NCM 118 - Lesson 7 (Pneumothorax)

Lesson 7
PNEUMOTHORAX
CONTENTS
I. Introduction
II. Assessment
a. Risk Factors / Predisposing Conditions
b. Clinical Manifestations
c. Diagnostic Examination/ Laboratory Tests
III. Treatment
IV. Nursing Intervention/Goals
V. Self Test / Self Directed Learning / Critical Thinking Drill
VI. References/Further Readings
I. Introduction
 This condition is characterized by air in the pleural space resulting in the collapse or atelectasis of
that portion of the lung.
 Positive air pressure from the outside environment rushes in to the pleural space, which has
negative pressure, inhibiting lung expansion
 Tension pneumothorax: the development of a pneumothorax that allows excessive buildup of
pressure in the pleural space, causing a shift in the mediastinum towards the unaffected side and
rapidly become an emergency condition.
II. Assessment
A. Risk Factors / Etiology

1. Ruptured bleb (spontaneous)
2. Thoracentesis
3. Caused by infection
4. Trauma
B. Clinical Manifestations
1. Diminished or absent breath sounds on the affected side
2. Dyspnea, hypoxia
3. Tachycardia, tachypnea
4. Sudden onset of persistent chest pain
5. Anxiety
6. Asymmetrical chest wall expansion
7. Hyperresonance on percussion of affected side
8. Possible development of a tension pneumothorax
a. Decreased cardiac filling, leading to decreased cardiac output
b. Tracheal shift from midline towards the unaffected side
c. Increasing problems of hypoxia
C. Diagnostic Exam
1. Chest X-ray
2. ABGs (PaO2, PaCO2)
III. Treatment
a. Placement of chest tubes connected to water-sealed drainage
IV. Nursing Intervention
Goal # 1: To recognize the problem early on and prevent a severe hypoxic episode
A. Notify physician upon assessment of the problem
B. Begin O2 therapy
C. Prepare client for insertion of the chest tube
Goal # 2: To re-inflate lung without complications

A. Have client cough and deep breathe every 2 hours as possible
B. Encourage exercise and ambulation
C. Establish and maintain water-sealed chest drainage
V. Self Test / Critical Thinking Drill
SELF TEST QUESTIONS
1. The client is admitted to the emergency department with chest trauma. When assessing the client,
which signs/symptoms would the nurse expect to find that support the diagnosis of pneumothorax?
a. Bronchovesicular lung sounds and bradypnea.
b. Unequal lung expansion and dyspnea.
SELF-DIRECTED LEARNING
c. Frothy bloody sputum and consolidation.
d. Barrel chest and polycythemia. VIDEO OBSERVATION
Watch a video online about pneumothorax and

2. The client had a right-sided chest tube inserted chest tube drainage. Make a short description of
two (2) hours ago for a pneumothorax. Which the chest tube drainage and cite a few important
idea you’ve learned about the procedure.
action should the nurse take if there is no
fluctuation (tidaling) in the water-seal Check the following links for videos regarding
this topic.
compartment?
a. Obtain an order for a stat chest x-ray. https://www.youtube.com/watch?v=JB-
CqwMyrTM
b. Increase the amount of wall suction.
https://www.youtube.com/watch?
c. Check the tubing for kinks or clots.
v=WfoXkJM6XHw
d. Monitor the client's pulse oximeter
_______________________________________
reading.
_______________________________________
_______________________________________
3. Which intervention should the nurse _______________________________________
implement for a male client who has had a left- _______________________________________
sided chest tube for six (6) hours and refuses to _______________________________________
_______________________________________
take deep breaths because it hurts too much?
_______________________________________
a. Medicate the client and have the client _______________________________________
take deep breaths. _______________________________________
_______________________________________
b. Encourage the client to take shallow
_______________________________________
breaths to help with the pain. _______________________________________
c. Explain that deep breaths do not have to _______________________________________
_______________________________________
be taken at this time.
_______________________________________
d. Tell the client that if he doesn't take _______________________________________
deep breaths, he could die. _______________________________________
4. The client has a right-sided chest tube. As the

client is getting out of the bed it is accidentally pulled out of the pleural space. Which action should the
nurse implement first?
a. Notify the health-care provider to have chest tubes reinserted STAT.
b. Instruct the client to take slow shallow breaths until the tube is reinserted.
c. Take no action and assess the client's respiratory status every 15 minutes.
d. Tape a petroleum jelly occlusive dressing on three (3) sides to the insertion site.
5. Which assessment data indicate that the chest tubes have been effective in treating the client with a
hemothorax who has a right-sided chest tube?
a. There is gentle bubbling in the suction compartment.
b. There is no fluctuation (tidaling) in the water-seal compartment.
c. There is 250 mL of blood in the drainage compartment
d. The client is able to deep breathe without any pain

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Lesson 7

A. Risk Factors / Etiology

IV. Nursing Intervention

Goal # 2: To re-inflate lung without complications

V. Self Test / Critical Thinking Drill

SELF TEST QUESTIONS

Watch a video online about pneumothorax and

4. The client has a right-sided chest tube. As the

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