Pneumothorax (Air in Lungs)

  • It is the accumulation of air in the pleural space, which results in partial or complete lung collapse.

Diagnosis

  • X-ray or CT scan - shows tracheal deviation or placement away from affected side

Types:

  • Tension – air enters but can’t leave pleural space (one-way valve)

  • Secondary – air enters the pleural space as a result of injury to the chest wall, respiratory structures or esophagus

  • Spontaneous – air enters the pleural space when air-filled blebs (blisters) on the lung surface rupture.

Etiology

  • Tension pneumothorax - unknown causes

  • Secondary pneumothorax – injury to the chest wall from trauma

  • Spontaneous – ruptured bleb (common to smokers).

  • Pathophysiologic Processes and Manifestations

  • Severity of symptoms depends on the size of injury and the amount of tissue left intact.

Symptoms can include

  • Pleuritic pain (sharp pain occurring during inhalation)

  • Increased RR

  • Dyspnea

  • Asymmetry of chest wall (from rib fractures)

  • Decreased breath sounds over the area of pneumothorax

  • Hyperresonance in percussion

  • Trachea deviating to the injury site

  • Shifting of mediastinal structures to unaffected side of unaffected chest

  • Signs of shock (due to large pneumothorax)

In tension pneumothorax, onset is sudden and painful (can affect the heart)

Nursing Interventions

  • Monitor V/S, signs of shock

  • No shortness of breath, no treatment

  • Observe respiration; changing pattern may indicate worsening situation

  • Semi-Fowler’s position

  • Administer oxygen if necessary

  • Analgesics as ordered

  • Chest tube - escape route for air given in worse situation like tension or spontaneous

    • Maintain sterile dressing at chest tube insertion site

    • Maintain patency and integrity of closed chest drainage system

    • Evaluate amount of fluid and breath sounds.