Spontaneous Pneumothorax: A Nursing Student Overview
Introduction
A spontaneous pneumothorax is the accumulation of air in the pleural space without an antecedent trauma, resulting in partial or complete lung collapse. It’s classified as:
- Primary spontaneous pneumothorax (PSP): Occurs in otherwise healthy individuals, often tall, thin males aged 10–30.
- Secondary spontaneous pneumothorax (SSP): Occurs in patients with underlying lung pathology (e.g., chronic obstructive pulmonary disease, cystic fibrosis, asthma).
Epidemiology
- Incidence: PSP: ~7.4–18 cases per 100,000 males and 1.2–6 cases per 100,000 females annually (MacDuff et al., 2010).
- Risk factors: Tobacco use, family history, connective tissue disorders (e.g., Marfan syndrome), rapid changes in atmospheric pressure.
Pathophysiology
- Blebs and bullae rupture: Small subpleural air sacs (blebs) spontaneously rupture, allowing air to escape from the lung into the pleural space.
- Loss of negative intrapleural pressure: Disruption of the vacuum effect causes lung recoil and collapse.
Clinical Presentation
- Symptoms:
- Sudden, unilateral pleuritic chest pain
- Dyspnea (ranging from mild to severe)
- Signs:
- Decreased or absent breath sounds on affected side
- Hyperresonance on percussion
- Tachypnea, tachycardia
- In severe cases: hypoxia, hypotension (tension pneumothorax)
Diagnostic Evaluation
- Chest X-ray: First-line — shows visceral pleural line with absent lung markings beyond it.
- Ultrasound: Increasingly used at bedside for rapid detection.
- CT scan: Reserved for equivocal cases or to evaluate for underlying lung disease.
Management Principles
| Size/Severity | Intervention | Nursing Role |
| Small, asymptomatic (<2 cm rim) | Observation + supplemental Oâ‚‚ | Monitor vitals; educate on activity restrictions |
| Moderate to large or symptomatic | Needle aspiration or chest tube | Assist with procedure; maintain chest-drain system |
| Recurrent or persistent air leak | Surgical pleurodesis (VATS) | Pre-/post-operative monitoring; pain management |
| Tension pneumothorax | Emergency needle decompression | Rapid assessment; prepare emergency equipment |
Nursing Considerations
- Respiratory Monitoring:
- Continuous SpO₂, respiratory rate, and work of breathing.
- Auscultate breath sounds every 2–4 hours.
- Chest-Drain Care:
- Keep system below chest level; maintain airtight connections.
- Observe for tidaling and continuous bubbling (air leak).
- Pain Management:
- Administer analgesics (e.g., NSAIDs, opioids as ordered).
- Encourage deep breathing and incentive spirometry.
- Patient Education:
- Avoid flying or scuba diving until cleared (usually ≥2–3 weeks post-resolution).
- Smoking cessation support.
- Recognize signs of recurrence (sudden chest pain, dyspnea) and seek immediate care.
Complications
- Recurrence: Up to 30% after first episode (Brown et al., 2020).
- Tension pneumothorax: Medical emergency—mediastinal shift, hemodynamic instability.
Conclusion
Early recognition, prompt intervention, and meticulous nursing care—including respiratory assessment, chest-drain management, pain control, and patient teaching—are essential to optimize outcomes for individuals with spontaneous pneumothorax.
References
Brown, S. G. A., Ball, E., Macdonald, S., & Holdsworth, D. A. (2020). Recurrence rates and risk factors for spontaneous pneumothorax: A systematic review. Chest, 158(5), 1980–1996. https://doi.org/10.1016/j.chest.2020.06.012
Light, R. W. (2020). Pleural Diseases (7th ed.). Wolters Kluwer.
MacDuff, A., Arnold, A., & Harvey, J. (2010). Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010. Thorax, 65(Suppl 2), ii18–ii31. https://doi.org/10.1136/thx.2010.136986