Pneumothorax and Hemothorax

Pneumothorax and Hemothorax Nursing Diagnosis Interventions and Care Plans

Pneumothorax and Hemothorax Nursing Diagnosis NCLEX Review Care Plans

Pneumothorax and Hemothorax

Pneumothorax is a medical condition where in a lung collapses due to the air leakage in the pleural space, or the space in between the chest wall and the lung.

Hemothorax, on the other hand, happens when blood fills the pleural space. Both medical conditions result from penetration of the chest cavity in an accident or trauma, a surgical or medical procedure, or an underlying severe lung damage or disease.

Pneumothorax and hemothorax can be fatal if left untreated.

Signs and Symptoms of Pneumothorax and Hemothorax

Pneumothorax

  • Sudden chest pain, especially during inhalation
  • Shortness of breath
  • Tachycardia or rapid heart rate
  • Hypotension or low blood pressure
  • Cold, clammy skin
  • Restlessness

Hemothorax

 (In addition to the signs and symptoms of above)#

  • Coughing up blood

Causes of Pneumothorax and Hemothorax

Chest injury through accident and trauma is one of the most common causes of pneumothorax and hemothorax.

Car accidents or vehicular crashes can result to chest injury. Ruptured blebs or air blisters on the top of the lungs may also cause pneumothorax.

Lung disease such as pneumonia and cystic fibrosis can cause severe damage to the lung tissue and may cause a portion or the whole lung to collapse.

Mechanical ventilation is a treatment for breathing assistance, but may eventually cause lung collapse.

Complication of Pneumothorax and Hemothorax

Recurring air leak can happen in pneumothorax patients, and may required surgical intervention to close the air leak every time it occurs.

Leakage or accumulation of 1L of blood or more can be diagnosed as massive hemothorax and may lead to shock.

Cardiac arrest and respiratory failure may also occur in severe pneumothorax and/or hemothorax.

Diagnostic Tests for Pneumothorax and Hemothorax

  • Pulse oximetry – to measure the oxygen level in the blood
  • Chest X-ray, and may also require CT scan
  • Blood tests – including arterial blood gas analysis, full blood count

Treatments for Pneumothorax and Hemothorax

  1. Observation. A mild pneumothorax which involves only a small area of lung collapse may not need any medical or surgical intervention. The doctor may simply monitor the lungs through a series of x-rays for several weeks.
  2. Needle aspiration. Larger or more severe pneumothorax or hemothorax may require mechanical removal of the air or blood through inserting a catheter into the pleural space. The doctor may need to leave the catheter in situ for a few hours to monitor the re-expansion of the lungs and to reduce the risk of recurrent pneumothorax.
  3. Chest drainage. A chest tube is inserted into the pleural space and attached to a device where the continuous removal of air or blood from the chest cavity can be observed by the nurses and other members of the healthcare team. Once the lung has re-expanded and healed, the chest tube drain may be removed.
  4. Surgery. This might be the treatment option to close larger or multiple air/ blood leaks by means of creating small incisions to reach the pleural space and sealing the air/blood leakage.

Nursing Care Plans for Pneumothorax

1. Nursing Diagnosis: Ineffective Breathing Pattern related to pneumothorax as evidenced by shortness of breath, SpO2 level of 85%, respiratory rate of 29, chest pain when breathing, cold and clammy skin, and restlessness

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours. Auscultate for breath sounds.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Breath sounds may be absent or diminished in the portion of the lung that has collapsed.
Assist in needle aspiration as needed.To effectively pull out the excessive air from the pleural space.
Monitor the chest drain for any abnormalities. Ensure that the water seal chamber is neither underfilled nor overfilled.A chest drain may be required to remove air or blood in the pleural space and allow the lung to re-expand and heal. Bubbling of the water seal chamber when the patient exhales is the desired action. Absence of bubbling may indicate either full lung expansion (desired outcome) or obstruction in the chest tube (problem or complication), An underfilled water seal chamber may result to more air exposure, worsening the pneumothorax/ hemothorax of the patient. An overfilled water seal chamber may hinder the air from escaping the pleural space, making the chest drain ineffective.  
Administer the prescribed antibiotic/antiviral medications.Antibiotics or antivirals: To treat the underlying infection if this is the cause of lung collapse.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Teach the patient to splint the painful or uncomfortable body part when coughing or performing deep breathing exercises.To provide support to the abdominal and respiratory muscles, reducing trauma and enhancing breathing and comfort.
Pneumothorax and Hemothorax Nursing Care Plan

2. Nursing Diagnosis: Impaired Gas Exchange related to pneumothorax as evidenced by shortness of breath, SpO2 level of 85%, productive cough, and frothy phlegm

Desired Outcome: The patient will maintain optimal gas exchange as evidenced by respiratory rates between 12 to 20 breaths per minutes, oxygen saturation within the target range, and verbalize ease of breathing.

InterventionsRationales
Assess the patient’s vital signs, especially the oxygen saturation and characteristics of respirations at least every 4 hours. Also, monitor the results of ABG analysis.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. ABG Analysis: To check if there is an increase in PaCO2 and a decrease in PaO2, which are the signs of hypoxemia and respiratory acidosis.
Administer supplemental oxygen carefully, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.
Turn the patient at least every 2 hours, as tolerated. Encourage to mobilize as tolerated.To prevent the complications of immobility such as thromboembolism that may worsen the pneumothorax.
Monitor the chest drain for any abnormalities.A chest drain may be required to remove air in the pleural space and allow the lung to re-expand and heal.
Pneumothorax and Hemothorax Nursing Care Plan

Other possible nursing diagnoses:

  • Activity Intolerance
  • Anxiety related to Pneumothorax/Hemothorax
  • Fatigue

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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