DISTURBANCE IN OXYGENATION

PNEUMOTHORAX

Prepared by;
ALINGAN, M.
TOMADA, S.
 INTRODUCTION
 Pneumothorax is a collection of air or gas in the chest or pleural space
that causes part or all of a lung to collapse.
 Normally, the pressure in the lungs is greater than the pressure in the
pleural space surrounding the lungs. However, if air enters the pleural
space, the pressure in the pleura then becomes greater than the pressure
in the lungs, causing the lung to collapse partially or completely.
Pneumothorax can be either spontaneous or due to trauma.
 If a pneumothorax occurs suddenly or for no known reason, it is called a
spontaneous pneumothorax. This condition most often strikes tall, thin
men between the ages of 20 to 40. In addition, people with lung
disorders, such as emphysema, cystic fibrosis, and tuberculosis, are at
higher risk for spontaneous pneumothorax. Traumatic pneumothorax is
the result of accident or injury due to medical procedures performed to
the chest cavity, such as thoracentesis or mechanical ventilation. Tension
pneumothorax is a serious and potentially life-threatening condition that
may be caused by traumatic injury, chronic lung disease, or as a
complication of a medical procedure. In this type of pneumothorax, air
enters the chest cavity, but cannot escape. This greatly increased
pressure in the pleural space causes the lung to collapse completely,
compresses the heart, and pushes the heart and associated blood vessels
toward the unaffected side.
 Pneumothorax
Pathophysiology:  Left-sided pneumothorax (on
the right side of the image) on
 “Accumulation of CT scan of the chest with chest
air or gas in the tube in place.

pleural cavity”
Pneumothorax
Anatomy Review- Pleural
cavity
 Visceral pleura
 Encases lungs
 Pleural space/cavity
 Area between pleura
 Contains fluid (4ml)
 Fluid prevents friction
 Fluid circulated by…
 lymph system
 Parietal pleura
 Lines chest wall
Pneumothorax
Anatomy review - Breathing
 Diaphragm  & accessory
muscles move outward

 Negative pressure in the
thoracic cavity 
 Negative pressure pulls
air into the lungs via the
nose and mouth
 Diaphragm & accessory
muscle relax () 
 air exhaled
Pneumothorax
 If the visceral pleural
is perforated or the
chest wall & parietal
pleural are perforated
 air enters the pleural
space 
 negative pressure is
lost 
 Lung on the affected
side collapses
Pneumothorax
 An abnormal chest x-ray shows the presence of an air pocket (arrows) in the
pleural sac surrounding one lung, which has collapsed. This finding is typical
of a severe pneumothorax. A normal chest x-ray is shown on the right for
comparison; the heart (H), lungs (L), vertebrae (v), and collarbone (C) can be
seen.
Pneumothorax
Classifications of
pneumothorax
 Spontaneous
pneumothorax
 with out injury
 Air enters the
pleural cavity via
the airway
 Farther classified
as:
 Primary
 Secondary
Pneumothorax
Spontaneous (Primary)
Pneumothorax
 Pt. with no known
lung disease.
 D/T a rupture of a
bulla in the lung.
 Most often tall, thin
men between 20
and 40 years old.
Pneumothorax
Spontaneous Secondary
Pneumothorax
 occurs in pt. with
known lung disease
 most often COPD
 Other lung diseases
commonly assoc. with
 Tuberculosis
 Pneumonia
 Asthma
 lung cancer
 Often severe & life
threatening
Pneumothorax
 Traumatic
Pneumothorax
 D/T injury to the
chest wall
 Further classified
as Open or closed
Pneumothorax
Open Pneumothorax
 Air enters pleural cavity
via outside
 A free communication
between the exterior
and the pleural space as
through an open wound
 blowing wound
 sucking wound
 may be caused by a
penetrating injury
 stab wound,
 gunshot wound
 impaled object
Pneumothorax
Closed
pneumothorax
 Air enters the
pleural cavity via
lungs
 D/t/ blunt chest
trauma
 Car crash
 Fall
 Crushing chest
injury
Pneumothorax
Tension Peumothorax
 air accumulates in the
pleural space with each
breath.
 The remorseless
increase in intrathoracic
pressure 
 massive shifts of the
mediastinum away
from the affected lung

 compressing
intrathoracic vessels 
 cardiovascular collapse
Pneumothorax
Tension
Pneumonthorax
 a piece of tissue
forms a one-way
valve that allows
air to enter the
pleural cavity but
not to escape,
overpressure can
build up with
every breath
Pneumothorax
Pneumothorax
Etiology / Contributing
factors
 Spontaneous
 Lung disease - COPD
 Tall, thin men
 Traumatic
 A penetrating chest
wound
 Barotrauma
 scuba divers
 Iatrogenic Pneumothorax
 * insertion of a central
line
 * thoracic surgery
 * thoracentesis
 * pleural or
transbronchial biopsy.
 Pneumothorax
Clinical Manifestations
(all types)
 Sudden sharp chest
pain
 Asymmetrical chest
expansion
 dyspnea
 Cyanosis
 Percussion
 Hyper resonance or
tympany
 Breath sounds
 diminished
 Absent
Pneumothorax
Clinical Manifestations (all
types)
 Respiratory distress

 O2 Sats

 decreased

 Tachypnea

 Tachycardia

 Restlessness/ Anxiety
Pneumothorax

S&S of open
pneumothorax
 Crepitus
 (subcutaneous
emphysema)
 Sucking chest
wound”
Pneumothorax
S&S Tension
pneumothorax
  cardiac output
 Hypotension
 Tachycardia
(compensatory)
 Tachypnea
 Mediastinal shift and
tracheal deviation
 To the unaffected
side
 Cardiac arrest
 Distended neck veins
Pneumothorax
Dx exam and tests
 HX & PE
 Chest x-ray
 ABG’s
 Initial PaCO2
 Decreased
 respiratory
alkalosis
 Later ABG’s
 Hypoxemia
 Hypercapnia
 Acidosis
Pneumothorax
Treatment - First
aid: Open
pneumothorax
 Cover
immediately with
an occlusive
dressing, made
air-tight with
petroleum jelly or
clean plastic
sheeting.
Pneumothorax
Tx: Small
pneumothorax
 Spontaneous
recovery
 Bed rest
 resolve on its own
in 1 to 2 weeks
 Remove with small
bore needle
inserted into the
pleural space
Pneumothorax
Tx: Larger
pneumothorax
 Chest tube

 Surgery repair

 Pleurodesis
 “glue”
 Very painful
 Prep with analgesic
 O2
 Surgery
Pneumothorax
Nursing interventions
 Closely monitor resp  Notify MD for:
status  SpO2 < 90% or
 Frequent assess Change Greater Than
 LOC
5%
 Color  Respiratory Distress
 VS
 Inadequate Sedation
 Chest pain?
 Restlessness?
  Peak Airway
Pressure (Especially
 Chest Tube with Pressure Control
 Rest/Activity Balance Mode)
 Sedation
 Provide a means for
communicate
 Educate patient & family
Pneumothorax
Complications
 Recurrent
pneumothorax
 D/C
 smoking
 high altitudes
 scuba diving
 flying in
unpressurized
aircrafts
 Cardiac damage