What are the typical signs of a pneumothorax in an intubated patient and what are the immediate nursing interventions?

• A. Signs: sudden hypoxia, increased airway pressures, diminished breath sounds on the affected side; interventions: notify physician, prepare for chest tube or needle decompression if tension; maintain lung-protective ventilation if possible.
• B. Signs: gradual improvement in oxygenation; actions: observe.
• C. Signs: hypercapnia; actions: increase FiO2 only.
• D. Signs: improved chest movement; actions: withhold treatment.

Answer: (A)

When an intubated patient develops a pneumothorax, ventilation becomes suddenly impaired and oxygenation worsens because air collects in the pleural space and collapses part of the lung. The most reliable signs in this situation are a rapid drop in oxygen saturation, a rise in peak inspiratory pressures on the ventilator (reflecting decreased lung compliance), and diminished or absent breath sounds on the side of the pneumothorax. In a tension pneumothorax, these changes may be accompanied by rapid hemodynamic instability due to compression of the heart and great vessels. Quick recognition is essential.

The immediate nursing actions focus on rapid stabilization and definitive treatment. Notify the physician right away and prepare for emergent chest decompression if a tension pneumothorax is suspected (needle decompression followed by chest tube placement). At the same time, support oxygenation—administer 100% oxygen as ordered—and review ventilator settings to minimize further lung injury, applying lung-protective ventilation strategies if feasible (for example, low tidal volumes and careful control of pressures). Do not delay decompression for imaging if a tension pneumothorax is suspected, and after stabilization, ensure chest tube management and monitoring continue as ordered.

These signs and actions fit because they reflect acute air in the pleural space causing rapid deterioration in ventilation, requiring prompt decompression and protective ventilation, rather than gradual improvement, hypercapnia alone, or any improvement in chest movement.