MACRO TEACHING

(NRS556)

PNEUMOTHORAX
& HEMOTHORAX

SITI AISHAH BINTI AZMI

(2020441204)
 Objectives
• Define the pneumothorax and hemothorax
• List the etiology and clinical manifestation of pneumothorax and
hemothorax
• Explain the pathophysiology of pneumothorax and hemothorax
• Explain the collaborative management of pneumothorax and hemothorax
• Determine how to treat a pneumothorax and a hemothorax with nursing
care
 Definition Pneumothorax

Pneumothorax is defined as the presence of air or gas in the pleural cavity

(ie, the potential space between the visceral and parietal pleura of the lung),

which can impair oxygenation, ventilation or causing hemodynamic

unstability.
 Definition Hemothorax
• Hemothorax is when blood collects between your chest wall and your lungs. This

area where blood can pool is known as the pleural cavity. The buildup of the

volume of blood in this space can eventually cause your lung to collapse as the

blood pushes on the outside of the lung.

 TYPES OF PNEUMOTHORAX
1)TRAUMATIC- Traumatic pneumothorax occurs after some type of trauma or injury has
happened to the chest or lung wall. It can be a minor or significant injury. The trauma can
damage chest structures and cause air to leak into the pleural space
-simple, tension and open pneumothorax

2)NON TRAUMATIC :
-PRIMARY (SPONTANEOUS)

-SECONDARY-underlying lung diseases, tuberculosis

 TYPES OF HEMOTHORAX
1)TRAUMATIC- e.g: punctured wound, blunt chest injury

2)NON-TRAUMATIC- e.g: iatrogenic, idiopatic, neoplasia, coagulopathies,

infectious process
hemothorax
 Risk factors

• Smoking. The risk increases with the length of time and the number of
cigarettes smoked, even without emphysema.
• Genetics.
• Lung disease.
• Mechanical ventilation.
• Previous pneumothorax.
 Sign and symptoms
• Pain or feeling of heaviness in your chest
• Feeling anxious or nervous
• Dyspnea or having trouble breathing
• Breathing quickly
• Abnormally fast heartbeat
• Breaking out in cold sweats
• Skin turning pale
• Fever
 Clinical Manifestation
• Pneumothorax: usually presented with acute onset of chest pain and shortness of
breath. They might have history of traumatic event prior to onset of symptoms.
• Clinically on physical examination:
I. Inspection : reduces chest movement
II. Auscultation : reduced air-entry over affected side
III. Palpation : subcutaneous emphysema
IV. Percussion : hyper resonance on affected side
 Clinical Manifestation
• HEMOTHORAX- usually presented with chest pain and shortness of
breath, and history of traumatic event
• On clinical examination mainly overlap with symptom of pneumothorax
but differ on:
I. Auscultation-reduced air-entry
II. Percussion-dullness
 Pathophysiology Pneumothorax
• Disruption of parietal or visceral pleural or the tracheobronchial tree
• Injured tissue forms a one –way valve into pleural space
• Air enters and fills pleural space (due to physiologic negative pleural
pressure)
• Increase pressure in collapse lung
• No air entry into affected lung
• Decrease chest wall expansion, decrease breaths sound, cause dyspnea
 Pathophysiology Hemothorax
• Any disturbance of the tissues of the chest wall and pleura (intrathoracic
structures) can cause bleeding of pleural space
• The physiologic response to a hemothorax can be divided into two
categories: hemodynamic and respiratory.
 Pathophysiology Hemothorax
• Hemodynamic response
The amount of bleeding and the speed at which blood is lost affects
hemodynamic changes.
• Respiratory response
The amount of blood needed to cause these symptoms in a person depends
on a variety of factors, including the organs injured, the seriousness of the
injury, and the underlying pulmonary and cardiac reserve.
 PROCEDURE

• Needle aspiration. A hollow needle with small flexible tube (catheter) is inserted between
the ribs into the air-filled space that is pressing on the collapsed lung. The needle is
withdrawn, and the catheter is linked to a syringe, allowing the doctor to extract the excess
air. The catheter may be left in for a few hours to ensure the lung is re-expanded and the
pneumothorax does not recur.

