Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall, causing the lung to collapse. It can occur spontaneously due to lung blebs or as a result of trauma. Symptoms include chest pain and difficulty breathing. Diagnosis involves chest x-ray and ultrasound. Treatment depends on severity but may include oxygen, needle aspiration, chest tube insertion, or surgery to repair blebs or remove air. Nursing care focuses on improving breathing, managing pain, and preventing infection.
Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall, causing the lung to collapse. It can occur spontaneously due to lung blebs or as a result of trauma. Symptoms include chest pain and difficulty breathing. Diagnosis involves chest x-ray and ultrasound. Treatment depends on severity but may include oxygen, needle aspiration, chest tube insertion, or surgery to repair blebs or remove air. Nursing care focuses on improving breathing, managing pain, and preventing infection.
Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall, causing the lung to collapse. It can occur spontaneously due to lung blebs or as a result of trauma. Symptoms include chest pain and difficulty breathing. Diagnosis involves chest x-ray and ultrasound. Treatment depends on severity but may include oxygen, needle aspiration, chest tube insertion, or surgery to repair blebs or remove air. Nursing care focuses on improving breathing, managing pain, and preventing infection.
Pneumothorax is the accumulation of air in the pleural space between the lung and chest wall, causing the lung to collapse. It can occur spontaneously due to lung blebs or as a result of trauma. Symptoms include chest pain and difficulty breathing. Diagnosis involves chest x-ray and ultrasound. Treatment depends on severity but may include oxygen, needle aspiration, chest tube insertion, or surgery to repair blebs or remove air. Nursing care focuses on improving breathing, managing pain, and preventing infection.
• Tracheostomy • Tube or needle puncture • Mechanical ventilation • High-flow therapy (moved from non-iatrogenic) Pathophysiology Clinical Manifestation
• Dyspnea
• Cyanosis
• Chest pain
• Mediastinal shift to healthy side
• Hyper-resonant percussion note
• Flat percussion indicates presence of fluid
Diagnosis
History: • Chief complaints, onset, duration, pain description, associated symptoms such as cough, fever, fatigue, dizziness etc.
Physical examination: • General apperance, signs of distress, cyanosis, chest movement during respiration, breathe sound, tracheal deviation etc. Diagnosis Contd…
Chest X-ray: • This is the primary diagnostic tool to confirm the presence and extent of pneumothorax.
Chest ultrasonography: • It is especially useful when a chest X-ray is inconclusive or in cases where immediate bedside evaluation is needed to quickly assess and diagnose pneumothorax. Diagnosis Contd… Arterial blood gas (ABG) analysis: • ABG analysis can help assess the patient's respiratory function and determine the severity of respiratory compromise caused by pneumothorax. • It provides information about oxygenation levels (PaO2) and carbon dioxide retention (PaCO2) and can guide decision-making on the need for supplemental oxygen or assisted ventilation. Diagnosis Contd…
CT scan: • CT scans can provide a more comprehensive visualization of the lungs and pleural spaces, allowing for a better assessment of the condition and associated abnormalities. Treatment and management Goal- to evacuate air promptly and allow the lung to re-inflate.
Supplemental oxygen: • To treat hypoxia, maintaining adequate oxygenation while awaiting other interventions.
Conservative management: • In some cases, pneumothorax may resolve on its own over time, without the need for intervention but close monitoring is necessary. Treatment and management Contd…
Pharmacotherapy: • Local anesthetics (eg, lidocaine hydrochloride) • Opioid anesthetics (eg, fentanyl citrate, morphine) • Benzodiazepines (eg, midazolam, lorazepam) • Antibiotics (eg, doxycycline, cefazolin) Treatment and management contd… Surgery: If the patient has had repeated episodes of pneumothorax or if the lung remains unexpanded after 5 days with a chest tube in place, operative therapy such as the following may be necessary: • Needle aspiration/ decompression • Chest tube insertion • Thoracoscopy: Video-assisted thoracoscopic surgery (VATS) • Pleurodesis or sclerotherapy • Resection of blebs or pleura • Open thoracotomy Needle aspiration/ Simple aspiration:
• For clinically stable patients with larger pneumothorax or
symptoms present, needle aspiration may be performed.
