PNEUMOTHORAX

ASKEP
PNEUMOTHORAKS
Pneumothorax
 PENDAHULUAN
 Pneumotoraks didefinisikan sebagai adanya udara di dalam

kavum/rongga pleura.

 Tekanan di rongga pleura pada orang sehat selalu negatif

 Tekanan pada rongga pleura pada akhir inspirasi 4 s/d 8 cm H2O

dan pada akhir ekspirasi 2 s/d 4 cm H2O.

 Kerusakan pada pleura parietal dan/atau pleura viseral dapat

menyebabkan udaraluar masuk ke dalam rongga pleura,

Sehingga paru akan kolaps.

 Paling sering terjadi spontan tanpa ada riwayat trauma; dapat

pula sebagai akibat trauma toraks dan karena berbagai

prosedur diagnostik maupun terapeutik.
 Pleurae fluid disorders
Fluid Disorder: Color
Air Pneumothorax: no fluid drainage

Trapped Air Tension Pneumothorax: a nursing and

Blood
Fluid between pleural lining
(exudates or transudates)
Pus between pleural lining
medical emergency
Hemothorax: bloody or brownish
color
Pleural Effusion: clearer yellowish
color
Empyema: yellowish or greenish color

Lymphatic fluid Chylothorax: milky white color

 PENGERTIAN
 Pneumothorax adalah penimbunan udara atau gas di dalam

rongga pleura. Rongga pleura adalah rongga yang terletak

diantara selaput yang melapisi paru-paru dan rongga dada.
 Pneumothorax  udara atau gas dalam rongga pleura, yang

dapat terjadi secara spontan (spontaneous pleura), sebagai

akibat trauma ataupun proses patologis, atau dimasukkan
dengan sengaja (Dorland 1998 : 872).
 Pneumothorax atau sering disebut sebagai kolaps paru – paru

 penimbunan udara atau gas di dalam rongga pleura.

 Opening that connect the outside air with intrapleural space;

result is that air flows into intrapleural space; this eliminates the
pressure gradient between the thoracic cavity and the
atmosphere, and the lungs cannot inflate

 Collapse of a lung resulting from disruption of the negative

pressure of air in the pleural cavity; may be associated with

fractured rib

 Reduces the surface area for gaseous exchange and leads to

hypoxia and retention of co2 (hypercarbia)

 ETIOLOGI

1. Pneumotoraks Spontan (primer dan sekunder).

Pneumotoraks spontan primer terjadi tanpa disertai

penyakit paru yang mendasarinya, sedangkan
pneumotoraks spontan sekunder merupakan komplikasi
dari penyakit paru yang mendahuluinya.
2. Pneumotoraks traumatik 

Terjadi akibat cedera traumatik pada dada.

Traumanya bisa bersifat menembus (luka tusuk,
peluru) atau tumpul (benturan pada kecelakaan
kendaraan bermotor).

 
Pneumotoraks juga bisa merupakan komplikasi dari
tindakan medis tertentu (misalnya torakosentesis).
3. Pneumotoraks karena tekanan

Terjadi jika paru-paru mendapatkan tekanan

berlebihan sehingga paru-paru mengalami kolaps. 
Tekanan yang berlebihan juga bisa menghalangi
pemompaan darah oleh jantung secara efektif
sehingga terjadi syok. 
 Types of Pneumothorax

1. Spontaneous: thought to occur when a weakened area of

the lung (bleb) ruptures; air then moves from the lung to
the intrapleural space causing collapse

2. Open: laceration (e.g., a stab wound) through the chest

wall into the intrapleural space. Hole in the chest wall,
communicates with the lung

3. Hemothorax: collection blood within the pleural cavity.

NursingBulletin.com
4. Hydrothorax: accumulation of fluid in the pleural cavity.

5. Tension: buildup of pressure as air accumulates within the

pleural space; the pressure increase likely to induce a
mediastinal shift.
 Closed pneumothorax: air is forced into the pleural space with a

continued pressure build up. Hole in lung, chest wall intact

 Shifts mediastinum away from the affected side with results of a

compressed heart
 Cardiac and respiratory arrest if not treated
: Mediastinal Shift may occur toward the uninvolved side as a result of increased pressure
within the pleural space; this involves the trachea, esophagus, heart, and great vessels.
 PATOFISIOLOGI
Adanya trauma dada yang dapat mengakibatkan kebocoran /
tusukan / laserasi pleura viseral sehingga paru-paru kolaps
sebagian / komplit dikarenakan udara masuk ke dalam ruang
pleura. Volume udara di ruang pleura menjadi meningkat dan
mengakibatkan peningkatan tekanan intra toraks. Akibat
peningkatan ini maka akan terjadi distress pernapasan,
gangguan pertukaran gas dan menimbulkan tekanan pada
mediastinum yang dapat mencetuskan gangguan jantung
dan sirkulasi sistemik.
 CLINICAL FINDINGS

1. Subjective:
Dyspnea (80-100%)

sering mendadak dan memberat

Chest pain (75-90%)

usually described as sharp and increasing on exertion

Batuk (25-35%)

