A 66-year-old male patient with a history of COPD presents to the ER for shortness of breath. He
has a Respiratory rate of 24, Sp02 of 90% and a HR of 112. On exam you find absent breath
sounds and hyperresonance to percussion over the left lung and the right lung is clear to
auscultation.
1. What do you suspect the diagnosis is?
Pneumothorax
2. What other finding could a patient with this diagnosis have?
Tracheal deviation and JVD if tension pneumo, otherwise unequal lung expansion,
abnormal CXR, pleuritic pain and subcutaneous emphysema are possible findings
3. Explain the pathophysiology the diagnosis
Air is filling the left side of the chest with increasing intrathoracic pressure (usually a
negative pressure environment), causing the left lung to collapse
4. What may have caused this, given the patients history?
Pt has COPD and a bleb rupturing is the likely cause. (Would that be closed or open?
Closed, Traumatic or spontaneous? spontaneous)
5. What are your priority nursing interventions?
Monitor vital signs, O2 if ordered, fowlers position, pain relief, prepare for chest tube
placement
A chest tube was placed
6. Why was this placed?
To relieve positive intrathoracic pressure and allow lung re-expansion
7. Nursing interventions and patient education
Keep all tubing free of kinks and occlusions, watch for tidaling, if
disconnected place in 2cm of NS, if bubbling check for air leaks, do not
lift collection system above patient’s chest, ensure all connections are
tight, change dressing per order
has a Respiratory rate of 24, Sp02 of 90% and a HR of 112. On exam you find absent breath
sounds and hyperresonance to percussion over the left lung and the right lung is clear to
auscultation.
1. What do you suspect the diagnosis is?
Pneumothorax
2. What other finding could a patient with this diagnosis have?
Tracheal deviation and JVD if tension pneumo, otherwise unequal lung expansion,
abnormal CXR, pleuritic pain and subcutaneous emphysema are possible findings
3. Explain the pathophysiology the diagnosis
Air is filling the left side of the chest with increasing intrathoracic pressure (usually a
negative pressure environment), causing the left lung to collapse
4. What may have caused this, given the patients history?
Pt has COPD and a bleb rupturing is the likely cause. (Would that be closed or open?
Closed, Traumatic or spontaneous? spontaneous)
5. What are your priority nursing interventions?
Monitor vital signs, O2 if ordered, fowlers position, pain relief, prepare for chest tube
placement
A chest tube was placed
6. Why was this placed?
To relieve positive intrathoracic pressure and allow lung re-expansion
7. Nursing interventions and patient education
Keep all tubing free of kinks and occlusions, watch for tidaling, if
disconnected place in 2cm of NS, if bubbling check for air leaks, do not
lift collection system above patient’s chest, ensure all connections are
tight, change dressing per order
