A patient is diagnosed with a right tension pneumothorax. The nurse would understand that the pneumothorax is worsening when which of the following is observed?

Displacement of point of maximal impulse (PMI)
Increased oxygen requirements
Left deviation of the trachea


•A tension pneumothorax occurs when there is a trauma (like a stab wound) creating a one-way valve effect that allows air to enter the pleural space but not escape it. It gradually worsens as air leaks in, and can often be confirmed by x-ray when a deviation of the trachea to the unaffected side is noted from the buildup of pressure on the affected side.

•Tracheal deviation to the unaffected side is characteristic of a worsening tension pneumothorax. 

•Other signs would include asymmetry of thorax and breath sounds, worsening cyanosis, tachypnea, and displacement of the point of maximal impulse (PMI). 

•Oxygen demands increase as there is a less functional pulmonary capillary bed for diffusion.  

•Bradycardia and crackles are not symptoms of pneumothorax.

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