Lindsey Gamrat

Pneumothorax Case Study

A 22-year-old male patient presents to the ED post motor vehicle accident

with penetrating trauma to the chest. You note that he is cyanotic, short
of breath, and his trachea is deviating to the right.

1. What is this patient likely experiencing (be specifictell me on which

side hes experiencing it) that could be causing these assessment
findings? Provide rationale.
This patient is most likely experiencing a left pneumothorax. The type of
pneumothorax is probably a penetrating/open traumatic pneumothorax because
this patient was in a motor vehicle accident where something penetrated his chest.
It is likely the left lung that is experiencing the problem because the trachea is
deviated to the opposite side. Increased pressure on the left side will push the
trachea to the right. Cyanosis and shortness of breath are also signs of a
pneumothorax.

2. Name at least four other assessment findings you would see upon
assessing this patient. Provide rationale.
I would expect to find this patient experiencing high levels of anxiety due to the
dyspnea and shortness of breath. Feeling like you cannot catch your breath can be
very scary to a patient. I would also expect lung sounds to be absent on the
affected side because there is no respiration occurring on the part of the lung that is
collapsed. This patient may also have jugular vein distention due to the decrease in
the return flow of venous blood. Vital signs would likely show tachypnea,
tachycardia, hypotension, and decreased SpO2. If an ABG were drawn and analyzed
on this patient, it would likely show hypoxemia due to impaired gas exchange and
respiratory alkalosis because the patient will be hyperventilating and blowing off
excess carbon dioxide due to anxiety.

3. What is the primary nursing diagnosis for this patient? Provide

rationale.
Following the ABC format to determine priorities, the priority nursing diagnosis for a
pneumothorax is impaired gas exchange. Part or all of a lung is not functioning
correctly and this really causes a problem that can lead to many other nursing

diagnoses as well (but this is the root of it all). Restoring adequate gas exchange
will help improve perfusion, acid-base balance, circulation, anxiety, and pain. While
these are also important, treating the oxygenation problem needs to be the first
priority.

4. What nursing and medical interventions do you anticipate this

patient receiving?
Medical interventions that I would anticipate this patient receiving would be a
needle decompression and/or chest tube insertion. These are needed to reduce
pressure and allow the pressure in the pleural cavity to return to normal so that the
lung can eventually function adequately again. Surgery could also be required to
repair the lung depending on how severe the damage is. The patient will also need
to be on oxygen to keep their SpO2 within a desirable range and he may even
require ventilation. As far as medications, I would expect the patient to be on pain
medication because he will likely be in a lot of pain from the pneumothorax and the
motor vehicle accident. He may also need vasopressors (i.e. epinephrine) or
inotropes (i.e. digoxin) to increase blood pressure and cardiac output if he goes into
shock or a hypotensive shock-like state. Nursing interventions would include
positioning to promote comfort, relaxation techniques to decrease pain and anxiety,
education, encouraging cough/deep breathing to encourage expectorating
secretions, preventing infection to the open chest cavity, and limiting activities to
conserve energy.