Pneumothorax for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Pneumothorax for Certified Emergency Nursing (CEN)
Outline
Pneumothorax
Definition/Etiology:
An accumulation of air in the pleural space. This can be caused spontaneously, or from an injury. Whether open or closed, the patient is going to be experiencing some type of pleuritic chest pain and dyspnea. One of the gold signs of a pneumothorax is decreased or absent lung sounds on the affected side. The goal of treatment is to equalize the pressure.
Causes can be:
- Trauma
- Primary spontaneous: No active disease…Marfans, scuba diving, high altitude.
- Secondary spontaneous: from a disease process such as COPD, or a bleb
- Iatrogenic: From a bad central line insertion
Pathophysiology:
Air entering the pleural space can compress the lung and can cause partial or complete collapse. The pleural cavity is inherently a negative pressure environment, and this “leak” causes a loss of that negative pressure.
Clinical Presentation:
In most pneumo:
- Chest pain
- Dyspnea
- Cough
- Restlessness
- Tachypnea
In tension:
- The above
- Signs of obstructive shock: Hypotension, cyanosis, tachycardia
- JVD secondary to mediastinal shift (LATE)
- Deviated trachea away from affected side
- Decreased LOC as condition worsens
In Open:
- The above and:
- Some sort of hole!
- “Sucking” sound heard with respiration
Bubbling around chest wound with exhalation
IN ALL – Markedly decreased or absent lung sounds on affected side!
Collaborative Management:
- Clinical assessment: Paint a picture for a diagnosis!
- Chest X-Ray
- Needle decompression: 14-16g over the needle catheter, 3-6cm in length. Above the third rib, midclavicular line – affected side!
- Chest tube insertion
Evaluation | Patient Monitoring | Education:
- Maintain chest drainage system (separate lecture)
- Maintain O2 Saturation
- VS monitoring
- Prep for OR if necessary (likely in traumatic open PTX).
- With open PTX, or with chest tube in place, observe for development of tension PTX
- We also need to watch our intubated patients. Mechanical ventilation can cause a tension PTX as well. Make sure you are collaborating with RT
Linchpins: (Key Points)
- Use your eyes and ears
- Needle Decomp
- Chest tube
- Continued monitoring
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System