• In needle aspiration, air is manuaaly withdrawn using an
intravenous catheter connected to a syringe and three way
stopcock. Chest tube insertion
• In more severe cases or if needle aspiration is insufficient, a chest
tube may be inserted to drain the air and re-expand the lung.
• This is done under sterile conditions and usually requires
hospitalization. Video-assisted thoracoscopic surgery (VATS):
• Video-assisted thoracoscopic surgery (VATS) is a minimally
invasive procedure that utilizes a small video camera and specialized instruments inserted through small incisions in the chest wall. • Less invasive surgical approach used to treat persistent or recurrent pneumothorax. Video-assisted thoracoscopic surgery (VATS) contd… • It allows for visualization and treatment of the pleural space, including the resection of blebs or bullae, pleurodesis, or removal of adhesions. Pleurodesis or sclerotherapy • Mechanical Pleurodesis or sclerotherapy: It can be performed using electrocautery. Electrocautery uses heat to create intentional inflammation and scarring between the two layers of the pleura, promoting adhesion and preventing the recurrence of pneumothorax. Pleurodesis or sclerotherapy contd…
• Chemical Pleurodesis: Chemical pleurodesis involves the instillation
of a sclerosing agent into the pleural space to create inflammation and promote adhesion formation. Common sclerosing agents used include talc (most commonly used), bleomycin, tetracycline, doxycycline, and erythromycin. Resection of blebs or pleura • Blebs are thin-walled air-filled sacs on the lung's surface that are prone to rupture and cause pneumothorax.
• Resection of blebs or bullae (larger air-filled spaces) can be performed
to prevent further episodes of pneumothorax.
• In some cases, the pleura (the membrane lining the chest cavity and lungs) may also need to be resected if it is causing recurrent air leaks. Open thoracotomy • In severe or complicated cases, an open thoracotomy may be necessary.
• This involves making a larger incision in the chest wall to access the thoracic cavity and perform more extensive surgical procedures, such as lung resection or repair of underlying lung diseases like emphysema. Nursing Management Assessment • Assess the child's vital signs including oxygen saturation, respiratory rate, breath sounds, and effort.
• Obtain a thorough health history, including any previous episodes of
pneumothorax, lung diseases, trauma, or underlying conditions.
• Monitor for signs of respiratory distress, such as increased work of
breathing, use of accessory muscles, and cyanosis. Nursing Management Contd…
Nursing diagnosis: • Impaired gas exchange related to lung collapse and decreased oxygenation.
• Ineffective breathing pattern related to reduced lung expansion and
increased work of breathing.
• Acute Pain related to lung collapse and tissue irritation.
Nursing Management Contd…
• Parental Anxiety related to the child's condition and required medical
interventions.
• Risk for infection related to invasive procedures or interventions.
Nursing Management Contd…
Nursing Interventions:
To improve gas exchange:
• Monitor respiratory rate, effort, and oxygen saturation levels regularly.
• Administer oxygen therapy as prescribed to maintain adequate
oxygenation. Nursing Management Contd…
• Position the child in a comfortable position that promotes lung
expansion and optimal gas exchange.
• Encourage deep breathing exercises and coughing to help remove
trapped air and improve lung function.
• Monitor and manage pain or discomfort that may interfere with
breathing and deep breathing exercises. Nursing Management Contd… To alleviate pain
• Assess and document the child's pain level using appropriate pain assessment tools.
• Administer prescribed pain medications, such as opioids, as ordered
by the healthcare provider.
• Provide non-pharmacological pain relief measures, such as distraction
techniques, comfort measures, and repositioning. Nursing Management Contd…
• Educate the child and family about pain management strategies and the importance of reporting any changes in pain intensity or location. Nursing Management Contd…
To prevent infection
• Practice appropriate hand hygiene and aseptic technique during any
invasive procedures.
