cause no clinical
manifestations & may require no
intervention with the blood being
reabsorbed spontaneously.

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Definition

Ú Presence of the blood in the pleural

space.
(Black & Hawks, 2004)

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 Cont..

Ø Severe hemothorax (1400 to 2500mls) may

be life threatening because of resultant
hypovolemia and tension.

Ø Massive hemothorax is associated with 50%

to 75% mortality.

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 Clinical manifestations

Ø Respiratory distress
Ø Shock
Ø Mediastinal shift
Ø Dullness upon percussion at affected
side.

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Cont..

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 Investigations

Ú Chest x ray
– To confirm diagnosis of hemothorax

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 Managements

Ú Client have severe distress

– Hemothorax aspiration
• Insert 16G needle to 5th/6th intercostal space at the
maxillary line.
– Hemothorax drainage
• Insert large caliber (36F or larger) chest catheter
which connected to a drainage system.

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 Cont..

Ú Drainage of 500-1000ml of blood

(moderate)
– No additional required
Ú Drainage of blood >than 1500 and cont
large amnt of drainage of 200ml/H
– Need immediate exploratory thoracotomy
– Repair the site of bleeding
– Fluid replacement is needed (blood transfusion)

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 Reference
 Black, J.M. & Hawks, J.H. (2005), Medical-Surgical Nursing: Clinical
Management for Positive Outcomes (7th ed.). Elsevier Inc.
 Ballinger, A. & Patchett, S. (2007), Pocket Essentials of Clinical Medicine (4th
ed.). Elseveie Inc.
 Henry, J. A., (2004). The British Medical Association: New Guide to Medicine
& Drugs (6th ed). London: Dorling Kindesley Limited.
 Kozier, B., Erb, G., Berman, A. & Snyder, S. (2004), Fundamentals of
Nursing, Concepts, Process & Practice (7th ed.). Pearson Education Inc.
 Tortora, G. J., & Grabowski, S. R., (2003). Principles of Anatomy and
Physiology. (10th ed). United State of America: John Wiley & Sons, Inc.
 Smeltzer, S.C. & Bare, B. (2004). Brunner & Suddarth’s Textbook of Medical-
Surgical Nursing (10th ed.). Philadelphia, New York: Lippincott.
 Smeltzer, S.C. , Bare, B., Hinkle, J. L., & Cheever, K. H. (2008). Brunner &
Suddarth’s Textbook of Medical-Surgical Nursing (11th ed.). Philadelphia,
New York: Lippincott.

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