Pneumothorax Nursing, Pathophysiology, Interventions | Open vs Closed vs Tension Pneumothorax

 Pneumothorax Nursing, Pathophysiology, Interventions.

the respiratory system so I'm going to be talking about the path oh the different types of pneumothorax the signs and symptoms and the nursing interventions and I highly recommend that  chest tube care because chest tubes and pneumothorax go hand-in-hand so you can learn those nursing ginterventions and a card should be popping up so you can access that this and as always over here on the side and  you can access the quiz and the notes so let's get started first let's start out talking about what is a pneumothorax what is the definition of it well in a nutshell what it is is it's the collapsing of a long due to air accumulating in the pore space which the floor space is the space between the visceral and the parotid pleura and it's also called the intrapleural space now before we dive into our pathos signs and symptoms of nursing interventions let me go over some key points with you so you can remember and keep these in the back of your mind as we're discussing this stuff okay a pneumothorax can be partial or total um collapsing of a lung and it usually affects one lung causes of pneumothorax include it can happen spontaneously without any warning it can be caused by trauma to the chest like blunt trauma or a penetrating trauma for instance if a patient was in a car wreck that airbag hitting the chest can cause it or CPR or a gunshot wound or a stabbing can cause air to go into that space other things lung disease a medical procedure like a central line placement a lot of times after a patient has a central line in place like saying a PICC line the you'll need to get a chest x-ray to make sure and there isn't a pneumothorax and everything's good or mechanical ventilation we with a positive end expiratory pressure.

where a barotrauma can happen and we'll really be talking about this with tension pneumothorax and how our pneumothorax how's it diagnosed it's diagnosed usually with a chest x-ray and ultrasound or a CT scan small pneumothorax you can have small large they vary in size small ones tend to resolve on their own without treatment however if it's large and they will need treatment like a chest tube placement which will help drain that air out of the Interflora space or needle decompression where they stick a needle into that space and um aspirate the air and again we'll really be hitting on that with the tension pneumothorax which is a medical emergency and that is one of the treatments for it now let's look at the pathophysiology of a pneumothorax so first let's look at our lung anatomy  because it goes hand in hand okay here you have some lungs and what you see in red is the chest wall and attached to the chest wall is your Prato pleura and then you have in the white area that is the inter porous space and then next the green is your visceral pleura which attaches to the lung and what happens in this Interflora space.

you have small amounts of serous fluid so as you breathe in and breathe out that fluid allows your lungs to glide over one another without any pain and it creates a negative pressure and your lungs love negative pressure if anything is added into this space like with the pneumothorax your lungs collapse I do not like that so they thrive on negative pressure and this negative pressure acts like suction to keep your lungs inflated so in order to keep your lungs inflated you need that negative pressure now when air enters into the space it can happen again through like an object piercing through this chest wall will we would get an open pneumothorax and all the air from out is entering into this space causing pressure to push on that lung and collapse it or layer the visceral pleura ruptures and whenever it ruptures it releases air that you're breathing in into that Interflora space which that is like a closed pneumothorax or Barrow trauma like with mechanical ventilation that can happen as well now as this air builds in this space what happens is that it decreases the ability of the lungs to recoil on that affected side so what happens is that lung gets pushed away from that chest wall and it leads to collapse and remember your lungs like negative pressure so they don't have that you're going to have some major problems now let's talk about the different types of pneumothorax what I want to hit on is things you need to know for your nursing lecture exam and in clicks because they ask about specific and types of pneumothorax like spontaneous open closed or attention so let me go over those with you first let's talk about closed pneumothorax what is this this is where air leads into the interspace without an outside wound so the key thing with this is that your chest wall which is here in red and your pleura are going to remain intact it's the opposite of what happens in an open pneumothorax which we'll go over here in a second so what can cause this one thing that can cause this is a ribfracture say that the person falls downstairs and breaks the rib you get a sharp bony prominence off of that broken rib it goes in it pierces through tears through that visceral pleura of the lungs so you have a tear and every time that person breathes in and breathe out air is going to escape through that tear into this space which should not happen so what happens is that this space gets bigger and bigger as it just fills with air think about it like you're blowing up a balloon as you blow into the balloon it gets bigger and bigger and so that's what's going to happen because remember your lungs like negative pressure this is adding pressure to it so it's going to cause the lung to laughs another thing another common cause of a closed pneumothorax is what's called a spontaneous pneumothorax and this is where you have a defect in the alveolar wall and the visceral pleura and this causes what happens is that you develop a pulmonary bled and this is like a sack like blister that developed on the visceral layer of the lungs and what can happen is that this web can rupture no warning sign that's why it's really called spontaneous because there wasn't an injury that caused it it just happened without warning and that blister ruptures and it releases air into the intra porous space and these bloods can develop over time patients can have multiple one multiple blabs and they may not rupture immediately once they develop however some things that can increase a pulmonary blood to rupture is like changes in air pressure.

