Blood in the pleural cavity
May result in lung collapse

Damaged intercostal, pleural, mediastinal, and sometimes lung parenchymal vessels cause blood to enter the pleural cavity.
The amount of bleeding and the cause is associated with varying degrees of lung collapse and mediastinal shift.

Anticoagulant therapy
Blunt or penetrating chest trauma (most common cause)
Central venous catheter insertion
Damaged intercostal, pleural, or mediastinal vessels
Damaged parenchymal vessels
Dissecting thoracic aneurysm
Heart or thorax surgery
Hereditary hemorrhagic telangiectasis
Necrotizing infections
Pulmonary arteriovenous fistulas
Pulmonary infarction
Thoracic endometriosis

Hemothorax occurs in approximately 300,000 cases of trauma per year.

Mediastinal shift
Ventilatory compromise
Lung collapse
Cardiopulmonary arrest

Recent trauma
Recent thoracic surgery
Metastatic disease
Chest pain

Assessment-Physical Findings
Dusky skin color
Affected side may expand and stiffen
Unaffected side may rise with gasping respirations
Dullness over affected side
Decreased or absent breath sounds over affected side
Symptoms associated with blunt trauma such as bruising

Diagnostic Test Results-Laboratory
Pleural fluid analysis shows hematocrit greater than 50% of serum hematocrit.
Arterial blood gas (ABG) analysis may show increased partial pressure of carbon dioxide and decreased partial pressure of oxygen.
Serum hemoglobin level may be decreased, depending on blood loss.

Diagnostic Test Results-Imaging
Chest X-rays and computed tomography scan of the thorax show presence and extent of hemothorax and help to evaluate treatment.

Diagnostic Test Results-Diagnostic Procedures
Thoracentesis may yield blood or serosanguineous fluid.

Stabilization of the patient’s clinical condition
Stoppage of bleeding
Insertion of chest tube
Autotransfusion if blood loss approaches or exceeds 1 L (see Using autotransfusion for chest wounds)

As tolerated

As tolerated

I.V. fluid therapy

Thoracotomy if a chest tube doesn’t improve the condition and massive hemothorax or persistent bleeding are present
Video-assisted thorascopic surgery to directly remove clot and allow for precise placement of chest tubes

Nursing Considerations-Nursing Diagnoses
Acute pain
Deficient fluid volume
Impaired gas exchange
Ineffective breathing pattern
Risk for decreased cardiac perfusion
Risk for infection

Nursing Considerations-Expected Outcomes
express feelings of increased comfort and decreased pain
express feelings of reduced anxiety
maintain fluid volume balance
maintain adequate ventilation and oxygenation
maintain effective breathing pattern
maintain adequate cardiopulmonary perfusion
remain free from signs and symptoms of infection.

Nursing Considerations-Nursing Interventions
Administer analgesics as ordered.
Institute comfort measures and help the patient relax.
Auscultate lung sounds for changes.
Institute energy conservation measures. Cluster nursing activities and provide frequent rest periods to minimize oxygen demands.
Give prescribed oxygen, based on oxygen saturation levels.
Give prescribed I.V. fluids and blood transfusions.
If indicated, assist with chest tube insertion, ensure the tube is attached to a closed drainage system, and arrange for chest X-rays to evaluate chest tube location; ensure follow-up chest X-ray after removal of chest tube.
Change the chest tube dressing and provide chest tube care, as needed. Maintain underwater chest tube drainage as indicated.
Prepare the patient for surgery, if needed.
Obtain specimens for laboratory testing, such as ABG analysis and complete blood count (CBC).

Nursing Considerations-Monitoring
Vital signs
Intake and output
Chest tube drainage
Cardiopulmonary status
Closed drainage system function
Hemodynamic parameters
ABG results
Chest X-ray results
CBC results
Signs and symptoms of infection

Nursing Considerations-Associated Nursing Procedures
Blood pressure assessment
Chest tube drainage system monitoring and care
Chest tube drainage system setup
Chest tube insertion, assisting
Chest tube removal, assisting
IV bag preparation
IV bolus injection
IV catheter insertion
Oxygen administration
Postoperative care
Preoperative care
Preparing a patient for thoracic surgery, OR
Pulse oximetry
Respiration assessment
Thoracentesis, assisting

Patient Teaching-General
disorder, diagnosis, and treatment, including possible surgery if hemothorax is severe
signs and symptoms of worsening condition and the need to notify a practitioner
preoperative and postoperative care, if needed
respiratory hygiene measures, including the need for deep-breathing and coughing after hemothorax resolves and the chest tube is removed
safety measures to prevent recurrence if hemothorax was the result of trauma
smoking cessation, if appropriate.

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