Page 2463 - Saunders Comprehensive Review For NCLEX-RN

reduced vital capacity
2. The loss of negative intrapleural pressure results in
collapse of the lung.
3. A spontaneous pneumothorax occurs with the rupture
of a pulmonary bleb, or small air-containing spaces
deep in the lung.
4. An open pneumothorax occurs when an opening
through the chest wall allows the entrance of positive
atmospheric air pressure into the pleural space.
5. A tension pneumothorax occurs from a blunt chest
injury or from mechanical ventilation with PEEP
when a buildup of positive pressure occurs in the
pleural space.
6. Assessment (Box 69-15)

7. Interventions

a. Diagnosis of pneumothorax is made by
chest x-ray.
b. Apply a nonporous dressing over an
open chest wound.
c. Administer oxygen as prescribed.
d. Place the client in a Fowler’s position.
e. Prepare for chest tube placement, which
will remain in place until the lung has
expanded fully (see section IV, O, for
information on chest tubes).
f. Monitor the chest tube drainage system.
g. Monitor for subcutaneous emphysema.

Clients with a respiratory disorder should

be positioned with the head of the bed elevated.

H. Acute respiratory failure

1. Occurs when insufficient oxygen is transported to the
blood or inadequate carbon dioxide is removed from
the lungs and the client’s compensatory mechanisms
fail
2. Causes include a mechanical abnormality of the lungs
or chest wall, a defect in the respiratory control center
in the brain, or an impairment in the function of the
respiratory muscles.

3. In oxygenation failure, or hypoxemic

respiratory failure, oxygen may reach the alveoli but
cannot be absorbed or used properly, resulting in a

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