• Monitor the child's vital signs, temperature, and signs of infection
(e.g., fever, increased white blood cell count). Nursing Management Contd…
• Assess and monitor the insertion site for chest tube or other invasive procedures for signs of infection or inflammation.
• Educate the child and family about signs and symptoms of infection and when to seek medical attention. Nursing Management Contd…
To reduce parental anxiety
• Explain the condition of pneumothorax, its causes, and treatment
options to parents.
• Provide a safe and supportive environment for parents to express their
feelings and concerns.
• Listen actively and empathetically to parents' anxieties, fears, and
frustrations. Nursing Management Contd… • Validate their emotions and reassure them that their feelings are understandable and normal.
• Involve parents in their child's care as much as possible
• Teach parents how to perform non-invasive tasks, such as positioning
their child comfortably or assisting with activities of daily living.
• Keep parents informed about their child's progress and any changes in the treatment plan. Nursing Responsibilities/Care of Patient with Chest Tube • Keep drainage system 2-3 feet below patient's chest
• Keep tubing patent; make sure no kinks or clots present
• Observe and record amount of drainage ( > 100cc/hr is heavy...notify
physician).
• Encourage TCDB, ambulation as ordered.
Prognosis
• Prognosis varies depending in patient’s underlying disease and
pulmonary reserve.
• If other trauma was sustained at the same time or tension
pneumothorax occurred with subsequent shock and hypoperfusion, the prognosis worsens.
• If the patient was allowed to be hypoxic for a long period, brain injury is possible. Prognosis contd…
• Recurrence after the first episode of primary spontaneous
pneumothorax in children is frequent and difficult to predict.
• The recurrence rate of spontaneous pneumothoraces can range from
40-87%.
• Patients with obstructive pulmonary disease (eg, asthma, cystic
fibrosis) have an especially high rate of recurrence. Complication • Hypoxemic respiratory failure • Respiratory or cardiac arrest • Hemopneumothorax • Bronchopulmonary fistula • Pulmonary edema (following lung reexpansion) • Empyema • Pneumomediastinum, Pneumopericardium, Pneumoperitoneum • Pyopneumothorax Complication contd… Complications of surgical procedures include the following: • Acute respiratory distress or failure • Infection of the pleural space • Cutaneous or systemic infection • Persistent air leak • Reexpansion pulmonary edema • Pain at the site of chest tube insertion • Prolonged tube drainage and hospital stay Prevention
• Prompt recognition and treatment of bronchopulmonary infections
decreases the risk of progression to a pneumothorax
• Encourage children to maintain a healthy lifestyle by engaging in
regular physical activity, eating a balanced diet, and avoiding smoking or exposure to secondhand smoke. Prevention contd… • Preventive measures should be taken to reduce the risk of traumatic injuries in children e.g. promoting seatbelt and helmet use, childproofing the home to prevent falls or accidents, and supervising children during play or sports activities.
• Medical procedures, such as central line insertion or mechanical
ventilation, should be performed by trained healthcare professionals using proper techniques to minimize the risk of iatrogenic (procedure- related) pneumothorax. Prevention contd…
• Educate children, parents, and caregivers about the signs and
symptoms of pneumothorax, especially in those with underlying lung conditions as the prompt recognition and seeking medical attention at the earliest signs can help in early diagnosis and management. References • Ghai, O., Paul, K.V and Bagga. A. Essential Pediatrics(7th ed.). CBS Publisher and Distributor • Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2018). Wong’s Nursing Care of Infants and Children (11th ed.). St. Louis, MO: Elsevier. • Kliegman, M.R (2014).Nelson Textbook of pediatrics(1st ed.). Klsevier • https://www.slideshare.net/PushpaNepal/pneumothorax-ppt-368-final • https://emedicine.medscape.com/article/1003552overview?&icd=login_success_e mail_match_fpf#a3
