Nursing care plan pneumothorax hemothorax

I. Pathophysiology
a. Partial or complete collapse of lung due to accumulation of
air (pneumothorax), blood (hemothorax), or other fluid
(pleural effusion) in the pleural space
b. Intrathoracic pressure changes induced by increased pleural
space volumes and reduced lung capacity, causing respiratory
distress and gas exchange problems and producing tension
on mediastinal structures that can impede cardiac and
systemic circulation
c. Complications include hypoxemia, respiratory failure, and
cardiac arrest.

II. Classification
a. Primary spontaneous pneumothorax
b. Secondary spontaneous pneumothorax
c. Iatrogenic pneumothorax
d. Traumatic pneumothorax

III. Etiology
a. Primary spontaneous: rupture of pleural blebs typically
occurs in young people without parenchymal lung disease or
occurs in the absence of traumatic injury to the chest or lungs
b. Secondary spontaneous: occurs in the presence of lung
disease, primarily emphysema, but can also occur with
tuberculosis (TB), sarcoidosis, cystic fibrosis, malignancy,
and pulmonary fibrosis
c. Iatrogenic: complication of medical or surgical procedures,
such as therapeutic thoracentesis, tracheostomy, pleural
biopsy, central venous catheter insertion, positive pressure
mechanical ventilation, inadvertent intubation of right
mainstem bronchus
d. Traumatic: most common form of pneumothorax and
hemothorax, caused by open or closed chest trauma related
to blunt or penetrating injuries

IV. Statistics (American Lung Association, June 2005)
a. Morbidity: Primary spontaneous pneumothorax affects
9,000 persons per year and is more common in tall, thin
men between 20 and 40 years of age.
b. Recurrence rate: Is about 40% for both primary and
secondary spontaneous pneumothorax, occurring in
intervals of 1.5 to 2 years.
c. Mortality: Rate is 15% for those with secondary pneumothorax.

Care Setting
Client is treated in inpatient medical or surgical unit.

Related Concerns
Cardiac surgery: postoperative care
Chronic obstructive pulmonary disease (COPD) and
asthma
Psychosocial aspects of care
Pulmonary tuberculosis (TB)
Ventilatory assistance (mechanical)

Nursing Priorities
1. Promote or maintain lung reexpansion for adequate oxygenation
and ventilation.
2. Minimize or prevent complications.
3. Reduce discomfort and pain.
4. Provide information about disease process, treatment regimen,
and prognosis.

Discharge Goals
1. Adequate ventilation and oxygenation maintained.
2. Complications prevented or resolved.
3. Pain absent or controlled.
4. Disease process, prognosis, and therapy needs understood.
5. Plan in place to meet needs after discharge.

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