Pneumothorax & Chest Tube Care Nursing Care Plan
Air in the pleural space; drainage system monitoring and lung re-expansion.
Quick answer
A Pneumothorax & Chest Tube Care nursing care plan centers on recognize and immediately treat tension pneumothorax; restore lung expansion and maintain gas exchange; maintain a functioning, patent chest drainage system. Priority nursing diagnoses are Impaired gas exchange, Acute pain, Risk for injury. The plan below gives assessment cues, measurable goals, 5 intervention sets with rationales, and patient teaching.
Overview
A pneumothorax is air in the pleural space that destroys the normal negative pressure and lets the lung collapse. It may be spontaneous — classically in a tall, thin young man or in someone with COPD — traumatic from penetrating or blunt injury, or iatrogenic after central line placement, thoracentesis or barotrauma. A hemothorax is blood in the same space and can hold liters of blood, causing hypovolemia as well as compression.
A tension pneumothorax is the emergency: a one-way valve lets air in with each breath and none out, so pressure rises, the mediastinum shifts, venous return falls and cardiac arrest follows. It is recognized clinically — severe distress, absent unilateral breath sounds, tracheal deviation away from the affected side, distended neck veins and hypotension — and treated immediately with needle decompression, not with a trip to radiology. Chest tube management then centers on knowing what bubbling and tidaling mean, and keeping the drainage system below chest level and upright at all times.
Key numbers to know
Tension signs
Tracheal deviation away from the affected side, absent breath sounds, distended neck veins, hypotension, severe distress — decompress immediately.
Tidaling
Fluctuation of fluid in the water seal with respiration is normal; it stops when the lung re-expands or the tube is obstructed.
Bubbling
Intermittent bubbling in the water seal is expected with air leak; continuous bubbling means a leak in the system — check connections working from patient to drainage unit.
System handling
Keep the unit upright and below chest level, never clamp routinely, never strip or milk tubing, and never empty a water-seal chamber.
If it dislodges
Tube out of the chest — cover with a dressing taped on three sides; tube out of the drainage unit — place the end in sterile water and call for help.
Nursing priorities
- Recognize and immediately treat tension pneumothorax.
- Restore lung expansion and maintain gas exchange.
- Maintain a functioning, patent chest drainage system.
- Control pain enough to permit deep breathing and coughing.
- Prevent infection at the insertion site and in the pleural space.
- Teach recurrence prevention and post-removal warning signs.
Nursing assessment
Subjective data
- Sudden sharp pleuritic chest pain worse with inspiration
- Acute shortness of breath and a feeling of not getting enough air
- Anxiety, restlessness and a sense of impending doom
- Pain at the chest tube insertion site limiting deep breathing
- Recent trauma, procedure, or history of prior pneumothorax or lung disease
Objective data
- Absent or diminished breath sounds and hyperresonance on the affected side
- Asymmetric chest expansion, tachypnea, tachycardia, use of accessory muscles
- Falling oxygen saturation, cyanosis, restlessness progressing to confusion
- Tracheal deviation away from the affected side, distended neck veins, hypotension — tension
- Subcutaneous emphysema with crepitus around the chest, neck and face
- Chest x-ray showing pleural air, lung collapse or mediastinal shift
- Chest drainage: volume, color and rate of output; tidaling and bubbling in the water seal
- Insertion site: dressing integrity, drainage, redness, air leak around the tube
Related factors
- Air or blood accumulation in the pleural space with loss of negative pressure
- Lung collapse reducing ventilated surface area and ventilation-perfusion matching
- Chest wall injury, rib fracture or surgical incision causing splinting
- Invasive tube providing a portal for infection
- Anxiety and pain limiting depth of respiration
Key nursing diagnoses
Goals and expected outcomes
- The client will maintain oxygen saturation above 94% with an unlabored respiratory rate.
- The client will demonstrate lung re-expansion on chest x-ray with return of breath sounds.
- The client will report pain controlled well enough to deep breathe, cough and use incentive spirometry.
- The chest drainage system will remain patent, intact and functioning without complication.
- The client will remain free of infection at the insertion site and within the pleural space.
- The client will state signs of recurrence and activity restrictions before discharge.
Nursing interventions and rationales
1. Emergency recognition and respiratory support
- Assess respiratory rate, effort, breath sounds, chest symmetry, tracheal position and saturation frequently, and more often after any procedure that risks the pleura.
- Suspect tension pneumothorax with sudden severe distress, absent unilateral breath sounds, tracheal deviation, distended neck veins and hypotension, and summon help for immediate needle decompression.
- Give supplemental oxygen to maintain the ordered saturation target and position in high Fowler's or semi-Fowler's to maximize expansion.
- For an open sucking chest wound, apply an occlusive dressing taped on three sides so air can escape but not enter.
- Monitor arterial blood gases and mental status; restlessness is an early hypoxia sign.
- Stay with the acutely dyspneic patient and coach slow controlled breathing to reduce panic and oxygen demand.
2. Chest drainage system management
- Keep the drainage unit upright and below the level of the chest at all times, including during transport and ambulation.
- Assess the water seal each shift: tidaling with respiration indicates a patent tube, and its absence means either re-expansion or obstruction.
