PNEUMOTHORAX

(Mayo Clinic, 2016) Prepared by Pushpa Nepal220118861 Word Count: 437

OVERVIEW Definition of pneumothorax Incidence Types of Pneumothorax Pathophysiology Clinical features Physical examination Investigations Treatment Chest drainage Role of nurse in managing chest drainage List of reference

DEFINITION Accumulation of air in the pleural cavity

causing lungs to collapse (Bell & Sluys, 2015, p.

807).

(Brigham and Women’s Hospital, 2016)

INCIDENCE Global health problem The estimated annual incidence of

one type (primary spontaneous ) pneumothorax is

7.4-18/100,000 in men 1.2-6/100,000 in women (The children's

hospital at Westmead, 2016, p. 3).

The incidence of pneumothorax in mechanically ventilated patients is approximately 4-15% (Hsu & Sun, 2014).

TYPES OF PNEUMOTHORAX Spontaneous Primary• No predisposing lungs

disease Secondary• COPD• Cystic Fibrosis• Pneumonia

Traumatic Open- Gunshot, stab Close- Fracture ribs

Iatrogenic Diagnostic Therapeutic

Tension Fatal- emergency

decompression

(Clarke, 2015, pp. 544- 546)

PATHOPHYSIOLOGY Normally intra-pleural pressure is negative Open trauma Close trauma

Air accumulation in pleural cavity (Built up positive pressure)

Compression and collapse of lung

Decrease vital capacity of lungs and mediastinal shift

CLINICAL FEATURES Depends on types, size and extent of

pneumothorax Tachypnea Tachycardia Dyspnea Shortness of breath Pleuritic chest pain Cyanosis Hypotension Shock (LeMone, Luxford & Fagan, 2011, p. 1301).

PHYSICAL EXAMINATION Inspection Tracheal deviation Distended neck vein Unilateral chest movements Palpation Absent tactile fremitus Percussion Hyperresonance Hyper tympanic sound over the affected side Auscultation Absent/Reduced breath sound on affected side (Hickman, 2013, p. 683).

TREATMENTGoal- to evacuate air promptly and allow the lung

to re-inflate (Yarmus & Feller-Kopman, 2012).

Supplemental oxygen- to treat hypoxia Conservative management- resolve at a rate of

approximately 1.25-2.2% of the volume per day Simple aspiration First line treatment (50-83% success rate) Chest tube drainage If simple aspiration fails Emergency decompression for tension

pneumothorax (66-97% success rate) (Kelly, 2015, p. 318).

INVESTIGATIONS Chest X-ray No pleural marking Hyperlucency

Chest Ultrasonography Accurate size (Thakur &

Mahomed, 2013) Chest computed tomography scanning Prompt and high-quality images

(Kline, Dionisio, Sullivan, Early, Wolf & Kline, 2013).

TREATMENT Pharmacotherapy Antibiotics (Cephalosporin) Opioids (Fentanyl, morphine) (Wetzig, Blackwood, & Currey, 2015, p. 454).

Surgery Open thoracotomy and pleurectomy Video-assisted thoracoscopic (Kelly, 2015, p. 319).

Pleurodesis or sclerotherapy To create adhesion between visceral and parietal pleura Talc Tetracycline Doxycycline (Zarogoulidis et al., 2014).

CHEST DRAINAGE Underwater seal drainage- 3 chambers Water seal Suction Drainage (LeMone et al., 2011, pp. 1303).

Role of Nurse during insertion Informed Consent Positioning Assist in insertion and securing Close monitoring and documentation (LeMone et al., 2011, pp. 1304).

Complications Lung infection Lung infarction Re-expansion pulmonary oedema Haemothorax Dislodgement

(Yartsev, 2016) (Kelly, 2015, p. 318).

ROLE OF NURSE IN MANAGING CHEST DRAINAGE Maintain patency Maintain UWSD Suction Position Pain management Observations• Oscillation• Bubbling• Air leak (Memorial Healthcare System,

2010) • Dressing site (John Hunter Children’s Hospital, 2014, pp. 3-4).

