A.W., a 52-year-old woman disabled from severe emphysema, was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” A.W. whispered to her walking companion, “I can’t get any air.” Her companion yelled for someone to call 911 and helped her to the nearest bench. By the time the rescue unit arrived, A.W. was stuporous and in severe respiratory distress. She was intubated, an IV of lactated Ringer’s (LR) to KVO (keep vein open) was started, and she was transported to the nearest emergency department (ED). On arrival at the ED, the physician auscultates mufﬂed heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is stuporous, tachycardic, and cyanotic. The paramedics inform the physician that it was difﬁcult to ventilate A.W. A STAT portable chest x-ray (CXR) and arterial blood gases (ABGs) are obtained. A.W. has an 80% pneumothorax on the right, and her ABGs on 100% oxygen are pH 7.18, PaCO2 92 mm Hg, PaO2 32 mm Hg, HCO3 27 mmol/L, base excess (BE) -5 mmol/L, SaO2 53%.
1) Given the diagnosis of pneumothorax, explain why the paramedic had difﬁculty ventilating A.W.
The paramedics couldn’t ventilate C.W. because the pleural space is full of air, which then forces pressure on the lungs which doesn’t allow the lungs to inflate when air is inhaled in. 2) Interpret A.W.’s ABGs. [c]
PH 7.18 acidotic
PaCO2 92 mm Hg
3) What is the reason for A.W.’s ABG results? [c]
Because oxygen exchange isn’t occurring and CO2 is being trapped in the lungs. 4) What kind of pneumothorax does A.W. have? Explain.
It is a closed pneumothorax because there isn’t any associated external wound and it just randomly happened. 5) The physician needs to insert a chest tube. Your responsibilities as the nurse include monitoring the patient during this process. What will this include? Identify at least 5 things....