- Distinguish intermittent from continuous bubbling; for continuous bubbling, briefly occlude along the tubing from the patient outward to locate the leak, then correct the connection.
- Never routinely clamp the tube, never strip or milk the tubing, and never raise the unit above chest level.
- Keep tubing free of kinks and dependent loops, coiled flat on the bed, and all connections taped and secure.
- Mark and record drainage volume, color and rate at set intervals; report output greater than about 100 mL/hr or a sudden change.
- Keep sterile occlusive dressings, sterile water and clamps at the bedside for emergencies, and know the response for tube dislodgement from the chest versus from the unit.
3. Pain control and pulmonary hygiene
- Give analgesia on a schedule and before pulmonary exercises; unrelieved chest tube pain causes splinting, atelectasis and pneumonia.
- Teach splinting the site with a pillow during coughing and movement.
- Have the patient use incentive spirometry every hour while awake and perform deep breathing and coughing to re-expand the lung.
- Assist with position changes and early ambulation with the drainage unit secured below chest level.
- Perform range of motion of the arm on the affected side to prevent frozen shoulder.
4. Infection prevention and site care
- Maintain an occlusive dressing and change it per protocol using sterile technique, inspecting the site for redness, drainage and odor.
- Assess for subcutaneous emphysema by palpating around the site and mark its border to track progression.
- Monitor temperature, WBC and drainage character for empyema.
- Ensure sutures are intact and the tube is anchored so movement does not drag on the site.
5. Tube removal and discharge preparation
- Confirm removal criteria are met: minimal drainage, no air leak, lung re-expanded on x-ray, and often a period of water seal without suction.
- Premedicate before removal and instruct the patient to take a deep breath and bear down or exhale fully as the tube is pulled, to prevent air entry.
- Apply an airtight occlusive dressing immediately and obtain the post-removal chest x-ray.
- Monitor closely afterward for recurrence — new dyspnea, chest pain, decreased breath sounds or subcutaneous emphysema.
- Teach recurrence risk, smoking cessation, and to avoid air travel, scuba diving and high altitude until cleared by the provider.
- Explain pleurodesis or surgical options when episodes recur.
Patient and family teaching
- Keep the drainage container upright and below your chest whenever you move or walk.
- Do incentive spirometry and deep breathing every hour — take pain medicine first so you can do it properly.
- Tell the nurse immediately about new shortness of breath, chest pain, a crackling feeling under the skin, or if the tube pulls or a connection comes apart.
- Stop smoking; it is the strongest modifiable risk factor for another collapse.
- Avoid flying, scuba diving and high altitude until your provider clears you.
- After discharge, seek care immediately for sudden chest pain or breathlessness — it may be a recurrence.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Pneumothorax & Chest Tube Care questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Respiratory care plans
Plans that share these nursing diagnoses
Care plan writing guides
Common questions
What are the nursing diagnoses for Pneumothorax & Chest Tube Care?
Priority nursing diagnoses for Pneumothorax & Chest Tube Care: Impaired gas exchange; Acute pain; Risk for injury.
What are the nursing interventions for Pneumothorax & Chest Tube Care?
Assess respiratory rate, effort, breath sounds, chest symmetry, tracheal position and saturation frequently, and more often after any procedure that risks the pleura. Suspect tension pneumothorax with sudden severe distress, absent unilateral breath sounds, tracheal deviation, distended neck veins and hypotension, and summon help for immediate needle decompression. Give supplemental oxygen to maintain the ordered saturation target and position in high Fowler's or semi-Fowler's to maximize expansion. For an open sucking chest wound, apply an occlusive dressing taped on three sides so air can escape but not enter. Monitor arterial blood gases and mental status; restlessness is an early hypoxia sign. Stay with the acutely dyspneic patient and coach slow controlled breathing to reduce panic and oxygen demand.
What are the nursing care goals for Pneumothorax & Chest Tube Care?
The client will maintain oxygen saturation above 94% with an unlabored respiratory rate. The client will demonstrate lung re-expansion on chest x-ray with return of breath sounds. The client will report pain controlled well enough to deep breathe, cough and use incentive spirometry. The chest drainage system will remain patent, intact and functioning without complication. The client will remain free of infection at the insertion site and within the pleural space. The client will state signs of recurrence and activity restrictions before discharge.
What should you assess in a patient with Pneumothorax & Chest Tube Care?
Sudden sharp pleuritic chest pain worse with inspiration; Acute shortness of breath and a feeling of not getting enough air; Anxiety, restlessness and a sense of impending doom; Pain at the chest tube insertion site limiting deep breathing; Recent trauma, procedure, or history of prior pneumothorax or lung disease; Absent or diminished breath sounds and hyperresonance on the affected side; Asymmetric chest expansion, tachypnea, tachycardia, use of accessory muscles; Falling oxygen saturation, cyanosis, restlessness progressing to confusion; Tracheal deviation away from the affected side, distended neck veins, hypotension — tension; Subcutaneous emphysema with crepitus around the chest, neck and face; Chest x-ray showing pleural air, lung collapse or mediastinal shift; Chest drainage: volume, color and rate of output; tidaling and bubbling in the water seal; Insertion site: dressing integrity, drainage, redness, air leak around the tube