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Definition and handling of Pneumothorax

Written By SALWA store on Friday, May 18, 2012 | 9:42 AM

Penumotaks is a collection of air in the pleural space between the visceral and the potential paretal. (Arif Mansjoer, et al, 2000). Intercostal vessels rupture, lung laceration or discharge of air from the lungs of the injured into the pleural space (Brunner & Suddarth, 2001).

Signs and symptoms Pneumotoraks
- The patient complained of shortness of breath, pain and coughing (Mansjoer Arif, et al, 2000)
- Chest pain of sudden

- Respiratory failure
- In the trauma preceded by chest trauma
- Percussion hipersonor
- Auscultation, decreased breath until it is gone
- Sometimes circulatory collapse due to tension
- Overview ro thoracic
   • T erlihat collapsed lung periphery of the line
   • If the total lung tissue can accumulate around the hilum
   • There is mediastinal shift
   (Dwi Wulansih, 2007).

The assessment needs to be done in patients with pneumothorax:
- Assess the patient's breathing pattern, the thoracic cavity, the respiratory movements
- Assess whether there fremitus or crepitus
- Assess the state of the trachea, heart and mediastinum position
- Perform coint test. A metal is emphasized in the anterior thoracic wall and tapped with another coin. While it performed posterior thoracic wall sukultasi. Jhika there is air in the pleural cavity, you will hear a distinctive metallic sound. If there is an accumulation of fluid and air in the pleural cavity and the patient change position suddenly you hear the sound of water movement is known as succession plash. (Brunner & Suddarth, 2001).

Diagnosis of pneumothorax may occur in patients
- Damage to gas exchange associated with lung damage
- Ineffective airway clearance related to lung damage, anxiety and pain
- Pain associated with the presence of chest trauma
- Changes in nutritional status associated with dyspnoea and anorexia. (Brunner & Suddarth, 2001).

Interventions appropriate cases
a. Damage to gas exchange in lung damage berhubunghan
  • Monitor respiratory status matches the instructions and requirements
  • Monitor and record TD, apical pulse and body temperature every 2-4 hours, central venous pressure (if indicated every 2 hours
  • Monitor the continuous electrocardiogram patterns and dysrhythmia
  • Elevate head of bed 30-40o when the patient's hemodynamic status is stable and oriented
  • Encourage deep breathing exercises and effective use of the spirometer (last maximal inspiration)
  • Give a boost and increase the effective cough routine should be done every 1-2 hours during the first 24 hours.

b. Ineffective airway clearance related to lung damage, anxiety and pain
  • Maintain an open airway
  • Perform endotrakhea suction to remove secretions of patients were able to effectively
  • Assess and treat pain, give impetus to deep breathing and coughing exercises
  • Monitor the amount of viscosity, color and odor of sputum, tell your doctor if excessive sputum or blood containing fresh red.
  • Auscultation both sides of the chest to determine the changes in breath sounds.

c. Pain associated with chest trauma
  • Evaluate the location, character, quality and severity of pain. Provide appropriate pain medication is prescribed and as needed d
  • Put the patient in Fowler's position Semo
  • Ask if the orders for PCA pumps allow for patient
  • Give analgesics as prescribed.

d. Changes in nutritional status associated with dyspnea and anorexia
  • Monitor the intake of calories and nutrients
  • Monitor changes in BB
  • Assess the presence of food allergy
  • Collaboration with a dietitian to determine the amount of calories and nutrients needed patient
  • Give health education about nutritional needs

      (Brunner & Suddarth, 2001).

Management of patients penumotoraks
  • - Pneumotoraks closed: Observations, when collapse <10% WSD when> 10%
  • - Open pneumothorax: pairs of WSD
  • - Pneumothorax ventil: Post WSD
  • - Emergency Action

In the life-threatening condition, yet there are doctors who are competent:
• Oxygen is 2-4 liters / minute
• Create a puncture on the lateral chest wall with 2-5 transfusion needle place
(Dwi Wulansih, 2007)

And different kinds of pneumothorax
a. Open pneumothorax
  • There is a direct relationship to the bronchus pleural cavity
  • Intra-pleural pressure = air pressure outside the
  • Occurs when opening the chest wall large enough to allow air to flow freely in and out of the thoracic cavity with each respiratory effort

b. Open pneumothorax
  • Pleural cavity was not associated with outdoor air
  • The air in the pleural cavity will diresorbsi

c. Pneumothorax ventil
    Has a positive pressure in the pleural fistula due visceral nature ventil
    (Dwi Wulansih, 2007)

