Question

You are the R.N. caring for a 72-year-old woman with severe emphysema. Today she was walking at a mall when she suddenly grabbed her right side and gasped, “Oh, something just popped.” She 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, she was stuporous and in severe respiratory distress. She was intubated, started on intravenous lactated Ringer's at KVO (keep vein open), and transported to the nearest emergency department (ED). On arrival at the ED, you auscultate muffled heart tones, no breath sounds on the right, and faint sounds on the left. She is stuporous, tachycardiac, and cyanotic. The paramedics inform you that it was difficult to ventilate her. A portable chest x-ray (CXR) examination shows an 80% pneumothorax on the right.

Arterial Blood Gases (ABGs) on 100% O2:

pH	7.25
PaCO2	92 mm Hg
HCO3	27 mEq/l
PaO2	32 mm HG
SpO2	53%

1. Explain the most important areas you need to evaluate during your physical assessment? (USLO 1,6)

Answer 1

Below and above clavicle area is auscultation and chest x ray

CT scane is done for chest to see the site of the pneumothorax formation

an icd get inserted for the relieve of pneumothorax

deviation of trachea and oesophagus also noted

collapse of lug is also noted