Spontaneous Pnemothorax Caitlin Darby April 9, 2013 Florida
Hospital Tampa
Slide 2
Objectives Discuss the pathophysiology of a pneumothorax
Discuss the types of pneumothoraxs Discuss the risk factors for a
pneumothorax Describe the signs and symptoms of a pneumothorax
Discuss the prevalence and prognosis of a pneumothorax in our
society Describe the complications and prevention of a pneumothorax
Discuss medical and nursing interventions for a pneumothorax
Describe a patient case scenario Describe patient outcomes from
interventions used in the hospital NCLEX review questions
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Pathophysiology Air leaks into the space between your lungs and
chest wall (pleural space). This air pushes on the outside of your
lung and causes it to collapse. In most cases, only a portion of
the lung collapses Not due to trauma Exact cause is unknown *
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Video
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Types of Pneumothoraxs Spontaneous Pneumothorax Open
Pneumothorax Closed Pneumothorax Tension pneumothorax Hemothorax
Chylothorax *
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Risk Factors First Spontaneous Pneumothorax Smoking Causes
small airways and risk increases with length of time and number of
cigarettes used Age Most likely to occur between ages 20-40 Doesnt
typically affect anyone over 40 Sex Men who are tall and thin are
more likely than women Pneumocystis carinii pneumonia (PCP)
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Risk Factors (cont.) Secondary Spontaneous Pneumothorax A
history of pneumothorax One pneumothorax increases your risk to
have another within 2 years Obstructive lung disease Ex. COPD
Infectious lung disease Ex. Tuberculosis Interstitial lung disease
Ex. Sarcoidosis Connective tissue disease Ex. Rheumatoid
arthritis
Slide 8
Symptoms Dyspnea upon exertion Sudden onset of chest pain on
the affected side (unilateral) Shoulder pain Shortness of breath
Dry cough Anxiety Clicking sound over the front of the thorax
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Signs Anxious appearance Asymmetrical chest expansion Cyanosis
Tachycardia Hypotension Increased respiratory rate Diminished or
absent lung sounds on the affected side Hyper resonance upon
percussion Mediastinal displacement (occasionally with a tension
pneumothorax)
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Complications of a Pneumothorax Recurrence Usually within three
years of the first Highly likely after first occurrence Persistent
air leak Air may continue to leak if the opening in the lung wont
close Surgery may be needed to close the leak. Chest x-ray confirms
Sign: bubbling in the water seal chamber
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Prevalence in the United States Primary Spontaneous
Pneumothorax Between 7.4-18 cases per 100,000 population per year
among men Between 1.2-6 cases per 100,000 population per year among
women Approximately 20,000 new cases of a spontaneous pneumothorax
are diagnosed each year
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Prognosis Death from a spontaneous pneumothorax is very rare
Mortality rate 1.26 per million a year for men 0.62 per million a
year for women Rates of recurrence are high in the United States,
finding a total recurrence rate of 35%
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Prevention of a Pneumothorax Smoking cessation Controlling lung
diseases Follow up chest x-rays every 4-6 months to monitor for
recurrence
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Medical Interventions From current research Antibiotic therapy
Chest x-ray CT scan Thorascopy Needle aspiration Heimlach valve
placement Chest tube placement (thoracostomy) Oxygen therapy
Breathing treatments Daily blood tests (ABGs, BMP, CBC)
Prescription for pain medication Telemetry monitoring Thoracotomy
Resection of lung lesions Partial or complete parietal pleurectomy
*
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Case Study The patient is a 48-year-old male who complains of
severe chest pain, difficulty breathing, shortness of breath and
coughing. He stated that he had been having these symptoms since
February 9, 2013. The patient stated that his symptoms were
constant throughout the day and interfered with his daily routines.
He described his chest pain and other symptoms as sharp, stabbing,
aching, and as though he couldnt catch his breath. The patient
stated that his symptoms were worse upon exertion. The patient
tried tums, Motrin and his albuterol inhaler to try and relieve his
symptoms. He stated that nothing relieved or lessened his symptoms
and that his pain did not radiate to anywhere else in his body.
