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Clinical vignette on Pneumothorax
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Chest pain and shortness of breath can be symptoms of many complications that require medical treatment. Pneumothorax is one of these complications that can be treated by doctors. Pneumothorax is simply a collapsed lung. A number of things can happen to cause a pneumothorax including: trauma to the chest, previously damaged lung tissue, or the rupture of air blisters called blebs (Mayo Foundation for Medical Education and Research, 2014).
The lungs and thoracic cavity are lined with visceral pleura and parietal pleura respectively. The space between the two layers, called the pleural space, is filled with a lubricant that holds the lungs and thorax together. When a pneumothorax occurs, a hole is made in the lung and air escapes into the
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Trauma includes any blunt force trauma to the chest or surgery involving the thorax. Damaged tissue can be a result of many different lung conditions. Blebs can form for many different reasons and can cause a spontaneous pneumothorax. There are risk factors that increase the chances or having a pneumothorax. Males typically are more likely to have a pneumothorax. Height to weight ratio, age, genetics and several other characteristics can affect the chances of a pneumothorax. One study on spontaneous pneumothorax, studying 214 patients, found the mean age to be 38.8 years of age (Uramoto, Shimokawa, & Tanaka, 2012). An article from Mayo Foundation for Medical Education and Research also says that a pneumothorax is more likely to occur in people ages 20-40 …show more content…
Depending on the severity of the collapsed lung, different procedures may be done to correct it. If only a small portion of the lung has collapsed, observation and periodic chest x-rays may be done to monitor the self-repair of the lung. Oxygen may be given to the patient to help the process. A full collapsed lung will require a chest tube or needle to remove the excess air between the lung and the thoracic cavity. A chest tube will be inserted between two ribs and is often connected to a machine that suctions the excess air out. A needle, also inserted between two ribs, can be used to remove the air from the chest cavity “just like a syringe is used to pull blood from a vein (Mayo Foundation for Medical Education and Research, 2014).” A chest tube may need to be left in for several days before the lung is completely reinflated. During this time the patient would need to be hospitalized. If a chest tube fails, surgery is the next procedure that should be done to repair the lung. If the leak in the lung is large, this is the best way to repair it. Surgery can also help prevent future incident. Tension pneumothorax is the most severe type of pneumothorax because it places pressure on the heart making it difficult for it to beat (Cipolle, Rhodes, & Tinkoff, 2012). This type of pneumothorax can cause death if the pressure is not relieved within a reasonable amount of time. Paramedics are not always trained
Pritesh has a previous medical history of asthma and has experienced right-sided haemothorax as he got hit by a hockey ball during a competition. Currently, the nurse suspects that Prithesh may be developing tension pneumothorax which is a life-threatening medical emergency (Brown & Edwards, 2012). Tension pneumothorax develops when a hole in the airway structures or the chest wall allows air to enter but not leave the thoracic cavity (Rodgers, 2008). The pressure in the intrathoracic space will continue increase until the lung collapses, place tension on the heart and the opposite lung leading to respiratory and cardiac function impairment, and eventually shock may result (Professional guide to pathophysiology, 2011; Rodgers, 2008). Tension pneumothorax usually results from a penetrating injury to the chest, blunt trauma to the chest, or during use of a mechanical ventilator (Brown & Edwards, 2012; Rodgers, 2008).
Tension Pneumothorax requires immediate attention. A needle or chest tube needs to be inserted into the chest cavity to release the pressure as soon as possible. If an evacuation is going to take a long period of time you may have to do this procedure yourself. That is not recommended though.
The main symptom of the disease is shortness of breath, which gets worse as the disease progresses. In severe cases, the patient may develop cor pulmonale, which is an enlargement and strain on the right side of the heart caused by chronic lung disease. Eventually, this may cause right-sided heart failure. Some patients develop emphysema as a complication of black lung disease. Others develop a severe type of black lung disease in which damage continues to the upper part of the lungs even after exposure to the dust has ended called progressive massive fibrosis.
