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     1  Pneumothorax Pathophysiology: “Accumulation of air or gas in the pleural cavity” Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place.
     2  Pneumothorax Anatomy Review- Pleural cavity Visceral pleura Encases lungs Pleural space/cavity Area between pleura Contains fluid (4ml) Fluid prevents friction Fluid circulated by… lymph system Parietal pleura Lines chest wall
     3  Pneumothorax Anatomy review - Breathing Diaphragm i & accessory muscles move outward ? Negative pressure in the thoracic cavity ? Negative pressure pulls air into the lungs via the nose and mouth Diaphragm & accessory muscle relax (h) ? air exhaled
     4  Pneumothorax If the visceral pleural is perforated or the chest wall & parietal pleural are perforated air enters the pleural space ? negative pressure is lost ? Lung on the affected side collapses
     5  Pneumothorax An abnormal chest x-ray shows the presence of an air pocket (arrows) in the pleural sac surrounding one lung, which has collapsed. This finding is typical of a severe pneumothorax. A normal chest x-ray is shown on the right for comparison; the heart (H), lungs (L), vertebrae (v), and collarbone (C) can be seen.
     6  Pneumothorax Classifications of pneumothorax Spontaneous pneumothorax with out injury Air enters the pleural cavity via the airway Farther classified as: Primary Secondary
     7  Pneumothorax Spontaneous (Primary) Pneumothorax Pt. with no known lung disease.  D/T a rupture of a bulla in the lung. Most often tall, thin men between 20 and 40 years old.
     8  Pneumothorax Spontaneous Secondary Pneumothorax occurs in pt. with known lung disease most often COPD  Other lung diseases commonly assoc. with Tuberculosis Pneumonia Asthma cystic fibrosis lung cancer Often severe & life threatening
     9  Pneumothorax Traumatic Pneumothorax D/T injury to the chest wall Further classified as Open or closed
     10  Pneumothorax Open Pneumothorax Air enters pleural cavity via outside A free communication between the exterior and the pleural space as through an open wound blowing wound sucking wound may be caused by a penetrating injury stab wound, gunshot wound impaled object
     11  Pneumothorax Closed pneumothorax Air enters the pleural cavity via lungs D/t/ blunt chest trauma Car crash Fall Crushing chest injury
     12  Pneumothorax Iatrogenic pneumothorax D/T procedure / treatment
     13  Pneumothorax Tension Peumothorax air accumulates in the pleural space with each breath. The remorseless increase in intrathoracic pressure ? massive shifts of the mediastinum away from the affected lung ? compressing intrathoracic vessels ? cardiovascular collapse
     14  Pneumothorax Tension Pneumonthorax a piece of tissue forms a one-way valve that allows air to enter the pleural cavity but not to escape, overpressure can build up with every breath
     15  Pneumothorax
     16  Pneumothorax Etiology / Contributing factors Spontaneous Lung disease - COPD Tall, thin men Traumatic A penetrating chest wound Barotrauma scuba divers Iatrogenic Pneumothorax * insertion of a central line * thoracic surgery * thoracentesis * pleural or transbronchial biopsy.
     17  Pneumothorax Clinical Manifestations (all types) Sudden sharp chest pain Asymmetrical chest expansion dyspnea Cyanosis Percussion Hyper resonance or tympany Breath sounds diminished Absent
     18  Pneumothorax Clinical Manifestations (all types) Respiratory distress O2 Sats decreased Tachypnea Tachycardia Restlessness/ Anxiety
     19  Pneumothorax S&S of open pneumothorax Cripitus (subcutaneous emphysema) Sucking chest wound”
     20  Pneumothorax S&S Tension pneumothorax i cardiac output Hypotension Tachycardia (compensatory) Tachypnea Mediastinal shift and tracheal deviation To the unaffected side Cardiac arrest Distended neck veins
     21  Pneumothorax Dx exam and tests HX & PE Chest x-ray ABG’s Initial PaCO2 Decreased respiratory alkalosis Later ABG’s Hypoxemia Hypercapnia Acidosis
     22  Pneumothorax Treatment - First aid: Open pneumothorax Cover immediately with an occulsive dressing, made air-tight with petroleum jelly or clean plastic sheeting.
     23  Pneumothorax Tx: Small pneumothorax Spontaneous recovery Bed rest resolve on its own in 1 to 2 weeks Remove with small bore needle inserted into the pleural space
     24  Pneumothorax Tx: Larger pneumothorax Chest tube Surgery repair Pleurodesis “glue” Very painful Prep with analgesic O2 Surgery
     25  Pneumothorax Nursing interventions Closely monitor resp status Frequent assess LOC Color VS Chest pain? Restlessness? Chest Tube Rest/Activity Balance Sedation Provide a means for communicate Educate patient & family Notify MD for: SpO2 < 90% or Change Greater Than 5% Extubation Respiratory Distress Inadequate Sedation h Peak Airway Pressure (Especially with Pressure Control Mode)
     26  Pneumothorax Complications Recurrent pneumothorax D/C smoking high altitudes scuba diving flying in unpressurized aircrafts Cardiac damage
     27  Question? A client who has been on a ventilator for two days experiences acute respiratory distress accompanied by distended neck veins. The best action of the nurse is to: hand ventilate the client. prepare for chest tube insertion. call the physician immediately. perform emergency chest decompression.
     28  The question is asking what the nurse should do when a client on a ventilator has these symptoms. When acute respiratory distress occurs along with neck vein distension, cyanosis and tracheal shift are evident, a tension pneumothorax has probably occurred. The client should be removed from the machine and ventilated by hand. Then the physician should be notified (option c). Equipment for chest tube insertion should be gathered (option b) so it will be ready for immediate use by the physician. Emergency chest decompression (option d) should only be attempted after specific training and if the physician will be delayed.
     29  Small Group Questions What is the pathophysiology of a pneumothorax? Describe the anatomy of the pleural membrane (including nerves endings) What is a spontaneous pneu