Pneumothorax

Definition
■ Disruption of lining of lung (visceral pleura) or lining of thoracic cavity
(parietal pleura) permitting air (pneumothorax) and/or blood (hemothorax)
into pleural space → lung collapse
■ 2° rib fx, stab or gunshot wound, thoracentesis, emphysema

Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, dyspnea, ↓breath sounds on affected side, ↓PaO2
■ Air/blood in pleural space on x-ray
Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)
Nursing
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube)
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)
■ Air/blood in pleural space on x-ray

Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)

Nursing Management
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube),
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)