if the patient and changes maybe altitude or something like that or there is where the patient takes a sudden deep breath or they smoke now and spontaneous pneumothorax is categorized by primary or secondary and let me go over those with you real fast I'm you can have a primary spontaneous pneumothorax and this tends to occur in people without lung disease they tend to be young less than the age of 30 and tall and thin however you can have a secondary pneumothorax and this occurs in people with lung disease like COPD asthma cystic fibrosis things like that now let's look at open pneumothorax what is this this is where there is an opening in the chest wall that causes a passage between the outside air and intra pleura space so as you can see in this illustration here you have the chest wall which is in red you have your product for let's say that this patient was stabbed it's a big stab wound and what it's done is it's allowing its create this open to allow inhale the exhaled air to pass back and forth so your pleura space is getting all this air in and out and as it passes in and out you can hear a sucking sound this open to my works is sometimes referred to as a sucking chest wound because what's happening is that your body is shunting air through the chest wall instead of the trachea which is what it does during normal circumstances when you don't have a big gaping wound on your chest and it will create that sucking sound and the interim pore pressure pressure will become equal with the outside pressure which will lead to lung collapse because remember your lungs thrive and negative pressure now in clips in clicks Tim thing you need to know about open pneumothorax may see it on your nursing lecture exams or the NCLEX okay a nurse in your dimension so you have a patient come in they have a big open wound they have this what are you going to do nursing intervention would be to place a sterile occlusive dressing and tape it on three sides leaving the fourth side untape because this is going to a while exhaled air to leave the opening but seal back over it when the patient's inhaling hence it's going to be tense.

it's going to help prevent a tension pneumothorax so what is a tension pneumothorax a tension pneumothorax happens when it opening to the inter polar space creates a one-way valve which leads air to collect in that interpolar space but it cannot escape so it just keeps building and building and building and this is a medical emergency that patient needs treatment immediately and attention in what the works can happen as a complication of a pneumothorax such as an open or closed so as you can see from this drawing here pressure is just building and building and building and as that pressure builds this leads to increase thoracic pressure and you get compression on the unaffected lung and the heart which is not good and you will get a mediastinum shift where your heart your trachea your esophagus and best vessels are going to shift to the unaffected side and this is going to cause major compression on your other lung and decrease venous return because your vena cava is being compressed so what's going to happen you're going to see these certain signs and symptoms in this patient and I would remember this.

