(2) Tension pneumothorax may also occur when a sucking chest wound has
been sealed with an occlusive dressing. The air will escape from the lung into the
pleural space with each inspiration, but will be trapped due to the occlusive dressing
over the exterior wound.
(3) Tension pneumothorax may also occur as a postoperative complication.
The opening at fault may be leakage around the drainage tube, an undiscovered
opening in the visceral pleura, or faulty suturing of resected lung tissue.
c. Hemothorax is the accumulation of blood in the pleural cavity. This condition
usually accompanies chest trauma. Blood from lacerated lung tissue and torn blood
vessels enters the pleural cavity and pools in the dependent area.
d. When air and blood are found in the chest cavity together, the condition is
e. Treatment for all the above conditions involves the removal of the air or blood
from the pleural cavity, thereby allowing the lung to expand once again. This is
routinely done by thoracentesis for small amounts of air or blood or by the insertion of
chest tubes to drainage when a large amount of air or blood is involved. Other
treatment measures involve administration of oxygen and analgesics.
2-49. THORACIC SURGERY
a. Pulmonary resection is removal of a significant portion of a lung. Resection in
which a lobe of a lung is removed is referred to as lobectomy. Removal of the entire
lung is referred to as pneumonectomy. These procedures are done to treat diseases
such as tuberculosis and cancer or to deal with the consequences of trauma to the
b. These procedures involve opening the pleural cavity containing the affected
lung. When the pleural cavity is opened, the affected lung will collapse. After
completion of the desired surgical procedure, the surgeon will place a tube into the
pleural cavity. The use of either an air-tight underwater seal or suction on the tube will
help recreate the naturally existing partial vacuum in the pleural cavity and re-expand
the remainder of the affected lung. The tube is withdrawn when the air and fluid has
been removed from the pleural cavity.
c. In addition to the routine preoperative care given to any surgical patient,
patients scheduled for thoracic surgery require special nursing considerations.
(1) Frequently, much time must be devoted to improving the patient's
respiratory status prior to surgery. This will make the preoperative period longer than