Pneumothorax Nursing Diagnosis: Comprehensive Guide for Healthcare Professionals

Pneumothorax, commonly known as a collapsed lung, occurs when air leaks into the pleural space, the area between the lung and the chest wall. This air accumulation creates pressure on the lung, causing it to collapse. Understanding the nuances of pneumothorax is crucial for healthcare professionals, especially nurses, to ensure timely and effective patient care. This article delves into the critical aspects of pneumothorax, focusing specifically on nursing diagnoses, assessments, interventions, and care plans to optimize patient outcomes.

Types of Pneumothorax

Pneumothoraces are broadly classified based on their etiology and characteristics. Recognizing these distinctions is fundamental for targeted nursing care and management:

• Spontaneous Pneumothorax: This type occurs unexpectedly, without any apparent injury or external cause. It is further divided into:
  • Primary Spontaneous Pneumothorax (PSP): Typically arises in individuals without underlying lung disease. Risk factors include being tall and thin, male gender, smoking, and a family history of pneumothorax. Rupture of small air-filled sacs called blebs on the lung surface is often implicated.
  • Secondary Spontaneous Pneumothorax (SSP): Occurs as a complication of pre-existing lung diseases such as COPD, asthma, cystic fibrosis, lung cancer, tuberculosis, and certain infections like Pneumocystis pneumonia in HIV/AIDS patients. SSP is often more severe due to compromised baseline lung function.
• Traumatic Pneumothorax: Results from chest injuries, which can be either penetrating (e.g., stab wound, gunshot wound) or non-penetrating (e.g., blunt trauma from a car accident). These injuries can disrupt the pleural space and allow air to enter.
• Iatrogenic Pneumothorax: This type is a consequence of medical procedures, including:
  • Thoracentesis
  • Central venous catheter insertion
  • Tracheostomy
  • Positive pressure ventilation
  • Cardiopulmonary resuscitation
  • Needle aspiration biopsy of the lung
  • Nasogastric feeding tube placement

Nursing Process for Pneumothorax

Effective nursing management of pneumothorax necessitates a systematic approach encompassing assessment, diagnosis, planning, intervention, and evaluation. The nursing process is paramount in addressing the respiratory distress and potential complications associated with this condition.

Nursing Assessment

A thorough nursing assessment is the cornerstone of care for patients with pneumothorax. It involves gathering both subjective and objective data to understand the patient’s condition comprehensively.

Review of Health History

A detailed health history provides crucial clues about the potential cause and risk factors for pneumothorax. Key areas to explore include:

1. Causative Factors: Identify potential triggers or underlying conditions.

   • Chest Trauma: History of recent injury to the chest.
   • Ruptured Blebs/Bullae: Pre-existing lung conditions known to cause blebs.
   • Underlying Lung Disease: Presence of COPD, asthma, cystic fibrosis, etc.
   • Recent Procedures: Any recent surgical or invasive procedures, especially those involving the chest or airway.

2. Medical History: Document existing lung diseases and conditions associated with SSP.

   • COPD: Chronic Obstructive Pulmonary Disease
   • Asthma: Reactive airway disease
   • Cystic Fibrosis: Genetic disorder affecting the lungs
   • Lung Cancer: Malignancy of the lung tissue
   • Sarcoidosis: Inflammatory disease affecting multiple organs, including lungs
   • Tuberculosis: Infectious bacterial disease affecting the lungs
   • HIV/AIDS: Immunodeficiency virus, increasing susceptibility to infections like pneumonia

3. Risk Factors for PSP: Determine if the patient has risk factors for primary spontaneous pneumothorax.

   • Male Gender: Higher incidence in males.
   • Age 20-30: Peak incidence for PSP.
   • Tall, Thin Body Type: Asthenic body habitus.
   • Smoking: Significantly increases risk.
   • Pregnancy: Hormonal and physiological changes.
   • Marfan Syndrome: Genetic disorder affecting connective tissue.
   • Family History: Genetic predisposition.

4. Genetic Predisposition: Consider genetic syndromes linked to PSP.

   • Marfan Syndrome, Homocystinuria, Birt-Hogg-Dube (BHD) Syndrome: These genetic conditions are associated with an increased risk of spontaneous pneumothorax. Genetic testing may be relevant, especially in recurrent cases or familial history.

