Pneumothorax

Mid 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 Rovers
  • Age: 58 years
  • Family: Married
  • Occupation: Postal delivery worker
  • Cultural: Not known

AMPLE

A: Unknown

M: None

P: Hypercholesterolaemia

L: Pizza yesterday evening

E: Fell from bicycle, pain in left thorax

SBAR

S: Mr Rovers has just been admitted to your ward. He fell from his bicycle 2 hours ago after missing the kerb and landed with his right flank on his handlebars. He initially thought it was not serious, but started to feel unwell and came to hospital with shortness of breath and chest pain.

B: Mr Rovers is 58 years old and has a history of hypercholesterolaemia.

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 25 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 91%.

C: Pale colour, CRT 4 sec, HR 109 bpm, weak regular pulse, skin cold and clammy, BP 103/54.

D: Alert on AVPU, glucose 6.5, pupils PEARL.

E: Temp 36.9°C, normal extremities. Urine output: at home 3 hours ago (amount unknown).

Situation at the end of scenario

A: Clear airway, in pain, alert.

B: RR 35 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 83%.

C: Pale clammy skin, CRT 4 sec, HR 135 bpm, weak regular pulse, skin cold and clammy, BP 90/48.

D: Alert on AVPU, glucose 6.5, pupils PEARL.

E: Temp 36.9°C, normal extremities.

Recommendations

  • Perform chest X-ray
  • Insert chest drain