TRIBHUWAN UNIVERSITY

INSTITUTE OF MEDICINE
POKHARA NURSING CAMPUS
BACHELOR OF SCIENCE OF NURSING
TEACHING LEARNING PRACTICUM
LESSON PLAN FOR TEACHING

Name of Student Teacher : Pooja Pant, BSN 4th year, Roll no: 6
Level of student teacher : BSN 4th Year
Subject : Adult Nursing-I
Unit : 3 (Disorders of Respiratory System)
Topic : Pneumothorax
Date :2077/08/25
Time : 9: 00 am
Place : Micro-soft Team virtual class
Duration : 1 hour :
Level of students : BSc Nursing second year students
No of students : 14
Name of Supervisor : Respected Madam Ms. Bishnu Gurung
Teaching /learning method : Interactive lectures & Discussion
Teaching media : PowerPoint slides

General Objective:
At the end of this teaching session, BSc 2nd year students will be able to explain about
pneumothorax

S. Specific Objectives Content Time Teaching Teaching Evaluation

N Learning Learning
method media
Greeting 4 min Brain storming PowerPoint
Introduction of topic display
Review of previous
class
Objective of teaching
Pre-test

At the end of this

teaching session, BSc
2nd year students will be
able to:

Brain storming PowerPoint What is

1 define pneumothorax Definition of 2min and display( text+ pneumothor
pneumothorax Interactive picture) ax?
Lecture

2 enlist the causes of Causes of pneumothorax 5 min Brain storming PowerPoint What are
pneumothorax and display the causes
Interactive (text + of
Lecture picture) pneumothor
ax?
3 state the types of Types of Pneumothorax 8 min Interactive PowerPoint What are
pneumothorax lecture display ( text ) the types of
pneumothor
ax?
4 state the Pathophysiology of 5 min Discussion PowerPoint What is the
pathophysiology of pneumothorax? display pathophysio
pneumothorax? Interactive (text) logy of
lecture pneumothor
ax?
5 list the clinical features Clinical Features of 5 min Interactive PowerPoint What are
of pneumothorax pneumothorax lecture display (text) the clinical
features of
pneumothor
ax?
6 state the diagnosis Diagnosis of 5 min Interactive PowerPoint How is
procedures of pneumothorax lecture display pneumothor
pneumothorax (text + ax
picture) diagnosed?

7 state the management Management of 15 min Discussion How is

of pneumothorax pneumothorax Interactive PowerPoint pneumothor
lecture display(text) ax
 managed?

9 list the complications Complications of 4 min Interactive PowerPoint What are

of pneumothorax pneumothorax lecture display (text the
+picture) complicatio
ns of
pneumothor
ax?
10  Post test 5 min Questions and PowerPoint
 Summary answering display
 Home
assignment Interactive
 Plan for next lecture
class
 References

Pneumothorax
Definition
It is the condition in which there is the collection of air or gas in the pleural space/cavity and that
prohibits lung expansion. It either occur spontaneously or results of iatrogenic injury or trauma
to the lungs of chest wall.
Causes/etiology
 Pleural or lung injury
 Invasive thoracic procedure
 Penetration of lung tissue by fracture
 Rupture of small blebs due to infection
Types of pneumothorax
1. Simple spontaneous/open pneumothorax: In this pneumothorax chest wall remains
intact and air enters the pleural space from the lungs surfaces. It is most commonly
occurs due to ruptures of blister on surface of lung, bronchopleural fistula and severe
emphysema.
2. Traumatic/close pneumothorax: It occurs when the wound in the chest is large enough
to allow air to pass freely in and out of the thorax. It can be occurred with blunt injury,
abdominal trauma, invasive procedures.
 3. Tension pneumothorax: It occurs when the air is blown into the pleural space and is
trapped with each breath. Tension builds up in the pleural space causing lung collapse. It
can act as a one way valve allowing air to enter the pleural cavity during inspiration but
not to escape on expiration. It may be the complication of other pneumothorax.
Pathophysiology

