Pneumothorax Overview and Symptoms

Pneumothorax Overview

• Definition: Collection of air in the pleural space, leading to collapse of the lung tissue.
• Pleural Space: Normally contains about 50 mL of fluid and maintains negative pressure for lung expansion.
• Consequence: Air accumulation inhibits lung expansion, resulting in partial or total lung collapse.

Symptoms

• Small Pneumothorax: Often asymptomatic; may show no signs.
• Large Pneumothorax: Can present with dyspnea, chest pain, hypoxia, reduced or absent breath sounds, and tachycardia.

Risk Factors

• Smoking
• Tall and lean physique
• Family history of pneumothorax
• Chronic respiratory conditions (like asthma or COPD)
• Pregnancy
• Lung infections (such as pneumonia)
• Mechanical ventilation usage
• History of previous pneumothorax

Causes

• Medical Procedures: Air may enter during procedures like needle aspirations or placement of subclavian catheters.
• Trauma: Includes rib fractures, penetrating injuries, or blunt trauma to the chest.
• Lung Disease: Certain conditions heighten the risk for spontaneous pneumothorax.

Types of Pneumothorax

• Spontaneous Pneumothorax: Results from the rupture of tiny air-filled sacs (blebs) on the lung surface. Frequent in individuals with conditions like COPD and asthma, commonly affecting tall, young males.
• Iatrogenic Pneumothorax: Arises from invasive medical procedures, including mechanical ventilation, leading to lung punctures or lacerations.
• Traumatic Pneumothorax: Develops due to external injury to the chest cavity.

Treatment & Management

• Emergency Management:
  • Open Wound: Apply occlusive dressing to prevent air ingress and allow air escape.
  • Penetrating Wound: Stabilize objects in place without removal.
  • Monitor respiratory function and administer oxygen as needed.
• Long-Term Management: May necessitate chest tube insertion or surgical intervention; patient education on risks and prevention strategies is vital.

Expected Outcomes

• Achieve stable respiratory patterns with normal arterial blood gases.
• Absence of cyanosis or hypoxic symptoms; pain levels managed adequately.
• Confirmation of pneumothorax resolution through imaging.

Nursing Management

• Position the patient upright to promote lung drainage and assess vital signs.
• Comprehensive pulmonary assessment: monitor breath sounds and oxygen saturation.
• Inspect chest tube site for drainage, infection signs, and subcutaneous emphysema indicators.
• Ensure the drainage device remains lower than the chest for effective fluid removal.

Ventilation Support Techniques

• Breathing Techniques:
  • Pressure Support Ventilation (PSV): Allows patient control over breathing while reducing effort through pressurized gas.
  • Synchronized Intermittent Mandatory Ventilation (SIMV): Synchronizes with patient breaths, minimizing respiratory muscle fatigue.
• Weaning: Gradual reduction in ventilator support; assess readiness for extubation based on vital signs.

Noninvasive Positive Pressure Ventilation (NPPV)

• Types:
  • CPAP: Continuous pressure support; indicates at sleep apnea, pulmonary edema.
  • BiPAP: Offers two pressure levels to facilitate easier inhalation/exhalation; indicated for COPD, ARDS, asthma, and pneumonia.
• Common Uses:
  • CPAP is recommended for keeping airways open, while BiPAP is suited for more intensive respiratory support.

Nursing Care for NPPV

• Collaborate with Respiratory Therapy for setup and monitoring of devices.
• Assess patient tolerance, oxygenation levels, and adaptability to therapy.
• Anticipate and manage complications such as claustrophobia, respiratory arrest, or airway trauma.

Nursing Actions for Ventilator Alarms

• High-Pressure Alarm: Resolution may involve suction, sedation, or adjusting tubing.
• Low-Pressure Alarm: Tasks include reattaching connections or replacing endotracheal tubes if necessary.
• Apnea Alarm: Actions may involve changing ventilator modes or confirming endotracheal tube placement.

Pneumothorax Overview

• Definition: Accumulation of air in the pleural space resulting in lung collapse.
• Pleural Space: Located between the lungs and chest cavity, contains ~50 mL of fluid for lubrication and maintaining negative pressure.
• Effect: Air build-up hinders lung expansion, leading to partial or complete lung collapse.

Symptoms

• Small Pneumothorax: Often asymptomatic, may not exhibit noticeable symptoms.
• Large Pneumothorax: Symptoms include shortness of breath (dyspnea), chest pain, hypoxia (low oxygen), absent or reduced breath sounds, and tachycardia (increased heart rate).