LIST OF REFERENCE Bell, C., & Sluys, K. P. (2015). Trauma Management. In L. Aitken, W. Chaboyer & A. Marshall, (Eds.), ACCCN's Critical Care Nursing 3

e (pp. 791- 828). Chatswood, NSW: Elsevier Australia. Brigham and Women's Hospital. (2016). Pneumothorax. Retrieved from

http://www.brighamandwomens.org/Departments_and_Services/lung-center/lung-diseases-and-conditions/pneumothorax.aspx Choi, W. I. (2014). Pneumothorax. Tuberculosis and respiratory diseases, 76(3), 99-104. Retrieved from

http://synapse.koreamed.org/DOIx.php?id=10.4046/trd.2014.76.3.99 Clarke, J. (2015). Nursing management: lower respiratory problems. In D. Brown., H. Edwards., S. Lewis., L. Dirksen., M. Heitkemper.,

P. O’Brien., L. Bucher, & I. Camera (Eds.), Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems (pp. 524- 563). Marrickville, N.S.W.: Elsevier Australia.`

Hsu, C. W., & Sun, S. F. (2014). Iatrogenic pneumothorax related to mechanical ventilation. World journal of critical care medicine, 3(1), 8. Retrieved from http://www.ncbi.nlm.nih.gov.ezproxy.une.edu.au/pmc/articles/PMC4021154/

John Hunter Children’s Hospital. (2014). Care and management of under water sealed chest drains in children-excluding neonates. Retrieved from http://www.hnekidshealth.nsw.gov.au/site/content.cfm?page_id=453347&current_category_code=8337

Kelly, A. (2015). Pneumothorax. In P. Cameron, G. Jelinek, A. Kelly, A. Brown & M. Little(Eds.), Textbook of adult medicine (pp. 316- 319). Elsevier, New York: Churchill Livingstone.

Kline, J. P., Dionisio, D., Sullivan, K., Early, T., Wolf, J., & Kline, D. (2013). Detection of pneumothorax with ultrasound. AANA J, 81(4), 265-71. Retrieved from http://digitaleditions.sheridan.com/article/Detection_of_Pneumothorax_with_Ultrasound/1461004/168310/article.html# 

LeMone, P., Luxford, Y., & Fagan, A. (2011). Medical-surgical nursing: Critical thinking in client care (1st Australian ed. ). Frenchs Forest, N.S.W.: Pearson Australia.

Mayo Clinic. (2016). Pneumothorax. Retrieved from http://www.mayoclinic.org/diseases-conditions/pneumothorax/home/ovc-20179880

Memorial Healthcare System. (2010). Pneumothorax (Collapsed Lung). Retrieved from https://secure.familyhealthtracker.com/deliver.aspx?s=sm&t=di&l=en&f=%7B1CA20BFB-56CE-481B-B50C-ECC9259DE3AA%7D&key=26dd85c28d515a89bff6d8625ddf298a

Thakur, R. K., & Mahomed, A. (2013). Correlating Radiology with Thoracoscopic Findings in a Case of Primary Spontaneous Pneumothorax in a Child. Journal of Minimally Invasive Surgical Sciences, 2(3), 31-4. Retrieved from http://minsurgery.com/6316.fulltext

The children's hospital at Westmead. (2016). Spontaneous Pneumothorax: Primary Management. Retrieved from http://www.schn.health.nsw.gov.au/_policies/pdf/2009-8031.pdf

Yarmus, L., & Feller-Kopman, D. (2012). Pneumothorax in the critically ill patient. CHEST Journal, 141(4), 1098-1105. Retrieved from http://journal.publications.chestnet.org/article.aspx?articleid=1206481&issueno=4&rss=1&ssource=mfr

Yartsev, A. (2016). Underwater Seal Chest Drain System. Retrieved from http://www.derangedphysiology.com/main/required-reading/equipment-and-procedures/Chapter%202.6.2/underwater-seal-chest-drain-system

Wetzig, S., Blackwood, B., & Currey, J. (2015). Respiratory alterations and management. In L. Aitken, W. Chaboyer & A. Marshall, (Eds.), ACCCN's Critical Care Nursing 3 e (pp. 438- 469). Chatswood, NSW: Elsevier Australia.

Zarogoulidis, P., Kioumis, I., Pitsiou, G., Porpodis, K., Lampaki, S., Papaiwannou, A., ... & Dryllis, G. (2014). Pneumothorax: from definition to diagnosis and treatment. Journal of thoracic disease, 6(4), S372-S376.