Pneumothorax

Goals

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

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.

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).

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.