Pneumothorax
&
Haemothorax
NURS 2213: Nursing Care of Adults
V. Waugh-Brown
May 2022
Objectives
Define Identify types Identify the
Describe the
pneumothorax, pathophysiology
of clinical
haemopneumpthora
of pneumothorax pneumothorax features of
x
and causes pneumothorax
Explain
Outline the Discuss the Outline
diagnostic
medical nursing relevant health
evaluation and
management management education tips
findings
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Case Study
• Carl is admitted to hospital with a history of stab wound
to the right chest. He is agitated and complains of severe
stabbing pain in his chest aggravated by inspiration.
• Assessment findings revealed: RR 36 bpm, trachea is
midline, decreased chest expansion, hyper-resonance and
diminished breath sounds elicited over right side of chest.
• Imaging study revealed pneumothorax
Pneumothorax [VHWB-2022] 3
What is pneumothorax?
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• Air within the pleural cavity
(between visceral and parietal
pleura) resulting in collapse of
that lung
• Air enters via a defect in the
visceral pleura (e.g. ruptured
Pneumothorax bulla) or, the parietal pleura
(e.g. puncture following rib
fracture)
• Lungs unable to expand
adequately; gas exchange
Pneumothorax [VHWB-2022]
compromised 5
Related Terms
• Haemothorax
– Blood in pleural cavity
• Haemopneumothorax
– Blood and air in pleural cavity
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Pathophysiology
• Positive pressure is
When either pleura is created
NegativeRequired to
pressure
maintain lung Breach compromised, air • Lung or portion of
Collapse
enters pleural space it collapses
inflation
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Pathophysiology
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Types of Pneumothorax
• Simple (Spontaneous)
• Tension
• Open / closed
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Types of Pneumothorax
Simple (Spontaneous)
Pneumothorax Primary
1. Rupture of a bleb
2. Rupture of a bronchopleural
• May be primary or secondary fistula
cause 3. Rupture of air filled blister
in a healthy person
May be associated with severe
• Mediastinum remains central emphysema or interstitial
lung disease
• Clinical condition stable
• Can wait for CXR to confirm
diagnosis
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Types of Pneumothorax
Tension Pneumothorax • Clinical condition
• Progressive build up of air in unstable
pleural space shift of the
heart and mediastinal • Do not wait for CXR
structures away from side of to confirm diagnosis
pneumothorax
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Types of Pneumothorax
Open or Closed Pneumothorax
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Causes of Pneumothorax
• Spontaneous Risk Factors
– Rupture of an apical bleb or bulla
include:
• Traumatic • Tobacco smoking
– With rib fractures
– Penetrating or blunt chest trauma • Gender (M>F)
– Invasive procedures (iatrogenic)
• Family history
• Pre-existing lung abnormality
• History of previous
– Pulmonary fibrosis pneumothorax
– Asthma
– Vasculitis • Physical built (being
– Pulmonary metastases close to edge tall and thin)
of lung
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Clinical Features
• Pleuritic pain: (sudden intense pain – sharp, stabbing,
burning); aggravated by deep breath or cough
• Dyspnoea
• Tachypnoea
• Decreased chest expansion
• Decreased or absent breath sounds
• Tracheal deviation (tension pneumothorax)
• Flaring alae nasi
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Clinical Features
• Cyanosis
• Light headedness and near fainting
• Easy fatigue
• Tachycardia
• Hyperresonance (depending on size of pneumothorax)
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Diagnosis
• Chest x-ray (CXR)
• CT scan
• CBC, ABGs
• Thoracentesis
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Medical Management
Goal of treatment is to evacuate the air from the pleural
space.
• Small chest tube (28 Fr) inserted near the second
intercostal space.
• Chest tube connected to water-seal drainage to remove
air and fluid.
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Medical Management
• Antibiotics (usually prescribed to combat infection from
contamination)
• Analgesic
• Oxygen
Thoracotomy – surgical intervention
The chest wall is opened surgically to remove blood or
air trapped in the pleural space.
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Nursing Interventions
• Position the client in High Fowler’s position – promote
lung expansion
• Administer oxygen as prescribed – improve PaO2 /
hypoxaemia
• Monitor vital signs and oxygen saturation levels
• Prepare for chest tube placement
• Maintain integrity of / monitor chest tube drainage system
– facilitate drainage and promote lung expansion
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Nursing Interventions
• Encourage deep breathing and coughing exercises –
maximise lung expansion and re-expand collapsed
alveoli / prevent atelectasis
• Encourage position change – prevent complications of
immobility; promote lung expansion and perfusion
• Medicate with analgesic as prescribed – improve comfort,
reduce anxiety, promote coughing and deep breathing
• Monitor for complications
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Nursing Considerations
Assessment of respiratory status includes:
• Ease of breathing and respiratory rate
• Lung sounds
• Use of O₂ and oxygenation
• Mental status level of alertness, restlessness,
confusion, irritability, or stupor
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Nursing Diagnoses
State three possible nursing diagnoses
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Nursing Diagnoses Include:
• Acute pain related to the positive pressure in the pleural
space.
• Ineffective breathing pattern related to respiratory distress
• Anxiety related to difficulty in breathing
• Ineffective (peripheral) tissue perfusion related to severe
hypoxemia
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Health Education
• jbn
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Summary – Quiz based on case study
• Carl is admitted to hospital with a history of stab wound to
the right chest. He is agitated and complains of severe
stabbing pain in his chest aggravated by inspiration.
• Assessment findings revealed: RR 36 bpm, trachea is
midline, decreased chest expansion, hyper-resonance and
diminished breath sounds elicited over right side of chest.
• Imaging study revealed pneumothorax
Pneumothorax [VHWB-2022] 26
