PATHOPHYSIOLOGY

Of
PNEUMOTHORAX

A. Description
1. Pneumothorax is the accumula- b.Secondary pneumothor-
tion of air in the pleural space, ax: Air enters the pleural
which results in partial or com- space as a result of injury
to the chest wall, respir-
atory structures, or eso-

Chest Cavity is
open to outside
Air from the
lung enters
the pleural
space, push-
ing the lung
away from
the chest.

plete lung collapse. phagus.

2. Types include: c.Spontaneous pneumo-
a.Tension pneumothorax: thorax: air enters the
Air can enter the pleural pleural space when air-
space but cannot leave it. filled blebs (blisters) on
the lung surface rupture.
B. Etiology
1. Tension pneumothorax results
from unknown causes.
2. Secondary pneumothorax is
caused by injury to the chest
wall resulting from trauma (such
as crushing injuries0 or from
punctures (such as stab wounds
or gunshot wounds).
3. Spontaneous pneumothorax is
caused by a ruptured bleb and
 is seen more commonly on 2. Observe the patient’s respira-
smokers. tions (rate and depth); breath-
ing pattern changes may indic-
ate a worsening condition.
C. Pathophysiologic processes and 3. Position the patient in a semi-
manifestations Fowlers position.
1. Severity of symptoms depends 4. Monitor oximetry.
on the size of the injury and 5. Administer oxygen if necessary.
amount of lung tissue left intact. 6. Administer analgesics as pre-
2. Symptoms can include: scribed.
a.Pleuritic pain (a sharp 7. For a patient with chest tubes:
pain occurring during in- a.Maintain sterile dressing
halation) at chest tube insertion
b.Increased respiratory site.
rate b.Maintain patency and in-
c.Dyspnea tegrity of the closed
d.Visible asymmetry of the chest drainage system
chest, which results from and suction as ordered.
rib fracture c.Evaluate amount of fluid
e.Hyperresonant lung and breath sounds to de-
sounds termine progress of
f. Decreased breath sounds closed chest drainage.
over the area of pneumo- d.Assess for sign and
thorax symptoms of wound in-
g.Trachea deviating to the fection.
injured side e.Assess for fear and anxi-
h.Neck vain distention (res- ety and institute appro-
ulting from greater priate measures for alle-
amount of pressure in the viation and relief.
thorax)
i. Palpable subcutaneous
emphysema (as air
leaves the chest cavity
and remains in the subcu-
taneous space)
j. Shifting of mediastinal
structures to unaffected
side of the chest (caused
by large pneumothorax)
k.Hypoxemia (seen on
ABG) and clinical signs of
shock, such as low blood
pressure and tachycardia
(caused by large pneu-
mothorax)
3. In tension pneumothorax, the
onset of symptoms is sudden
and painful.

D. Overview of nursing interventions

1. Monitor vital signs, checking for
signs of shock (e.g., low blood
pressure and tachycardia).