5. Previous Pneumothorax: History of prior pneumothorax increases recurrence risk.

   • Recurrence is more common in smokers, younger individuals, tall and thin individuals, and those with COPD, AIDS, or pulmonary fibrosis. Recurrence typically occurs within the first six months to three years.

6. Past Medical Procedures: Identify procedures that could lead to iatrogenic pneumothorax.

   • Transthoracic Needle Aspiration: Biopsy procedure.
   • Thoracentesis: Pleural fluid aspiration.
   • Central Venous Catheter Insertion: Line placement in major veins.
   • Tracheostomy: Surgical airway creation.
   • Cardiopulmonary Resuscitation (CPR): Chest compressions.
   • ARDS with Positive Pressure Ventilation: Mechanical ventilation in Acute Respiratory Distress Syndrome.
   • Nasogastric Feeding Tube Placement: Tube insertion into stomach via nose.

7. Lifestyle and Occupation: Inquire about activities that may contribute to pneumothorax.

   • Inhaled Drug Use: Marijuana or cocaine use can cause bullae rupture.
   • Activities with Air Pressure Changes: Flying, scuba diving, deep-sea diving can predispose to pneumothorax due to pressure variations.

Physical Assessment

The physical assessment focuses on identifying signs and symptoms of pneumothorax and evaluating the severity of respiratory compromise.

1. General Symptoms: Assess for hallmark symptoms.

   • Sudden Chest Pain: Typically sharp, pleuritic, often worsening with inspiration, and may radiate to the shoulder on the affected side (ipsilateral).
   • Dyspnea: Shortness of breath, ranging from mild to severe, depending on the size of the pneumothorax and underlying lung function. PSP may present with milder symptoms compared to SSP.

2. Vital Signs: Monitor for indicators of respiratory and hemodynamic compromise.

   • Increased Respiratory Rate (Tachypnea): Body’s attempt to compensate for decreased oxygenation.
   • Increased Pulse Rate (Tachycardia): Compensatory mechanism for hypoxemia. Heart rate may exceed 134 bpm in severe cases.
   • Decreased Blood Pressure (Hypotension): May occur in tension pneumothorax due to decreased venous return and cardiac output.
   • Decreased Oxygen Saturation (SpO2): Hypoxemia due to reduced gas exchange.

3. Respiratory Status Assessment (IPPA): Employ the IPPA sequence (Inspection, Palpation, Percussion, Auscultation).

   • Inspection: Observe for:
     • Respiratory Distress: Use of accessory muscles, nasal flaring, intercostal retractions.
     • Airway Patency: Ensure no obstruction.
     • Tracheal Deviation: In tension pneumothorax, the trachea may deviate away from the affected side due to pressure buildup.
   • Palpation: Assess for:
     • Decreased Tactile Fremitus: Reduced vibrations felt on the chest wall when the patient speaks, indicative of air or fluid in the pleural space.
     • Asymmetrical Lung Expansion: Unequal chest movement during breathing, with reduced expansion on the affected side.
   • Percussion: Evaluate resonance.
     • Hyperresonance: Increased air in the pleural space causes a louder, lower-pitched sound on percussion over the affected area.
   • Auscultation: Listen for breath sounds.
     • Decreased or Absent Breath Sounds: Reduced or no air entry into the affected lung area.

4. Cardiovascular Status: Assess for signs of cardiovascular compromise, especially in tension pneumothorax.

   • Increased Heart Rate (Tachycardia): Often pronounced, exceeding 134 bpm.
   • Decreased Blood Pressure (Hypotension): Significant drop in blood pressure.
   • Jugular Vein Distension (JVD): Engorged neck veins due to increased intrathoracic pressure impeding venous return to the heart.
   • Cyanosis: Bluish discoloration of skin and mucous membranes, indicating severe hypoxemia.
   • Cardiac Arrest: A critical complication of tension pneumothorax if not promptly addressed.

Diagnostic Procedures

Diagnostic procedures are essential to confirm the diagnosis of pneumothorax and assess its extent and underlying causes.

1. Chest X-ray: The primary diagnostic imaging modality.

   • Diagnosis Confirmation: Visualizes air in the pleural space and lung collapse.
   • Severity Evaluation: Helps determine the size of the pneumothorax.
   • Etiology Assessment: May reveal underlying lung conditions or trauma.
   • Baseline for Treatment: Provides a reference point to monitor treatment effectiveness.

