Pneumothorax Diagnosis Quiz: Assess Your Medical Skills

When a person is suffering from pneumothorax, all of the above anatomic alterations occur. The chest wall moves outward due to the accumulation of air or gas in the pleural space, causing the lung on the affected side to collapse. This collapse occurs because the pressure in the pleural space exceeds the pressure in the lung, leading to the separation of the visceral and parietal pleura. Therefore, all three anatomic alterations mentioned in the options occur in pneumothorax.

The best explanation for the nurse to provide the patient is "The tube will remove excess air from your chest." This is because a pneumothorax is a condition where air accumulates in the space between the lungs and the chest wall, causing the lung to collapse. Inserting a chest tube helps to remove the excess air and re-expand the lung.

Diminished breathing sounds would indicate the presence of a pneumothorax in this patient. A pneumothorax occurs when air enters the pleural space, causing the lung to collapse partially or completely. This can result in diminished or absent breath sounds on the affected side. Other signs of a pneumothorax may include sudden sharp chest pain, shortness of breath, and a rapid heart rate. However, in this question, the only option that specifically indicates a pneumothorax is diminished breathing sounds.

The nurse would immediately assess for signs of a right pneumothorax. A pneumothorax occurs when air accumulates in the pleural space, causing the lung to collapse. In this case, the absence of breathing sounds in the right upper lobe of the lung suggests that there may be a pneumothorax on the right side. The high-pressure alarm on the ventilator could be indicating increased pressure in the pleural space due to the accumulation of air. Other signs of a pneumothorax may include sudden chest pain, shortness of breath, decreased breath sounds on auscultation, and asymmetrical chest movement.

In a recumbent, immobilized patient, lung ventilation may become altered due to reduced movement and decreased lung expansion. This can lead to respiratory complications such as respiratory acidosis, which occurs when there is an excess of carbon dioxide in the blood; atelectasis, which is the collapse of a lung or part of a lung; and hypostatic pneumonia, which is an infection that occurs when fluid accumulates in the lungs due to immobility. These complications can arise from the patient's inability to effectively clear secretions and maintain proper lung function while in a recumbent position.

In a patient with a large hemothorax, there is a collection of blood in the thoracic cavity which can compress the lungs and interfere with their ability to expand and contract properly. This can result in decreased cardiac output (CO), as the heart is unable to pump an adequate amount of blood to the rest of the body. Therefore, the correct answer is decreased CO.

The water-seal chamber not fluctuating until no suction is applied indicates that there is no air leak in the pleural space, which is a sign that the lung has re-expanded and the pneumothorax has resolved. This is a reliable measure to determine that the patient no longer needs the chest tube.

The constant bubbling in the water-seal chamber of a closed chest drainage system indicates that there is an air leak. When there is an air leak, air is able to enter the system and cause bubbling in the water-seal chamber. This is not a normal functioning of the system and should be addressed by the nurse. It is important to identify and fix the source of the air leak to prevent complications and ensure proper functioning of the chest drainage system.

Checking and taping all the connections is the correct answer because it ensures that there are no loose or disconnected parts in the chest tube system, which could lead to air leakage. By thoroughly checking and securely taping all the connections, the nurse can maintain the integrity of the system and prevent any potential complications.

The most likely cause of the client's findings is pericardial tamponade. Pericardial tamponade occurs when fluid accumulates in the pericardial sac, putting pressure on the heart and preventing it from filling properly. This can lead to decreased cardiac output and poor circulation, which would explain the client's lack of improvement in vital signs despite IV fluid administration. The elevated central venous pressure reading of 20 cm H^O is consistent with pericardial tamponade, as it indicates increased pressure in the venous system due to impaired cardiac filling.

After a lateral crushing chest injury, the client's rib fractures have caused a flail chest, resulting in paradoxical motion of the chest. This means that the affected area moves in the opposite direction during breathing compared to the rest of the chest. This can lead to a mediastinal shift, where the structures in the middle of the chest, such as the heart and major blood vessels, are pushed to one side. This complication is important for the nurse to observe because it can cause compression of these vital structures and lead to serious cardiovascular and respiratory problems.

Iatrogenic pneumothorax refers to a collapsed lung that is caused by medical intervention. Endotracheal intubation involves the insertion of a tube into the trachea to assist with breathing, and it does not directly cause a pneumothorax. However, the other options, such as pleural biopsy, positive-pressure mechanical ventilation, and subclavian vein cannulation, can potentially cause iatrogenic pneumothorax.

The rationale for replacing the Pleur-O-Vac with a Heimlich Flutter Valve is to eliminate the need for a water-seal drainage. A water-seal drainage system is typically used to prevent air from re-entering the pleural space after it has been drained. However, in this case, the small, persistent left-upper lobe pneumothorax can be effectively managed using a Heimlich Flutter Valve, which allows air and pleural drainage without the need for a water-seal drainage system. This eliminates the need for additional equipment and simplifies the management of the pneumothorax.

A pneumothorax is classified as open when air enters the pleural space through an external wound or injury, such as a gunshot or stab wound. On the other hand, a pneumothorax is classified as closed when air enters the pleural space without any external injury, usually due to a rupture in the lung tissue. Therefore, the answer "open, closed" correctly represents the two classifications of pneumothorax based on the way gas enters the pleural space.

The correct answer is that there is greater negative pressure within the chest cavity. This is because in a spontaneous pneumothorax, air enters the pleural space causing the lung to collapse. This results in a loss of negative pressure within the chest cavity, which is essential for proper lung expansion during inspiration. The loss of negative pressure leads to difficulty in breathing and can cause symptoms such as chest pain and shortness of breath. Therefore, understanding the concept of negative pressure within the chest cavity is important in teaching the client about spontaneous pneumothorax.