K.L. is a 30-year-old Caucasian male was brought to Emergency Department (ED) after a bicycle accident.  He was hit from behind by a compact car traveling at 35 miles per hour.  On arrival to the ED, he was alert and oriented to person, place and time, and he was complaining of right sided chest pain 9/10 on a 0-10 scale pain.  His medical history includes smoking 2 packs per day for 10 years.

His physical examination reveals a blood pressure of 100/59 mm Hg manually; heart rate 109 beats per minute, respiration rate 30 breaths per minute, temperature 99.0 and oxygen saturation of 90% on room air.    His stated weight is 195 lbs, height 5'11". His physical assessment revealed absent breath sounds on the left middle and left upper chest.  His chest x-ray showed results are consistent with 2 rib fractures and large left traumatic pneumothorax.  Oxygen is placed on K.L. at 3L nasal cannula to keep oxygen saturations at a level of greater than or equal to 93%. An 18 gauge peripheral IV is started in his left AC fossa.  K.L. will be prepped for chest tube placement immediately and then admitted to the progressive care unit (PCU).   

1.       Explain the pathophysiology of a traumatic pneumothorax.

2.      What are common clinical findings associated with pneumothorax?

3.       You are to assist with chest tube insertion.  Explain the chest tube insertion procedure.

1. List five nursing considerations that should addressed as the nurse preps K.L. for chest tube insertion?

1.  K.L. is attached to a three chamber chest tube system.  Explain the three chambers of the chest tube.
2. The MD orders "chest tube to wall suction."  What is the rationale for this and how much bubbling should be present in the suction chamber?
3. After the chest tube is inserted, what will the nurse document in K.L.'s assessment? Give specific assessments. 

1. The nurse is doing an assessment of the chest tube insertion site.  What should the nurse assess?
2. 48 hours later, the repeat chest x-ray confirmed that the pneumothorax is resolved and the chest tube will be removed today.  What should the nurse consider in regards to chest tube removal?