• Chest tube insertion. A flexible chest tube is inserted into the air-filled space and may be
attached to a one-way valve device that continuously removes air from the chest cavity
until your lung is re-expanded and healed.
 Diagnostic Tests
• Chest X-ray. (erect)
• A computerized tomography (CT) scan may be needed to provide more-
detailed images.
• Ultrasound imaging also may be used to identify a pneumothorax.
• Based on ABG result. Arterial blood gas measurements are frequently
abnormal in patients with pneumothorax, with the arterial oxygen tension
(PaO2) being <10.9 kPa in 75% of patients,31 but are not required if the
oxygen saturations are adequate (>92%) on breathing room air
Nursing management in pneumothorax and
hemothorax
 Chest Tube Insertion
Nursing intervention Rationales
Assess patient (put patient in cardiac position) For enhance lung expansion and ventilation
Monitor vital signs and check out respiratory function Respiratory distress & changes in vital sign occur as a
result of physiological stress and pain
Once chest tube inserted Maintaining lung expansion. Assess that the underwater
sealed is in top condition and that air or fluid will enter
without atmospheric air entering the pleural space.
Observe water-seal chamber bubbling Bubbling during expiration reflects venting of
pneumothorax
Seal drainage tubing connection sites securely Prevents and correct air leaks at connector sites
Assess the amount of chest tube drainage(tube is warm Useful in evaluating resolution of pneumothorax and
and full of blood in the water-seal bottle is rising) development of hemorrhage requiring prompt intervention
 Collaborative Care
• The goal in treating a pneumothorax is to relieve the pressure on your
lung, allowing it to re-expand. Depending on the cause of the
pneumothorax, a second goal may be to prevent recurrences. The methods
for achieving these goals depend on the severity of the lung collapse and
sometimes on your overall health.
• Treatment options may include observation with or without supplement
oxygen, needle aspiration, chest tube insertion, nonsurgical repair or
surgery.
 Nursing Diagnosis
• Ineffective breathing pattern r/t disease process (decreased lung
expansion, pain, anxiety)

• Risk for trauma

 • Ineffective breathing pattern d/t disease proses
Nursing intervention Rationales
Check out respiratory function, noting rapid or shallow Respiratory distress and changes in vital signs may occur
respirations, dyspnea, reports of “air hunger,” as a result of physiological stress and pain or may
development of cyanosis, changes in vital signs. indicate the development of shock due to hypoxia or
hemorrhage.
Assist patient with splinting painful area when coughing, Supporting chest and abdominal muscles make coughing
deep breathing. more effective and less traumatic.
Maintain a position of comfort, usually with the head of Promotes maximal inspiration; enhances lung expansion
bed elevated. Turn to the affected side. Encourage patient and ventilation in unaffected side.
to sit up as much as possible.
Monitor vital signs(SPO2 monitoring) Need the continuation or alteration of therapy
Give oxygen via cannula, mask or mechanical ventilation Reduce work of breathing
as indicated
 • Risk of trauma

Nursing intervention Rationales

Explain with patient purpose and function of the chest Information on how the system works provides
drainage unit, taking note of safety features. reassurance, reducing patient anxiety.
Advise patient to avoid lying and pulling on the tubing. Reduces the risk of obstructing drainage and inadvertently
disconnecting tubing.
Anchor thoracic catheter to chest wall and provide an Prevents thoracic catheter dislodgment or tubing
extra length of tubing before turning or moving patient; disconnection and reduces pain and discomfort associated
with pulling or jarring of tubing.

Secure drainage unit to patients bed Maintain upright position and reduces the risk of
accidental tipping and breaking of the unit

Observe for signs of respiratory distress if the thoracic Pneumothorax may reappear or worsen, impairing
catheter is disconnect or dislodged respiratory function and interventions immediate medical
attention.
 Recovery and aftercare
• Take any medications as prescribed by your doctor.
• Stay active while taking enough rest.
• Sleep in an elevated position for the first few days.
• Avoid putting unnecessary pressure on the ribcage.
• Wear loose-fitting clothing.
• Avoid smoking.
• Avoid a sudden change in air pressure.
• Avoid driving until you’re fully recovered.
• Watch for signs of a recurrence.
• Try breathing exercises that your doctor gives you.
• Attend all of your follow-up appointments.
 References
• 3 Hemothorax and Pneumothorax Nursing Care Plans - Nurseslabs. (n.d.). Retrieved May 7,
2021, from https://nurseslabs.com/3-hemothoraxpneumothorax-nursing-care-plans/

• Boersma, W. G., Stigt, J. A., & Smit, H. J. M. (n.d.). Treatment of haemothorax.

https://doi.org/10.1016/j.rmed.2010.08.006

• Hemothorax: Background, Anatomy, Pathophysiology. (n.d.). Retrieved May 7, 2021, from

https://emedicine.medscape.com/article/2047916-overview

• Pneumothorax: Practice Essentials, Background, Anatomy. (n.d.). Retrieved May 7, 2021,

from https://emedicine.medscape.com/article/424547-overview#a4