Normally in pleura pressure is

negative to maintain lung inflation

Any breaches in the pleural space

result in the loss if negative
pleural pressure

Reduce expansion of lungs

Reduce exchange of gases

Causing partial or total

collapse of lungs

Clinical features
 Sudden pleuritic pain, hyper resonance sounds
 Reduced mobility of affected half of thorax
 Tachypnea, dyspnea, diminished or absence of breath sounds, in simple pneumothorax
 Tracheal deviation away from the affected side in tension pneumothorax
 Abnormal chest movement
 Tachycardia, hypertension, pale, col clammy skin, cyanosis
Diagnostic procedures
  History taking
 Physical examination
 CBC count
 Arterial blood gas analysis
 Chest x-ray & CT scan confirms the presence of air in pleural space.
Management
Management is done according to the type of pneumothorax
Simple spontaneous pneumothorax: Treatment is usually non operative if pneumothorax is not
so extensive
 Observe and allow for spontaneous resolution for less than 50% pneumothorax in
otherwise healthy person
 Needle aspiration or chest tube drainage may be necessary to achieve re-expansion of
collapsed lung if greater than 50% pneumothorax
 Surgical intervention: pleurodesis or thoracotomy with resection of apical blebs for
recurrent spontaneous pneumothorax.
Traumatic pneumothorax
 Close the chest wound immediately to restore adequate ventilation and respiration. A
patient is instructed to inhale and exhale gently against a closed glottis (Valsalva
maneuver)
 A pressure dressing (petroleum guaze secured with elastic adhesive) is applied. This
helps to expand collapsed lung
 Chest tube is inserted and water seal- drain set up to permit evacuation of fluid/air and
produce re-expansion of the lungs
 Surgical intervention: to repair trauma
 Maintain patency of chest tubes
 Assist to splint chest while turning or coughing & administer pain medication as
prescribed.
Tension pneumothorax
 Immediate decompression to prevent cardiovascular collapse by thoracentesis or chest
tube insertion to let air escape.
 Chest tube drainage with under water seal suction to allow for full lung expansion and
healing.
Nursing Management
Nursing assessment
 Assess the general condition of patients, vital sign, type of pneumothorax, and severity of
the disease condition
 Assess the pain level
  Assess the aggravating factors of the disease condition
 Assess the knowledge level about disease condition among patients and visitors
Nursing diagnosis
 Ineffective breathing pattern related to interference with lung expansion
 Acute pain related to positive pressure in the pleural space
 Activity intolerance related to compromised pulmonary function
 Anxiety related to difficulty in breathing
 Knowledge deficit related to unknown disease condition
Planning/Implementation
 Careful observation of the condition of the patient should be done
 Keep patient in rest in sitting position calm or quiet as far as possible
 Assist while coughing or aspiration or sneezing
 Administered oxygen as prescribed
 Check vital signs regularly
 The penetrating substance if present shouldn’t be removed before calling the physicians
as there will be the chance of more air entry
 The physical activity should be restricted for 24 hours.
 Frequent chest x-ray should be done to check the condition of the lungs and pleural space
 Chest tube drainage care should be done.
 Observe for sign of infections and inflammation, around suture site
 Provide ventilator support to the patient and maintain sterility during the procedure
 Provide chest physiotherapy such as percussion, vibration
 Maintain intake output chart and correction if deviation occurs ( fluid replacement or
injecting diuretics)
 Maintain the gravity of chest tube drainage. The tubing should be below the chest level.
Never lift drain above chest level
 Secure the tube to prevent the leakage. The tubing should be anchored to the patient’s
skin to prevent pulling of the drain
 Monitor the vital signs and hemodynamics hourly
 Ensure the chest tube drain is securely positioned on its stand or hanging on the bed
 Perform pulmonary toileting (suctioning) on the drain as prescribed and record the
procedure if done
 Position change in every 2 hours should be encouraged as prescribed to promote drainage
 Clamping of the tube must be done as prescribed and ensure the prevention of air
bubbling inside the tube and bottle
 Maintain the skin integrity by applying soothing bath and releasing the pressure point
 Dressing of the site should done maintaining sterilization as prescribed

Patient education/health maintenance

 Advise not to smoke
  Avoid smoky or dusty atmosphere
 Prevent cough
 Regular check up to take prescribed medicine
 Encourage self care
Complications
 Major pain
 Pleura effusion
 Respiratory failure
 Arrhythmias

Summary
Pneumothorax is the collection of air in the pleural space and that prohibits lung expansion. It
occurs due injury to lungs or Infectionof chest or thorax. There are 3 types of pneumothorax:
simple spontaneous, traumatic and tension pneumothorax. The clinical features are pleuritic
pain, dyspnea, hypertension, hyperresonance sounds, abnormal chest movement. The
diagnostic procedures carried out are history taking, physical examination, chest x-ray etc.
The management are done according to the types of pneumothorax caused.t the preventives
measures are avoid smoking, avoid diving etc. The complications are pulmonary edema,
pleural effusion, sepsis etc.
Home assignment
Write the pathophysiology of pneumothorax.
Plan for next class
We will do discuss about COPD in next class
References
 Poudel, k., Sharma, M & Gautam, R, (2020), Comprehensive Textbook of Medical-
Surgical Nursing, 3rd edition , Samikshya Publication pvt.td
 Rai, L. (2074), Textbook of Medical-Surgical Nursing, 1st edition, Akshav Publication
 Sharma, M., (2015), Essential Textbook of Medical Surgical Nursing, 1st edition
 Williams, L.S & Hopper, P. D, (2012),Understanding of Medical-Surgical Nursing, 1 st
edition, Jaypee Brother’s Publication

Net references
 https://www.mayoclinic.org/diseases-conditions/
 https://emedicine.medscape.com/article/424547-overview
 https://www.medicinenet.com/pneumothorax/article.htm