Asthma is a chronic disease that makes it difficult to breathe. The airways to the lungs swell up and become inflamed, which narrows the air passageway to the lungs and the lungs cannot receive the amount of oxygen that it needs. “Mucus builds up inside the airways so you have trouble getting air in and out of your lungs.” (Pope, 2002, p.44). If the lungs do not receive the essential amount of air, it will cause a lot of distress and wheezing to the patient.
One of the common diseases in the respiratory system that many people around the world face is emphysema or also known as chronic obstructive pulmonary disease (COPD). It is a chronic lung condition where the alveoli or air sacs may be damaged or enlarged resulting in short of breath (Mayo Clinic, 2011). If emphysema is left untreated, it will worsen causing the sphere shaped air sacs to come together making holes and reduce the surface area of the lungs and the amount of oxygen that travels through the bloodstream, blocking the airways of the lungs (Karriem- Norwood, 2012). The most common ways a patient can get emphysema are by cigarette smoking or being exposed to chemicals, dust or air pollutants for a long period of time. Common physical exams reveal a temperature of 100.8 Fahrenheit, 104 beats per minute, a blood pressure of 146/92, and a respiratory rate of 36 breaths per min (Karriem- Norwood, 2012). (see appendix A.1,A.2, A.3, A.4 for complete proof.)
The lungs are two large sacs within the human body that optimize gas exchange between the air breathed and the blood. (Lung cancer, 2013) The lungs take in oxygen and release carbon dioxide. The lungs are made of spongy tissue, which allows for expansion and contraction. The lungs occupy most of the thoracic cavity. Because of the location of the heart the right lung is slightly larger than the left lung. The base of the lungs sits on the diaphragm allowing the diaphragm to help with breathing.
-Shortness of breath=described as tightness of the chest. Some people have trouble breathing during exercise, others experience it after inhaling smoke, while others need to ingest a particular food-regardless of the circumstance, all people with asthma have trouble breathing.
Bronchiectasis is a chronic disease of the lungs where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection (Nhs.uk.2014). The extent of the disease can vary greatly- may be one section of an airway that is widened and abnormal or many airways- usually somewhere between these extremes. Widened parts of the airways are damaged and inflamed, which causes excess mucus to form which is less easily cleared. Furthermore, these parts of the airways are weaker and more liable to collapse inwards which may affect airflow through the affected airways- severity depends on how many of the airways are affected (Patient.co.uk. 2014). Patients with bronchiectasis have chronic cough and excess sputum production, and infections due to bacteria develop in them- this results in the loss of lung function (O’Donnell 2008).
Husain, A., (2010), The Lung, Robbins and Cotran Pathologic Basis of Disease, pp. 677-737, Philadelphia: Saunders Elsevier
The causes of Pulmonary Fibrosis vary from a patient’s occupation to their medical conditions. Pulmonary Fibrosis is caused by environmental factors along with genetic factors. Genetics plays a role in the contraction by determining a person’s vulnerability. A person being in an environment with asbestos fibers, silica dust, grain dust, and bird or animal droppings is at risk for this disease. Patients who also have gone through radiation could be at risk depending on how much the lung was exposed and how long it was exposed to the radiation. Medications can also factor in to the cause of the disease. Chemotherapy drugs, heart medications, and some antibiotics have been linked to Pulmonary Fibrosis. A patient’s previous medical conditions can aid in the formation of this disease such as pneumonia, tuberculosis, scleroderma, and systemic lupus erythematosus. Some other known causes are smoking and lung infection.
Natioanl Heart, Lung, and Blood Institute. (2013). What Is Pulmonary Embolism? News and Resources, 5.
Hinkle, Janice, and Kerry Cheever. “Management of Patients with Chronic Pulmonary Disease." Textbook of Medical-Surgical Nursing, 13th Ed. Philadelphia: Lisa McAllister, 2013. 619-630. Print.
A pneumothorax is defined as “the presence of air or gas in the plural cavity which can impair oxygenation and/or ventilation” (Daley, 2014). The development of a pneumothorax to a tension pneumothorax can be caused from positive pressure ventilation.
... role of infant-directed speech with a computer model. Acoustical Society of America, 4(4), 129-134.
...o Pneumonia, it causes respiratory failure. The treatment for this would most likely be ventilator breathing for the patient with supplemental oxygen. (Boothby, L. A. (2004)