2. Computed Tomography (CT) Scan: May be necessary for detailed assessment, especially in trauma cases.

   • Thoracic Damage Detection: More sensitive than plain radiographs in identifying subtle injuries.
   • Underlying Cause Identification: Better visualization of lung parenchyma to identify blebs, bullae, or other pathologies.

3. Ultrasound: Emerging bedside tool, particularly in emergency and intensive care settings.

   • Rapid Diagnosis: Quickly identify pneumothorax at the bedside.
   • High Sensitivity and Specificity: Effective when performed by a trained operator.

4. Arterial Blood Gases (ABGs): Crucial for assessing respiratory function, especially in patients with respiratory distress or underlying lung disease.

   • Hypoxemia Detection: Low partial pressure of oxygen in arterial blood (PaO2).
   • Hypercarbia Detection: Elevated partial pressure of carbon dioxide in arterial blood (PaCO2), indicating inadequate ventilation.
   • Acidosis Assessment: Abnormal blood pH, often respiratory acidosis due to carbon dioxide retention.

Alt text: Chest X-ray showing a large pneumothorax on the left side, with the collapsed lung clearly visible and the pleural space filled with air.

Nursing Interventions for Pneumothorax

Nursing interventions are directed at managing the pneumothorax, alleviating symptoms, preventing complications, and educating the patient on preventive measures.

Pneumothorax Management Assistance

1. Medication Administration: Administer medications as prescribed.

   • Prophylactic Antibiotics: Given prior to chest tube insertion to reduce infection risk from skin flora.
   • Analgesics: Pain relief is essential. Administer analgesics or prepare for nerve blocks to manage chest pain.

2. Needle Decompression Preparation: Prepare for emergent needle decompression in tension pneumothorax.

   • Emergency Procedure: Large-bore catheter insertion into the chest wall to release trapped air. Typically performed in emergency medical services (EMS) or emergency departments (ED).

3. Thoracostomy Tube Insertion Assistance: Assist with chest tube (thoracostomy tube) insertion.

   • Post-Decompression Treatment: Chest tube placement usually follows needle decompression to continuously drain air and fluid.
   • Heimlich Valve: One-way valve that allows air to escape but not re-enter, sometimes used for simple pneumothorax management.
   • Suction: Typically required for SSP and larger pneumothoraces to facilitate lung re-expansion.

4. Watchful Waiting for Small Pneumothoraces: Implement observation for small, asymptomatic PSPs.

   • Spontaneous Resolution: Small pneumothoraces may resolve on their own without active intervention.
   • Oxygen Administration: Oxygen can be administered to enhance air reabsorption.

5. Supplemental Oxygen Administration: Apply oxygen therapy.

   • Hypoxemia Treatment: Administer oxygen via nasal cannula or mask, starting at 3 L/min or higher, to treat hypoxemia and increase the rate of air absorption from the pleural space.

6. Surgical Intervention Preparation: Prepare patients for potential surgical options for recurrent or persistent pneumothoraces.

   • Recurrent Pneumothorax or Persistent Air Leak: Surgery may be needed if pneumothorax recurs or if the lung does not re-expand after several days with chest tube drainage.
   • Surgical Options:
     • Thoracoscopy: Minimally invasive surgical procedure using a video camera.
     • Electrocautery: Using heat to destroy tissue and seal air leaks.
     • Laser Treatment: Similar to electrocautery, using laser energy.
     • Resection of Blebs or Pleura: Surgical removal of blebs or a portion of the pleura.
     • Open Thoracotomy: Traditional open chest surgery.
     • Video-Assisted Thoracoscopic Surgery (VATS): Minimally invasive surgery using video assistance.

7. Pleurodesis for Recurrence Prevention: Consider pleurodesis for patients with recurrent pneumothoraces who are not surgical candidates.

   • Sclerotherapy: Procedure to create pleural adhesion, reducing recurrence risk.
   • Scar Tissue Formation: Induces inflammation and scarring between the visceral and parietal pleura, effectively obliterating the pleural space and preventing air or fluid accumulation.

Patient Education on Prevention

Educating patients about lifestyle modifications and preventive measures is crucial to reduce the risk of pneumothorax, especially recurrence.

1. Smoking Cessation Encouragement: Strongly advise and assist with smoking cessation.

   • Risk Factor Reduction: Smoking is a major risk factor for both PSP and SSP.
   • Education and Resources: Provide counseling, nicotine replacement therapy information, and support groups.

