Pneumothorax/Hemothorax

  1. General information
    1. Partial or complete collapse of the lung due to an accumulation of air or fluid in the pleural space
    2. Types
      1. Spontaneous pneumothorax: the most common type of closed pneumothorax; air accumulates within the pleural space without an obvious cause. Rupture of a small bleb on the visceral pleura most frequently produces this type of pneumothorax.
      2. Open pneumothorax: air enters the pleural space through an opening in the chest wall; usually caused by stabbing or gunshot wound.
      3. Tension pneumothorax: air enters the pleural space with each inspiration but cannot escape; causes increased intrathoracic pressure and shifting of the mediastinal contents to the unaffected side (mediastinal shift).
      4. Hemothorax: accumulation of blood in the pleural space; frequently found with an open pneumothorax resulting in a hemopneumothorax.
  2. Assessment findings
    1. Sudden sharp pain in the chest, dyspnea, diminished or absent breath sounds on affected side, decreased respiratory excursion on affected side, hyperresonance on percussion, decreased vocal fremitus, tracheal shift to the opposite side (tension pneumothorax accompanied by mediastinal shift)
    2. Weak, rapid pulse; anxiety; diaphoresis
    3. Diagnostic tests
      1. Chest x-ray reveals area and degree of pneumothorax
      2. pCO2 elevated
      3. pO2, pH decreased
  3. Nursing interventions
    1. Provide nursing care for the client with an endotracheal tube: suction secretions, vomitus, blood from nose, mouth, throat, or via endotracheal tube; monitor mechanical ventilation.
    2. Restore/promote adequate respiratory function.
      1. Assist with thoracentesis and provide appropriate nursing care.
      2. Assist with insertion of a chest tube to water-seal drainage and provide appropriate nursing care.
      3. Continuously evaluate respiratory patterns and report any changes.
    3. Provide relief/control of pain.
      1. Administer narcotics/analgesics/sedatives as ordered and monitor effects.
      2. Position client in high-Fowler's position.

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