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HEMOTHORAX/PNEUMOTHORAX The lung may collapse partially or completely because of air (pneumothorax), blood (hemothorax), or other fluid (pleural effusion) collecting in the pleural/potential space. The intrathoracic pressure changes induced by increased pleural space volumes reduce lung capacity, causing respiratory distress and gas exchange problems and producing tension on mediastinal structures that can impede cardiac and systemic circulation. Pneumothorax may be traumatic (open or closed) or spontaneous. CARE SETTING 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) Patient Assessment Database Findings vary, depending on the amount of air and/or fluid accumulation, rate of accumulation, and underlying lung function. ACTIVITY/REST May report: Dyspnea with activity or even at rest CIRCULATION May exhibit: Tachycardia; irregular rate/dysrhythmias S 3 or S 4 /gallop heart rhythm (heart failure secondary to effusion) Apical pulse reveals point of maximal impulse (PMI) displaced in presence of mediastinal shift (with tension pneumothorax) Hamman’s sign (crunching sound correlating with heartbeat, reflecting air in mediastinum) BP: Hypertension/hypotension JVD EGO INTEGRITY May exhibit: Apprehension, irritability FOOD/FLUID May exhibit: Recent placement of central venous IV/pressure line (causative factor) PAIN/DISCOMFORT May report Unilateral chest pain, aggravated by breathing, coughing, and movement (depending on Sudden onset of symptoms while coughing or straining (spontaneous pneumothorax) the size/area Sharp, stabbing pain aggravated by deep breathing, possibly radiating to neck, shoulders, involved): abdomen (pleural effusion) May exhibit: Guarding affected area Distraction behaviors Facial grimacing RESPIRATION May report: Difficulty breathing, “air hunger” Coughing (may be presenting symptom)
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History of recent chest surgery/trauma; chronic lung disease, lung inflammation/infection (empyema/ effusion); diffuse interstitial disease (sarcoidosis); malignancies (e.g., obstructive tumor) Previous spontaneous pneumothorax; spontaneous rupture of emphysematous bulla, subpleural bleb (COPD) May exhibit: Respirations: Rate increased/tachypnea Increased work of breathing, use of accessory muscles in chest, neck; intercostal retractions, forced abdominal expiration Breath sounds decreased or absent (involved side) Fremitus decreased (involved site) Chest percussion: Hyperresonance over air-filled area (pneumothorax); dullness over fluid- filled area (hemothorax) Chest observation and palpation: Unequal (paradoxic) chest movement (if trauma, flail); reduced thoracic excursion (affected side) Skin: Pallor, cyanosis, diaphoresis, subcutaneous crepitation (air in tissues on palpation) Mentation: Anxiety, restlessness, confusion, stupor
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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