Pneumothorax

Low complexity — Respiration

Goals

  1. Recognise respiratory insufficiency based on a pneumothorax and apply nursing interventions accordingly.
  2. Be able to propose a chest drain as an intervention based on observations.
  3. Recognise and describe the compensatory mechanisms in respiratory insufficiency.
  4. Reason through possible causes of a pneumothorax in relation to the patient's history.

Anamnese

  • Name: Mr van Akkeren
  • Age: 64 years
  • Family: Married
  • Occupation: Guitarist
  • Cultural: Not known

AMPLE

A: Unknown

M: Citalopram

P: Anxiety disorders - Humeral fracture

L: 2 hours ago

E: Fell from a kitchen stepladder, pain in right thorax

SBAR

S: Mr van Akkeren has just been admitted to your ward after falling from a kitchen stepladder a few hours ago and landing with his right flank on a toolbox. Initially he waited to see how things developed, but he continues to have significant chest pain. He is also becoming increasingly breathless.

B: Mr van Akkeren is 64 years old and has a history of anxiety disorders and humeral fracture.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear airway, in pain, alert.

B: RR 22 breaths/min, asymmetrical thoracic excursions, right lagging behind left, shallow breathing, mildly distended jugular veins, normal breath sounds on left, absent breath sounds on right, painful right thorax, saturation 93%.

C: Pale colour, CRT 2 sec, HR 107 bpm, weak regular pulse, skin cold and clammy, BP 110/59 mmHg.

D: Alert on AVPU, glucose 5.8, pupils PEARL.

E: Temp 36.7°C, normal extremities. Urine output: at home 1 hour ago (amount unknown).

Situation at the end of scenario

A: Clear airway, in pain, alert.

B: RR 30 breaths/min, asymmetrical thoracic excursions, right lagging behind left, shallow breathing, mildly distended jugular veins, normal breath sounds on left, absent breath sounds on right, painful right thorax, saturation 85%.

C: Pale clammy skin, CRT 3 sec, HR 119 bpm, weak regular pulse, skin cold and clammy, BP 105/57 mmHg.

D: Alert on AVPU, glucose 5.8, pupils PEARL.

E: Temp 36.8°C, normal extremities.

Recommendations

  • Perform chest X-ray
  • Insert chest drain