Exam (elaborations)
Pneumothorax
Exam of 5 pages for the course BUS 475 at BUS 475 (Pneumothorax)
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PneumothoraxA large, right-sided pneumothorax has occurred from a rupture of a subpleural bleb - ANS-
A patient has a chest tube for treatment of a pneumothorax in the left lung. Which finding during
your assessment requires immediate nursing intervention? - ANS-The patient has slight tracheal
deviation to the right side.
A patient is admitted with a chest wound and experiencing extreme dyspnea, tachycardia, and
hypoxia. The chest wound is located on the left mid-axillary area of the chest. On assessment,
you note there is unequal rise and fall of the chest with absent breath sounds on the left side.
You also note a "sucking" sound when the patient inhales and exhales. The patient's chest x-ray
shows a pneumothorax. What type of pneumothorax is this known as? - ANS-Open
pneumothorax
A patient is diagnosed with a primary spontaneous pneumothorax. Which of the following is
NOT a correct statement about this type of pneumothorax? - ANS-It is most likely to occur in
patients with COPD, asthma, and cystic fibrosis
A patient is receiving mechanical ventilation with PEEP. The patient had developed a tension
pneumothorax. Select ALL the signs and symptoms that can present with this condition: -
ANS-Hypotension, Jugular Venous Distention,Tracheal deviation, Tachypnea
A patient receiving treatment for a pneumothorax calls on the call light to tell you something is
wrong with their chest tube. When you arrive to the room you note that the drainage system has
fallen on its side, and there is a large crack in the system. What is your next PRIORITY? -
ANS-Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of
sterile water and obtain a new system.
A tension pneumothorax is a medical emergency and is treated with needle decompression. -
ANS-The only correct statement about a tension pneumothorax is option B. Option A is wrong
because this condition happens when an opening to the intrapleural space creates a ONE-way
(not two-way) valve which causes pressure to build up in the space leading to shifting of the
mediastinum. Option C is wrong because tracheal deviation is a LATE (not early) sign of a
tension pneumothorax. Option D is wrong because not only can an open pneumothorax cause a
tension pneumothorax but a closed or spontaneous pneumothroax can as well.
Anatomy changes with a tension pneumothorax: - ANS-mediastinal shift causes heart, trachea,
esophagus, and vessels to shift to the UNAFFECTED side and this will compress the unaffected
lung and venous vessels.
, Assess patient's lung sounds to assess if the affected lung has re-expanded. - ANS-It is normal
for the water seal chamber to tidal up and down as the patient breathes in and out. If there is no
fluctuation of water in the water seal chamber there may be a kink in the tubing or the lung has
re-expanded. Therefore, it is important to check the system for kinks and if there are none then
check the patient's lung sounds to see if lung sounds are present on the affected side (hence
the lung has re-expanded).
Barotrauma Define - ANS-which causes buildup of pressure in the intrapleural space from
rupture of the visceral pleura
Closed Pneumothorax Example of what can cause this: - ANS-a rib fracture where the sharp,
bony part of the bone punctures the lung causing air to be released into the intrapleural space.
Closed Pneumothorax: - ANS-when air leaks into the intrapleural space without any outside
wound (hence the chest wall and pleural stay intact).
Cyanosis Define: - ANS-A bluish color of the skin and the mucous membranes due to
insufficient oxygen in the blood.
Definition of pneumothorax - ANS-is a collapsed lung. A pneumothorax occurs when air leaks
into the space between your lung and chest wall. This air pushes on the outside of your lung
and makes it collapse. In most cases, only a portion of the lung collapses.
Describe Chest pain with a Pneumothorax: - ANS-sharp and sudden and worst on inspiration
Disconnect the tubing from the drainage system and insert the tubing 1 inch into a bottle of
sterile water and obtain a new system. - ANS-A new system needs to be obtained, however, in
order to maintain a water seal until the new system arrives you will need to place the tubing 1
inch in sterile water or sterile saline to regain a water seal.
Dyspnea Define: - ANS-Difficult or labored breathing; shortness of breath. Dyspnea is a sign of
serious disease of the airway, lungs, or heart
Hypotension, JVD, tracheal deviation, and tachypnea - ANS-Hypotension, JVD, tracheal
deviation, and tachypnea can all be present in a tension pneumothorax. The other options are
not usually present.
It is most likely to occur in patients with COPD, asthma, and cystic fibrosis. - ANS-All options are
correct about primary spontaneous pneumothorax EXCEPT D. This describes SECONDARY
spontaneous pneumothorax not primary.
Known as a "Spontaneous" Pneumothorax why - ANS-because the pneumothorax was NOT
caused by an injury.
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