Question

A client is brought in with a gunshot wound to the chest. The nurse assesses for tension pneumothorax. What s/sx of tension pneumothorax can the nurse expect?

a) Bradycardia
b) Hypotension
c) Diminished breath sounds on the affected side
d) Tracheal deviation away from the affected side

Answer 1

The nurse can expect diminished breath sounds on the affected side and tracheal deviation away from the affected side as signs and symptoms of tension pneumothorax in a client with a gunshot wound. Bradycardia and hypotension are not typically associated with tension pneumothorax. Early recognition of these signs is important for timely intervention.

Step-by-step explanation:

The nurse can expect certain signs and symptoms suggestive of tension pneumothorax in a client with a gunshot wound to the chest. These include:

1. Diminished breath sounds on the affected side: Due to the collapse of the lung, breath sounds will be reduced or absent on the side of the chest where the injury occurred.
2. Tracheal deviation away from the affected side: In tension pneumothorax, the accumulation of air in the pleural space causes pressure to shift the trachea away from the side of the injury.

Bradycardia and hypotension are not typically associated with tension pneumothorax. It is crucial for the nurse to recognize these signs and symptoms to initiate prompt treatment and prevent further complications.