PNEUMOTHORAX

What is Pneumothorax?

Pneumothorax is a collection of air in the pleural space, between the lung and chest wall. It is an medical emergency condition.

Anatomy

Normal Situation:

• Pleural space has negative pressure
• Lung stays expanded

In Pneumothorax:

• Air enters pleural space
• Pressure increases
• Lung collapses partially or completely

Rememberable point- Problem is ventilation, not oxygen supply.

Types of Pneumothoraxes

1. Closed (Simple) Pneumothorax

• No external wound
• Air from ruptured lung
• Mild to moderate symptoms

2. Open Pneumothorax

• Chest wall wound (stab, gunshot)
• Air moves in & out
• Also called sucking chest wound

Note- It is an emergency condition

3. Tension Pneumothorax

• Air enters but cannot escape
• Pressure builds rapidly
• Compresses heart & lungs

Rememberable point- Tension = Too much pressure (Life-threatening)

4. Spontaneous Pneumothorax

• Occurs without trauma
• Tall, thin males
• Smokers

Causes of Pneumothorax

Traumatic Causes

• Rib fracture
• Stab or gunshot wound
• CPR
• Mechanical ventilation

Non-Traumatic Causes

• COPD
• TB
• Lung disease
• Ruptured blebs

Rememberable point- Sudden chest pain in a tall thin smoker- spontaneous pneumothorax.

Pathophysiology

Cause (Trauma / Spontaneous rupture / Iatrogenic injury)
↓
Air enters pleural space (between visceral and parietal pleura)
↓
Loss of negative intrapleural pressure
↓
Lung recoil inward (elastic collapse of affected lung)
↓
Partial or complete lung collapse
↓
Decreased alveolar ventilation
↓
Impaired gas exchange
↓
Hypoxemia (↓ PaO₂)
↓
Dyspnea, tachypnea, chest pain

If pneumothorax progresses (Tension pneumothorax): –

Continued air entry with no escape
↓
Progressive increase in intrapleural pressure
↓
Severe lung collapse
↓
Mediastinal shift to opposite side
↓
Compression of opposite lung & great vessels
↓
↓ Venous return to heart
↓
↓ Cardiac output
↓
Hypotension → Shock → Cardiac arrest (if untreated)

Clinical Manifestations

General Symptoms

• Sudden chest pain
• Shortness of breath
• Anxiety
• Tachypnea

Tension Pneumothorax Signs (VERY IMPORTANT)

• Severe respiratory distress
• Tracheal deviation
• Hypotension
• Jugular vein distension
• Cyanosis

Rememberable point- Tracheal deviation + hypotension = TENSION pneumothorax

Diagnosis

1. Physical Examination

• ↓ or absent breath sounds (affected side)
• Hyperresonance on percussion
• Asymmetrical chest movement

2. Chest X-ray- Visible air in pleural space, Collapsed lung
3. CT scan- In Small or unclear cases

Clinical Diagnosis (Tension Pneumothorax)

DO NOT WAIT for X-ray = Treat immediately

Medical Management

1. Simple Pneumothorax

• Oxygen therapy
• Observation (small cases)

2. Needle Decompression– Emergency for tension pneumothorax

Insert needle:

• 2nd intercostal space
• Mid-clavicular line

Purpose: release trapped air

3. Chest Tube Insertion

• Removes air
• Re-expands lung
• Connected to underwater seal

Nursing Management (Chest Tube Care)

• Ensure tube is not kinked
• Keep drainage system below chest level
• Observe for bubbling (air leak)
• Assess respiratory status frequently

Dietary Management

• High-protein diet
• High-calorie foods
• Adequate fluids

Nursing Care Plan (NCP)

NCP 1: Impaired Gas Exchange

Related to: Collapsed lung
Evidenced by: Dyspnea, ↓ SpO₂

Goals:

• SpO₂ ≥ 94%
• Improved breathing

Nursing Interventions & Rationale:

1. Administer oxygen
2. Increases oxygen availability
3. Position in high-Fowler’s
4. Maximizes lung expansion
5. Monitor ABGs & SpO₂
6. Detects hypoxia early

NCP 2: Ineffective Breathing Pattern

Related to: Chest pain and lung collapse

Interventions:

• Encourage slow deep breathing
• Provide pain relief
• Support chest during coughing

NCP 3: Acute Pain

Related to: Pleural irritation / chest tube

Interventions:

• Assess pain scale
• Administer analgesics
• Reassure patient

NCP 4: Anxiety

Related to: Sudden breathlessness

Interventions:

• Stay with patient
• Explain procedures calmly
• Encourage controlled breathing

Pneumothorax vs Hemothorax

Feature	Pneumothorax	Hemothorax
Pleural content	Air	Blood
Breath sounds	Absent	Dull
Percussion	Hyper resonant	Dull
Treatment	Chest tube	Chest tube