Pneumothorax

Pneumothorax results from disruption of the visceral or parietal pleura, allowing air to accumulate in the normally negative-pressure pleural space. In a simple pneumothorax, the lung collapses in proportion to the volume of trapped air. A tension pneumothorax adds a one-way valve: air enters during inspiration but cannot escape. Pressure rises, the affected lung collapses further, the mediastinum shifts, venous return falls, and cardiac output deteriorates. That is obstructive shock. The patient can die from impaired circulation as well as from impaired ventilation. A simple pneumothorax may be observed or treated according to its size, symptoms, cause, and the patient’s underlying lung function. Tension pneumothorax is different. It is a clinical emergency diagnosed at the bedside and treated immediately. The nurse’s priorities are rapid respiratory and cardiovascular assessment, escalation, oxygen and monitoring, preparation for decompression, and then management of definitive chest drainage.