1. Given the diagnosis of pneumothorax, explain why the paramedic had difficulty ventilating A.W.
• Air escaped from the lung into the pleural space. Eventually, enough air collected in the pleural space to cause the mediastinum to shift twoard the right. The collapsed left lung, increased intrapleural pressure, and rightward shift make it difficult to ventilate A.W.

2. Interpret A.W.’s ABG’s
• Significant respiratory acidosis with profound hypoxemia. A.W. is near death.

3. What is the reason for A.W.’s ABG results?

• 70% of her right lung is collapsed and is not taking part in gas exchange

4. The physician needs to insert a chest tube. What are your responsibilities as the nurse?

Preinsertion:
• Support patient with
Fluids are heavier and tend to seek the lowest level, therefore, chest tubes inserted to remove fluids are placed lower at around the 5th or 6th intercostal space, midaxillary line.

7. Given the information above, would you expect to observe an air leak when A.W.’s chest drainage system is in place and functioning?
• Yes. Since she ruptured a bleb into her pleural space, inspired air would continue to escape into the pleural space and into the chest tube drainage system until the hole has healed itself.

8. Would you expect A.W.’s lung to reexpand immediately after the chest tube insertion and initiation of underwater suction?

• Not necessarily. It can take hours to days for the lungs to completely reexpand. This time is individual for all clients and is assessed by the size of the air leak and by daily chest x-rays. (The level of bubbling will diminish over time as the hole in the lung heals and lung expands).

9. The clerk tells you A.W.’s husband has just arrived. A.W. will be admitted to the hospital. How would you address this issue with her husband?

• Be honest and supportive
• Inform him that his wife is doing much better and is waiting to be transferred to her room
• Explain that one of her lungs collapsed, so the doctor put a tube in her chest to let the air out and allow the lung to expand again. Tell him the tube will stay in her chest until