2. Avoidance of Air Pressure Changes: Counsel patients to avoid activities with drastic air pressure variations.

   • Occupational Hazards: Scuba diving, piloting planes should be avoided until definitive surgical treatment is undertaken.

3. Air Travel Limitation: Advise patients to limit or avoid air travel post-pneumothorax treatment.

   • Post-Treatment Precautions: Avoid flying for several weeks after pneumothorax treatment to allow complete lung healing and minimize recurrence risk.

4. Prompt Treatment of Respiratory Infections: Emphasize early recognition and treatment of respiratory infections.

   • Infection Management: Prompt treatment of bronchopulmonary infections reduces the risk of progression to pneumothorax, especially in susceptible individuals.

Pneumothorax Nursing Care Plans

Nursing care plans provide a structured framework for addressing identified nursing diagnoses, setting goals, and outlining specific interventions to achieve desired patient outcomes. Common nursing diagnoses associated with pneumothorax include Acute Pain, Impaired Gas Exchange, Impaired Spontaneous Ventilation, Ineffective Airway Clearance, and Ineffective Breathing Pattern.

Acute Pain

Sudden chest pain is a hallmark symptom of pneumothorax, significantly impacting patient comfort and respiratory mechanics.

Nursing Diagnosis: Acute Pain related to chest injury and pneumothorax.

As evidenced by:

• Distraction behaviors (restlessness, moaning)
• Expressive pain behaviors (facial grimacing, crying)
• Guarding behavior of the chest
• Positioning to ease pain (leaning forward, splinting chest)
• Hesitancy to take deep breaths, resulting in shallow breathing

Expected Outcomes:

• Patient will report a reduction in pain intensity when breathing within 24-48 hours.
• Patient will demonstrate a relaxed respiratory pattern without overt expressions of pain by discharge.

Nursing Assessments:

1. Comprehensive Pain Assessment: Evaluate pain characteristics using a pain scale (e.g., numeric rating scale, visual analog scale), noting onset, location, duration, character, aggravating/relieving factors, and radiation. Chest pain in pneumothorax is typically sudden, severe, stabbing, radiates to the shoulder, and worsens with inspiration.

2. Analgesic Effectiveness Monitoring: Regularly assess pain levels and the effectiveness of prescribed analgesics. Patients may be hesitant to breathe deeply due to pain; effective pain control is crucial to facilitate adequate ventilation and participation in respiratory exercises.

Nursing Interventions:

1. Chest Splinting Encouragement: Instruct and assist the patient to use a chest splint (pillow or hand pressure) when breathing or coughing. Splinting provides support and reduces pain during respiratory movements, promoting comfort.

2. Comfort Positioning Assistance: Assist the patient to assume a position of comfort, typically high-Fowler’s position. Upright positioning promotes optimal lung expansion and can alleviate pressure and pain.

3. Analgesic Administration: Administer prescribed analgesics promptly and as needed. Anticipate pain, especially before procedures, movement, or breathing exercises, and premedicate accordingly.

4. Diversional Activities Provision: Offer diversional activities to distract from pain and promote relaxation. Reading, watching movies, listening to music, or engaging in conversation can help reduce pain perception and anxiety.

Impaired Gas Exchange

Pneumothorax disrupts normal gas exchange by reducing the functional lung surface area and creating ventilation-perfusion mismatch.

Nursing Diagnosis: Impaired Gas Exchange related to ventilation-perfusion imbalance, decreased functional lung tissue, pain, chest trauma, and ineffective breathing pattern.

As evidenced by:

• Abnormal arterial blood gases (ABGs) indicating hypoxemia or hypercarbia
• Altered respiratory depth (shallow or labored breathing)
• Altered respiratory rhythm (tachypnea, bradypnea, irregular rhythm)
• Cyanosis (peripheral or central)
• Hypoxemia (SpO2 < 90% or PaO2 < 60 mmHg)
• Hypoxia (signs and symptoms of tissue oxygen deprivation)
• Nasal flaring

Expected Outcomes:

• Patient will demonstrate improved ventilation and adequate oxygenation as evidenced by ABGs within normal parameters (PaO2 > 80 mmHg, PaCO2 35-45 mmHg) within 24-72 hours.

Nursing Assessments:

1. Lung Sounds Auscultation: Assess lung sounds bilaterally. Pneumothorax typically presents with decreased or absent breath sounds on the affected side, indicating reduced airflow. Also assess for adventitious sounds in unaffected lung fields which could indicate compensatory mechanisms or co-existing conditions.

