In order to attain this clinical ability, and add to knowledge and skills, this literature review focuses on addressing what is known about the condition, the signs and symptoms it presents, and the management of the chest drainage system which is the most common treatment for patients with spontaneous pneumothorax.
Background and Definitions: Spontaneous pneumothorax is partial or complete lung collapse, either without any previous trauma, or with perceptible medical causes, and occurs as a result of the build-up of air in the pleural cavity. It is classified as primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP). PSP may be present in patients in the absence of any fundamental lung disease, typically affecting, for example, a young, healthy, tall thin man. Also, a history of smoking may be associated with an increased risk of PSP. More than one third of patients with PSP relapse within a few years. On the other hand, SSP is found in patients with the complications of underlying lung disorder, which include chronic obstructive pulmonary disease (COPD), asthma, or infectious lung disorders. The risk of recurrence in patients with SSP is higher than with PSP, due to underlying pulmonary disease (Baumann, 2006; Baumann and Noppen, 2004; Guo, Xie, Rodriguez and Light, 2005; Sheah and Peh, 2003; Roman et al, 2003; Ryan, 2005; Wakai, 2006).
Symptoms Identified and Recorded in the Literature: There are two main symptoms presented by spontaneous pneumothorax, namely chest pain and dyspnoea. Chest pain is the most common symptom with regard to PSP. In Seremetis' study, (cited in Roman, 2003), 90% of patients with PSP presented with chest pain, which was commonly described as sharp and limited to the region of the pneumothorax, increasing with deep inhalation. Other symptoms include dyspnoea, tachycardia, decreased or absent chest movement and breath sounds in the affected area. However, patients with SSP commonly present more severe dyspnoea, making it potentially fatal. In particular, hypoxemia and hypotension can be severe in COPD patients with SSP. Symptoms of SSP can be difficult to detect, due to underlying pulmonary disease (Baumann, 2006; Baumann and Noppen, 2004; Roman et al, 2003; Ryan, 2005).
Treatment: The most widely used treatment for spontaneous pneumothorax is the chest drainage system, the management of which is the nurse's responsibility. Therefore, it is very important that nurses know the functions of the chest drainage system and nursing interventions for managing patients. (Allibone, 2003; Lehwaldt and Timmins, 2005; Thorn, 2006). Chest drainage removes abnormal accumulations of air or fluid in the pleural cavities, while preventing air or fluid returning. It is necessary to ensure that chest drainage bottles are placed below chest level. The system includes three basic components: suction control, water seal, and collection chambers (Allibone, 2003; Roman et al, 2003; Thorn, 2006). The suction control chamber is used to advance the drainage rate and lung re-expansion. The British Thoracic Society guidelines (Lehwaldt and Timmins, 2005), recommend low pressure suction, approximately -10 to -29 mmHg; however, there is no consensus on the amount of suction that should be applied.