Risk Factors

• Smoking and family history of pneumothorax.
• Body type: Tall and thin individuals.
• Chronic lung diseases such as asthma and COPD.
• Other factors: Pregnancy, lung infections, mechanical ventilation, history of previous pneumothorax.

Causes

• Medical Procedures: Lung puncture during needle aspirations or catheter insertions.
• Trauma: Includes rib fractures and penetrating or blunt chest injuries.
• Lung Disease: Existing conditions may predispose individuals to spontaneous pneumothorax.

Types of Pneumothorax

• Spontaneous Pneumothorax:
  • Caused by rupture of small air-filled sacs (blebs).
  • Air collects in the pleural cavity, often observed at the apex.
  • Associated lung diseases: COPD, asthma, cystic fibrosis, pneumonia.
  • Risk factors include smoking, tall/thin physique, male gender, and personal/family history.
• Iatrogenic Pneumothorax:
  • Results from medical procedures leading to lung puncture.
  • High-pressure mechanical ventilation can cause barotrauma.
• Traumatic Pneumothorax:
  • Arises from blunt or penetrating trauma to the chest.

Treatment & Management

• Emergency Management:
  • For open wounds: Use an occlusive dressing on three sides to allow air to escape.
  • For penetrating wounds: Stabilize objects and refrain from removal.
  • Position patient to facilitate breathing and administer oxygen if needed.
• Long-Term Management:
  • May involve chest tube insertion or surgical intervention.
  • Education on risk factors and prevention, including smoking cessation.

Expected Outcomes

• Normalization of respiratory patterns and arterial blood gases (ABGs).
• Absence of cyanosis or hypoxic symptoms.
• Pain management to an acceptable level.

Evaluation

• Confirmation of pneumothorax resolution via X-ray.
• Restoration of normal respiratory patterns.
• Ensured adequate tissue perfusion and controlled pain.

Nursing Management of a Client with a Chest Tube

• Client Assessment:
  • Positioning in upright Fowler's position to enhance drainage.
  • Regular monitoring of respiratory rate, heart rate, blood pressure, and temperature.
  • Inspect dressing and insertion site for signs of infection or complications.
• Chest Tube and Drainage System Assessment:
  • Ensure drainage unit remains below chest level.
  • Consistent monitoring of drainage characteristics and water seal.
  • Assess for bubbling—continuous bubbling may indicate a leak.
• Documenting:
  • Record drainage information every 8 hours and report sudden changes.

Key Safety Measures for Chest Tube Management

• Keep drainage below the level of the client's chest.
• Ensure no kinks or obstructions in tubing.
• Secure connections with tape to prevent disconnections.

Client Activity

• Bedrest Clients:
  • Implement frequent position changes and encourage deep breathing exercises.
• Ambulatory Clients:
  • Provide guidance on carrying and protecting the drainage system during movement.

Mechanical Ventilation Terminology

• Assist-Control Ventilation (AC): Delivers preset tidal volume and rate, suitable for sedated or unconscious patients.
• Extubating: Removal of endotracheal tube, can be intentional (weaning) or accidental.
• High-Frequency Oscillatory Ventilation (HFOV): Utilizes small tidal volumes at high rates, used for critically ill patients.
• Positive End-Expiratory Pressure (PEEP): Applied at end expiration to increase lung capacity, with contraindications in specific conditions.
• Pressure Support Ventilation (PSV): Patient-initiated breaths supported by pressurized gas to ease breathing.
• Synchronized Intermittent Mandatory Ventilation (SIMV): Helps synchronize with spontaneous breathing to mitigate muscle fatigue.

Nursing Response to Ventilator Alarms

• High-Pressure Alarm: Caused by secretions, correct with suction or sedation.
• Low-Pressure Alarm: Triggered by disconnections; reattach or adjust as needed.
• Apnea Alarm: Indicates respiratory issues; may require mode adjustment or confirmation of endotracheal tube (ETT) positioning.

Complications of Noninvasive Positive Pressure Ventilation (NPPV)

• Potential complications include claustrophobia, apnea, hypoventilation syndrome, and the presence of facial trauma.
• Risk of aspiration and inadequate ventilation could necessitate alternative invasive methods.

Nursing Actions for NPPV

• Collaborate with respiratory therapists for appropriate device selection.
• Continuously monitor client breathing patterns and mask fit to ensure efficacy.