Pneumonia Q 31

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Which of the following treatments would the nurse expect for a client with a spontaneous pneumothorax?

  

     A. Antibiotics

     B. Bronchodilators

     C. Chest tube placement

     D. Hyperbaric chamber

    

    

Correct Answer: C. Chest tube placement

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The only way to re-expand the lung is to place a chest tube on the right side so the air in the pleural space can be removed and the lung re-expanded. The American College of Chest Physicians recommends aspiration for large or symptomatic primary spontaneous pneumothorax with a small-bore catheter (14F or smaller) or, if the initial aspiration fails, admission with a chest tube (16F to 22F).

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Option A: For stable patients presenting with a small primary spontaneous pneumothorax for the first time, conservative management with supplemental oxygen and observation of at least 6 hours is recommended. If repeat chest radiograph shows evidence of a stable pneumothorax and the patient has access to adequate follow-up, then the patient can be discharged with strict return precautions for a 24-hour recheck.

Option B: Larger primary spontaneous pneumothorax can be further managed with video-assisted thoracoscopy surgery (VATS) or thoracotomy to perform bullectomy, pleurectomy, and mechanical pleurodesis (i.e., dry gauze abrasion). VATS is less invasive than thoracotomy and has been shown to be an effective measure in the treatment and prevention of spontaneous pneumothorax recurrence.

Option D: It is appropriate to initiate 100% oxygen via a non-rebreather mask and continuous cardiopulmonary monitoring for patients with spontaneous pneumothorax. Oxygen increases the rate of absorption of the gas from the pleural space up to four-fold compared to the absorption of 1% to 2% of the volume per day without oxygen.

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