Drowsiness
2. Objective:
Rapid, shallow respirations (nonsymmetric)

Suara napas pada sisi yang terkena diminished or absent

Chest x-ray examination ; tingkatan pneumothorax

Tachycardia

Tachypnea

Hypotension

Penurunan expansi dada unilateral

Cyanosis

Tracheal deviation

Tidak menunjukkan gejala (silent) yang terdapat pada 5-10%

pasien
 TEST DIAGNOSTIK

 AGD ; hipoksemia dan alkalosis respirasi akut

 EKG, pneumotoraks primer sebelah kiri dapat menyebabkan

aksis QRS dan gelombang T berubah

 garis pleura visceral yang tampak pada pemeriksaan radiologi

konvensional dengan pasien diposisikan terlentang akan

memberikan gambaran siklus kostofrenik radiolusen yang
abnormal.
Foto Rö pneumotoraks (PA) ditunjuk dengan anak panah merupakan bagian paru yang kolaps
 Low Blood
oxygen
levels

emfisema Respirato
subkutan * ry Failure

KOMPLIKASI
Pneumo –
Cardiac
mediastinu
m* Arrest

Tension
pneumotor Shock
aks
 PENATALAKSANAAN MEDIS
1. Terapi o2 dapat meningkatkan reabsorpsi udara dari ruang
pleura.
 Drainase sederhana untuk aspirasi udara pleura
menggunakan kateter  berdiameter kecil (seperti 16 G angio-
chateter / kateter drainase yang lebih besar)
 Penempatan pipa kecil yang dipasang satu jalur pada katup
helmic untuk memberikan perlindungan terhadap serangan
tension pneumotoraks
 Obat simptomatis untuk keluhan batuk dan nyeri dada
 Pemeriksaan radiologi
ASKEP
 Assessment
1. Auscultation of lung fields for diminished or absent breath
sounds

2. Chest percussion for hyperresonance

3. Check motion during inhalation for inequality

4. Baseline Vital Signs

5. Skin for changes in color

6. Auscultate breath sounds to observe for signs of pneumothorax

7. Monitor ABG
 DIAGNOSIS

 Diagnosis

Impaired Gas Exchange

 Goal

1. to relieve the pressure on the lung,

2. allowing it to re-expand,
3. and to prevent recurrences.
 Implementations
 Maintain constant supervision until stable

 Maintain patency of breath

 chest tubes

 Place in high-Fowler’s position

 Offer fluids frequently

 Monitor vital signs, particularly respirations

 Apply dressing over an open chest wound

 Oxygen as prescribed

 Chest tube placement

 Monitor for chest tube system

Diagnosa Keperawatan lain

1. Ketidak efektifan pola pernapasan yang berhubungan dengan

menurunya ekspansi paru sekunder terhadap peningkatan
tekanan dalam rongga pleura.

2. Resiko tinggi trauma pernapasan berhubungan dengan

pemasangan WSD.

3. Kurangnya pengetahuan berhubungan dengan kurang

terpajan pada informasi.
 CEST TUBE
THORACOSTOMY
 Indications for CTT
 If fluid, such as blood, or air, gets into the pleural space, the lung

can collapse, preventing adequate air exchange. Chest tubes are

used to treat conditions that can cause the lung to collapse, such
as:
 air leaks from the lung into the chest (pneumothorax)

 bleeding into the chest (hemothorax)

 after surgery or trauma in the chest (pneumothorax or

hemothorax)
 lung abscesses or pus in the chest (empyema).
INDICATIONS INTERCOSTAL TUBE DRAINAGE

 Unstable pneumothorax

 Severe dyspnea

 Large lung collapse

 Open or tension pneumothoraces

 Frequent recurrent pneumothoraces

 Simple aspiration or catheter aspiration drainage is

unsuccessful in controlling symptoms

Xie Can Mao

 Nursing Care for pt with CTT:
 Ensure that the tubing is not kinked; tape all connections to prevent

separation
 Do not milk the tube

 Maintain the drainage system below the level of the chest; mark and

monitor drainage
 Turn the client frequently, making sure the chest tubes are not

compressed.
 Observe for fluctuation of fluid in tube; the level will rise on inhalation and

fall on exhalation; if there are no fluctuations, either the lung has

expanded fully or the chest tube is clogged
 Place two clamps at your bedside for use if the underwater-seal

bottle is broken; clamps are used judiciously and only in emergency

situations

 Encourage coughing and deep breathing every 2 hours, splinting the

area as needed

 After lung re-expansion is verified by chest x-ray, instruct the client

to exhale or strain (Valsalva’s Maneuver) as the tube is withdrawn

by the physician; apply a gauze dressing immediately and firmly
secure the tape to make an airtight dressing
 Complications of CTT
 Death

 injury to lung or mediastinum

 hemorrhage (usually from intercostal artery injury)

 neurovascular bundle injury

 Infection

 bronchopleural fistula

 and subcutaneous or intraperitoneal tube placement

Intercostal tube drainage
Making a small incision
Using a forceps to extend the hole
Inserting a catheter into pleural cavity

Fix the catheter and cover with gauze

Intercostal tube drainage
TERIMA KASIH