2. Respiratory Rate and Rhythm Assessment: Monitor respiratory rate, depth, and rhythm. Tachypnea and changes in rhythm may indicate worsening respiratory distress and the need for more aggressive interventions.

3. Imaging Studies Review: Review chest x-ray, CT scan, or ultrasound reports to confirm pneumothorax diagnosis and assess the extent of lung collapse. Imaging provides objective data on the severity of the condition.

Nursing Interventions:

1. Oxygen Therapy Application: Administer supplemental oxygen as ordered to maintain SpO2 at the prescribed level (typically > 92-94%). Oxygen therapy increases the partial pressure of oxygen in the alveoli, enhancing oxygen diffusion and reabsorption of pleural air.

2. ABG Level Monitoring: Regularly monitor ABG levels to assess oxygenation and ventilation status. ABG analysis provides critical information on the patient’s respiratory function and response to interventions.

3. Chest Tube Thoracostomy Assistance: Assist with chest tube insertion and management. Chest tubes are crucial for evacuating air and fluid from the pleural space, restoring negative intrapleural pressure, and facilitating lung re-expansion.

4. Deep Breathing Exercises Encouragement: Instruct and encourage the patient to perform deep breathing exercises and utilize an incentive spirometer. Deep breathing helps to expand alveoli, improve ventilation, and prevent atelectasis in the remaining functional lung tissue.

Impaired Spontaneous Ventilation

Severe pneumothorax or complications can lead to impaired spontaneous ventilation, requiring prompt and aggressive management.

Nursing Diagnosis: Impaired Spontaneous Ventilation related to respiratory muscle fatigue, limited lung expansion, comorbid conditions, and hemodynamic instability.

As evidenced by:

• Dyspnea at rest or with minimal exertion
• Decreasing SpO2 despite oxygen administration
• Increased use of accessory muscles of respiration
• Restlessness, anxiety, or altered mental status
• Fatigue, weakness, or exhaustion

Expected Outcomes:

• Patient will exhibit clear lung sounds bilaterally and SpO2 within normal limits (>94%) while breathing spontaneously within 24-48 hours.
• Patient will demonstrate absence of complications related to impaired spontaneous ventilation, such as respiratory failure or cardiac arrest, throughout hospitalization.

Nursing Assessments:

1. ABCs Monitoring: Continuously monitor Airway, Breathing, and Circulation. These are the immediate priorities in managing pneumothorax. Closely observe respiratory rate, depth, effort, and vital signs for any deterioration.

2. CT Results Review: Review CT scan findings for detailed assessment of lung status and potential underlying causes, especially in complex cases or when clinical signs are disproportionate to initial chest x-ray findings.

Nursing Interventions:

1. Oxygen Administration: Administer high-flow supplemental oxygen as needed to maintain adequate oxygenation. Oxygen is critical to support tissue oxygenation while addressing the underlying cause of impaired ventilation.

2. Needle Decompression Preparation: Be prepared to assist with emergent needle decompression, particularly in cases of suspected tension pneumothorax. Rapid intervention can be life-saving in this situation.

3. Surgical Intervention Preparation: Prepare the patient for potential surgical intervention if conservative measures fail or if the pneumothorax is recurrent or persistent.

4. Mechanical Ventilation Implementation: Prepare for and assist with mechanical ventilation if the patient exhibits signs of respiratory muscle fatigue, severe hypoxemia, hypercapnia, acidosis, or altered mental status. Mechanical ventilation may be necessary to support respiratory function until the pneumothorax is resolved and spontaneous ventilation can be restored.

Ineffective Airway Clearance

Ineffective airway clearance can occur due to pain, underlying lung disease, or complications of pneumothorax treatment.

Nursing Diagnosis: Ineffective Airway Clearance related to underlying lung disease (COPD, asthma, pneumonia), tracheal deviation, and ineffective cough.

As evidenced by:

• Altered respiratory rate and rhythm (tachypnea, bradypnea, abnormal patterns)
• Abnormal breath sounds (wheezing, rhonchi, crackles)
• Dyspnea, orthopnea (shortness of breath when lying flat)
• Restlessness, anxiety
• Cyanosis (late sign)

Expected Outcomes:

• Patient will maintain a clear and open airway as evidenced by normal breath sounds and respiratory rate and depth within normal limits within 24-48 hours.
• Patient will demonstrate ABG results within acceptable limits, indicating adequate ventilation and oxygenation, by discharge.

