Clinical meaning
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 proportional to the volume of trapped air. In a tension pneumothorax, a one-way valve mechanism allows air entry but prevents exit, causing progressive ipsilateral lung collapse and mediastinal shift. This shift compresses the contralateral lung and impedes venous return to the heart, leading to obstructive shock. The nurse must perform rapid respiratory and cardiovascular assessment, assist with or prepare for needle decompression or chest tube insertion, manage the chest drainage system, and monitor for complications including re-expansion pulmonary edema.
Exam relevance
Risk factors: - Penetrating or blunt chest trauma - Iatrogenic (central line placement, thoracentesis, lung biopsy) - Positive pressure mechanical ventilation - COPD with emphysematous bullae - Primary spontaneous (tall, thin males 20-40 years) - Connective tissue disorders (Marfan, Ehlers-Danlos) - Cystic fibrosis - Tuberculosis or necrotizing pneumonia