what's going to happen is the patient's going to try to compensate because they are air hungry because they have limited amount of breathing room so they're going to become tacca panic they're going to try to breathe and breathe but it's not going to work they're going to be hypoxic then and they're going to have compression on that vena cava which drains the blood from your body to your heart to get reoxygenate 'add well what's going to happen is that your heart's going to become tachypnic you're going to I mean tachycardic you're going to increase your heart rate because it's noticing that you're not getting blood to all those organs and tissues that you need but there's nothing to pump because of that compression on those great vessels so you're going to have tachycardic they're going to be tachycardic but they're going to have hypotension because it's going to reduce your cardiac output and pretty much your patient is going into shock and the patient can also have jugular venous distention now a late sign of this is tracheal deviation that's going to happen late later on whenever things are really really bad so if you see that not good it's very late now one thing I want to touch on you need to watch patients who are on mechanical ventilation with peep that positive end expiratory pressure because they are at risk for developing this due to what's called barotrauma which over time all that extra pressure on that lungs is going to lead a lead to buildup of air in the Interflora space from rupture of the visceral pleura now if this happens they will need treatment that the physician will do will be needle decompression well they'll insert needle in and aspirate that extra air that has built and help relieve all that tension that is going on now let's look at the major signs and symptoms that a patient could have when they have a pneumothorax and to help you remember it remember the mnemonic collapsed because the pneumothorax is a collapsed lung so each letter will correlate with the sign and symptom okay C for chest pain patient may complain of chest pain all of a sudden that is sharp and could be worse on inspiration also another C for cyanosis just where they're not getting oxygenated good you can see blue around the lips the skin tone could turn a bluish color next o4 avert tachycardia and tachypnea that is where the body is trying to compensate for that low oxygen level that's going on the heart's trying to pump faster to get blood to the body because it has low oxygen level and the body's causing the respiratory system to increase in respiration so you can take more oxygen in l4 low blood pressure the other l4 low spo2 if you have them on an spo2 monitor you may notice that it would be less than 90% a for absent breath sounds on the affected side if they have a collapsed lung you're not going to hear breath sounds on that side that has a collapse on compared to the other side so you'd want to compare the sides see how they're sounding next P for pushing of the trachea to the unaffected side remember that was in a tension pneumothorax but remember if your patient has a pneumothorax or a chest tube they are at risk for a tension pneumothorax so if you see that and it could be developing into that but remember that's a late sign next s4 sub-q emphysema this is where a carbon dioxide can escape into the skin so you may see these little bulging areas maybe in the face the neck the lung I mean the abdomen and whenever you feel it it's like a crunchy feeling to it and this is known as sub-q emphysema another s4 sucking sound and remember that was in the open pneumothorax where you have that passage through the chest wall that is allowing air to go in and out of the lungs through the opening of the chest efore expand expansion of the chest will be an equal so wherever you have the collapse line remember it's not inflating and deflating fully like compared to the healthy lung on the other side so you'll have unequal chest rise and fall and then D for dis Mia of course they're going to have difficulty breathing because they only probably have one lung.

that's working appropriately now let's look at the nursing interventions what are you going to do for this patient as the nurse who have it who has a pneumothorax and you're going to of course be monitoring the breath sounds what do they sound like on this side compared to the other side and you're going to be watching the rise and the fall of the chest you'll be monitoring their bottle songs especially their blood pressure their heart rate the respiratory rate and their oxygen saturation assessing for that sub-q emphysema a ministry oxygen as ordered by the physician and its best whenever a patient has a respiratory issue to keep them in the head of the bed and Fowler's position to decrease that effort of breathing and remember whenever we talked about open pneumothorax what you're going to do with the dressing by using a sterile cluesive dressing placing it over the opening taping it on three sides and leaving one side untaped so it'll allow the air to escape and prevent a tension pneumothorax and then another biggie is maintaining that chest tube drainage system if it is placed by the position and that's why I really recommend that you watch that video on chest tubes because it will really help you understand how to care for them but let me go over some highlights with you a patient with the pneumothorax you would want to make sure while you're maintaining the drain that you're assessing for leaks in the system the test two drains drain system and make sure it's working appropriately how to troubleshoot it a lot of NCLEX questions and nursing exam questions like to ask you well the drain came out what are you going to do or the systems broken what do you to do because this stuff does happen in real life and they want you to be prepared for it next with a pneumothorax just from where we've talked about the anatomy and physiology of it we're removing the chest tube is removing air from the inter polar space so you may have intermittent bubbling and that water seal chamber as the air is escaping but excessive bubbling in the water soul chamber represents a leak somewhere in your system so you want to investigate and figure out where it i also as the patient breathes in and breathe out the water seal chain chamber will fluctuate up and down however a lot of questions like to ask you you've noticed that it's quit fluctuating up and down in the water soul chamber what could it be I'm either it's a kink somewhere in the system or that lung has re-expanded so you want to assess those breath sounds and see what it sounds like ok so that is about pneumothorax.