Nursing Assessments:

1. Respiratory Rate and Depth Monitoring: Monitor and document respiratory rate, depth, chest movement, and use of accessory muscles regularly. Changes in respiratory status, such as tachypnea, bradypnea, accessory muscle use, asymmetrical breathing, and decreasing SpO2 levels, indicate airway compromise.

2. Lung Sounds Auscultation: Auscultate lung sounds for presence, absence, or changes in breath sounds. With pneumothorax, lung sounds may be decreased or absent on the affected side. Adventitious sounds like crackles and wheezes may indicate underlying lung disease or developing complications.

Nursing Interventions:

1. Coughing and Deep Breathing Encouragement: Encourage and assist the patient with effective coughing and deep breathing exercises. These techniques promote airway clearance, mobilize secretions, and facilitate lung re-expansion. Incentive spirometry can be a valuable tool.

2. Upright Positioning: Position the patient upright (high-Fowler’s or semi-Fowler’s position) unless contraindicated. Upright positioning promotes better lung expansion, improves air exchange, and enhances drainage of secretions.

3. Analgesic Administration: Administer pain medication as prescribed to promote pulmonary hygiene. Pain can inhibit the patient’s ability to cough, deep breathe, and ambulate, thus impairing airway clearance. Effective pain management is essential.

4. ABGs and SpO2 Monitoring: Closely monitor ABGs and SpO2 levels for signs of hypoxia and acidosis, which may indicate worsening respiratory distress and ineffective airway clearance.

Ineffective Breathing Pattern

Pneumothorax directly impacts the breathing pattern by causing lung compression and altering respiratory mechanics.

Nursing Diagnosis: Ineffective Breathing Pattern related to pain, asymmetrical lung expansion, and body position that inhibits lung expansion.

As evidenced by:

• Abdominal paradoxical respiratory pattern (chest moves in with inspiration, abdomen moves out)
• Altered chest excursion (unequal or reduced chest movement)
• Altered tidal volume (shallow breaths)
• Bradypnea or tachypnea
• Decreased expiratory and inspiratory pressures
• Accessory muscle use

Expected Outcomes:

• Patient will maintain an oxygen saturation of 94% or greater throughout hospitalization.
• Patient will demonstrate an effective breathing pattern as evidenced by respiratory rate and depth within expected limits, and symmetrical chest excursion by discharge.

Nursing Assessments:

1. Chest Tube Drainage System Assessment: For patients with chest tubes, regularly assess the chest tube and drainage system. Check for patency, secure connections, appropriate drainage, and signs of air leaks (bubbling in the water seal chamber if present).

2. Respiratory Function Assessment: Continuously monitor the patient’s respiratory function, including rate, rhythm, depth, and effort. Assess for signs of respiratory distress, such as increased work of breathing, use of accessory muscles, and changes in mental status.

3. Imaging Tests Review: Review serial chest x-rays or other imaging tests as ordered to monitor pneumothorax resolution and lung re-expansion. Imaging helps to evaluate the effectiveness of treatment and identify any complications.

Nursing Interventions:

1. Thoracentesis Assistance: Assist with thoracentesis if ordered by the physician. Thoracentesis involves needle insertion into the pleural space to drain air or fluid and can improve breathing pattern by reducing pleural pressure.

2. Ambulation Encouragement: Encourage ambulation as tolerated and when medically stable. Ambulation promotes lung expansion, secretion clearance, and overall respiratory function, leading to quicker recovery and shorter hospital stay.

3. Respiratory Therapy Consultation: Consult with respiratory therapy for specialized interventions and management, especially if there are concerns about breathing patterns or chest tube system function. Respiratory therapists can provide expertise in airway management, ventilation strategies, and chest tube care.

4. Closed-Drainage System Maintenance: Maintain the chest tube closed-drainage system properly. Ensure the drainage system is kept below the level of the patient’s chest to facilitate gravity drainage. If suction is used, verify the prescribed level and ensure it is functioning correctly. Document drainage amount, color, and characteristics per facility protocol. Investigate and address any bubbling in the air leak chamber, which may indicate a system leak.

Alt text: Diagram of a chest tube drainage system, showing the collection chamber, water seal chamber, and suction control chamber, used to manage pneumothorax.

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