What about patient care that is attached WSD?
- Do luika care every single day to prevent infection
- Check the hose is still on the bed and drain
- Check the hose container, place 2-3 times below the patient's chest
- Fixation of a connector, given a plaster if necessary
- Observe the number, the character of the rate of drainage
- Check the limits and boundaries of water suction on suction control (when it is not correct)
- Clamp the hose with 2 clamps, connect the quiet side (preparing pads)
- Assess the physical condition (body temperature checks, lung examination, BP and pulse)
- Teach the client to move and change position, cough and deep breathing
- Move the client
• Releasing the connection to the suction hose
• Keep waterseal remain in an upright position
• Keeping the bottle container remains below the chest
• Keep quiet soundproof system
- Evaluate the condition of the client
• RR, breath sounds
• Pain and anxiety
• Integrity
• The type and amount of drainage
• The condition of the wound in the chest
(KMB Practicum Module II, 2008).

Normal breathing mechanism that works on the principle of negative pressure, what does that mean?
Basic principles. Normal breathing mechanism works on the principle of negative pressure, the pressure in the chest cavity is lower than atmospheric pressure, thus causing air to move into the lungs during inspiration. When the chest is opened, for whatever reason, there was loss of negative pressure, which can cause lung collapse, fluid, air or other substances in the chest can disrupt and even cause lung cardiopulmonary collapse.
(Brunner & Suddarth, 2001).

What type of Sitem WSD and the difference?
a. System of the bottle
End of the patient's chest drainage tube was immersed in water which allows air and fluid drainage from the pleural space but does not allow air to flow back into the chest. Functionally, depending on the gravity drainage and mechanical breathing. Circuitry increase the height of liquid in the bottle, it becomes more difficult for air and fluid out of the chest, can therefore be added suckers. Because the bottle is running one of two functions, limit the water content of 10-20 cm.
b. System of two bottles
System consists of two bottles of water seal chamber is the same plus the fluid collector vial. Circuitry similar to a single drainage unit, except that when the pleural fluid collected under water seal system is not affected by the volume drainse
c. System of three bottles
Similar in all aspects of the system except for an additional two bottles of a third bottle to control the amount of a given amount of suction. Amount determined by suction into a glass tube through which the tip is dipped vent. The third bottle regulates the amount of vacuum in the system. The amount of suction in the system is controlled by a manometer bottle. Motor mechanical suction or suction at the wall menci [ptakan and maintain negative pressure throughout the drainage system terutup.
(Brunner & Suddarth, 2001)

The tools used in the installation of WSD:
- Sterile Gloves
- Clean gloves
- Distilled water
- 2 clamps the artery
- Plaster
- Kassa
- The tools vital sign.
(KMB Practicum Module II, 2008).
- Duk sterile
- Sterile scissors
- Cotton alcohol
- Tweezers
- Betadine
- NaCl
- Com (2)
- Ointment
- Bent
- Sputi 5 cc of sterile
- Sterile Scalpel
- Donald voeder skin with a sterile needle
- Sterile silk thread for stitching leather 4x25 cm
- Interval for drainage (adult with a diameter of 8 mm, the children with a diameter of 6 mm).

Why does the patient have to do WSD post OP wound care once a day?
The goal is for the relief of pain, discomfort, an understanding of maintenance procedures and the absence of infection or complications.
(Brunner & Suddarth, 2001).

WSD is installed adjacent to where?
When right on the sidelines of the ribs to -7 or -8 and ribs on the left on the sidelines of the -8 and -9 underlined the posterior axillary or roughly the same height as the ribs of the angle between the inferior scapula.
When in front of the chest between the ribs to the selected line midklavikuler -2 in the right or left.
(Arif Mansjoer, et al, 2000).

Position the patient use the attached WSD
Whenever possible the patient in a sitting position. If not perhaps half-sitting, if not the patient may also lie at a slight angle to the healthy side or supine position.

Indications pemasnagan WSD
- Pneumothorax
- Hematothoraks
- Effusion
(Arif Mansjoer et al, 2000)

Risks that occur after the installation of WSD
- Infections
- Bleeding

When WSD should be removed?
WSD removed when no ronkhi, developing a normal lung, check vital signs normal.


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