Pneumothorax: NCLEX Priorities
Spontaneous vs tension pneumothorax, chest tube management, tracheal deviation.
Pneumothorax is air in the pleural space. Tension is emergency.
Recognition
Sudden chest pain, dyspnea. Diminished or absent breath sounds on affected side. Hyperresonance on percussion.
Tension pneumothorax
Tracheal deviation away from affected side. Hypotension. Distended neck veins. Emergency, needle decompression at 2nd intercostal space midclavicular line. Then chest tube.
Chest tube
Drain to underwater seal or suction. Monitor for bubbling (air leak), tidaling (chest movement). Don't clamp routinely. Keep below chest level.
Small spontaneous
Observation, O2 (helps reabsorption), serial CXR. Larger or symptomatic: chest tube.
Frequently asked
Air bubbling in water seal chamber, concern?
Air leak. Look for source (loose connection vs ongoing pneumothorax).
When pull chest tube?
No bubbling for 24h, no drainage, lung re-expanded on CXR.
Quick check
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