When asked to describe the severity of his symptoms on a scale of
0-10 he reported the intensity as a 5/10. The patient was
hospitalized on February 19, 2013 where he underwent treatment for
a right pneumothorax including a thorascopy with bleb resection,
chest x-rays, CT scan, chest tube placement and breathing
treatments.
Medical Interventions Used in the hospital Thorascopy with bleb
resection Incentive spirometry (Q1H) Continuous telemetry
monitoring Abdomen x-ray (flat & upright) Antibiotic therapy
Supplemental oxygen Analgesic therapy Bronchoscopy CBC and BMP lab
draws daily Arterial blood gases Daily chest x-rays Computed
tomography scan Chest tube placement *
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Nursing Interventions Used in the hospital and from current
research Incentive spirometry use Monitoring vital signs, breathing
pattern, rate, effort and use of accessory muscles every 2 hours
Monitor O2 saturation, daily labs and arterial blood gas results
Assess for changes in mental status, skin color and cyanosis
Administer medication and antibiotics as prescribed Control the
patients pain and anxiety with pharmacological and non
pharmacological techniques Provide oxygen therapy and breathing
treatments as needed Turn and reposition the patient Q2H and
position in fowlers or semi-fowlers position (30-45 degrees) to
promote expansion of the lungs Have patient do turn, cough and deep
breath exercises and pursed lip breathing exercises every hour
Auscultate lung fields every hour to observe for the return of lung
sounds or to note any changes Record the time and amount of
drainage from the chest tube daily Perform chest tube dressing
changes daily promoting a tight seal Observe for bubbling and
fluctuations in the water seal chamber of the drainage system
Ensure chest tube tubing is coiled on the bed with no dependent
loops Monitor results of diagnostic testing *
Patient Outcomes The patients pain level was reduced from a
5/10 to a 3/10 after administration of analgesics The patients
chest x-ray results showed a small air leak when coughing The
patients lung sounds returned post chest tube insertion The
patients BMP, CBC and ABGs came back within normal range The
patient was resting comfortably with HOB at 30 degrees The patient
was not discharged during my shift
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Nursing Diagnosis Ineffective breathing pattern r/t chest pain
a.e.b dyspnea and patient feeling breathless Anxiety r/t threat to
or change in health status a.e.b expressed concerns and
restlessness Acute pain secondary to pneumothorax a.e.b. patient
stating pain of a 5/10 and facial grimacing when changing positions
Impaired coping r/t inadequate opportunity to prepare for stressors
a.e.b lack of assertive behavior and change in usual communication
patterns Risk for infection r/t inadequate primary defenses a.e.b
surgical procedure
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NCLEX Question #1 Which treatment should a nurse expect for a
client with a spontaneous pneumothorax? A. Antibiotics B.
Bronchodilators C. Chest tube placement D. Hyperbaric chamber
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NCLEX Question #2 Which method is the best way to confirm the
diagnosis of a pneumothorax? A. Auscultate for breath sounds B.
Have the client use an incentive spirometer C. Take a chest x-ray
D. Stick a needle in the area of decreased breath sounds
Slide 24
References Horne, N.W. (1966, January 29). Spontaneous
pneumothorax: diagnosis and management. British medical journal,
281-284. Retrieved from http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC1843468/?page=1 Huether, S.,
McCanee, K. (2012). Understanding pathophysiology. Mayo clinic
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Spontaneous pneumothorax. Retrieved from http://
nursing.unboundmedicine.com/nursingcentral/ub/view/Tabers-Dictionary/762378/6/
pneumothorax Osborne, K.S., Wraa, C.E. &Watson, A.B. (2010).
Medical Surgical Nursing: Preparation for Practice. 988-999. Rivas
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Tschopp, J.M., Rami-Porta, R., Noppen, M., & Astoul, P. (2008,
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