Eight minutes after 900 mL of right pleural fluid is removed by thoracentesis, a client develops severe dyspnea and pleuritic pain. Oxygen saturation falls to 83%, blood pressure to 76/42 mm Hg, and heart rate rises to 134/min. Breath sounds are absent on the right, neck veins are distended, and the trachea is displaced to the left. Complete the bowtie by selecting the complication, two actions the nurse should take, and two parameters the nurse should monitor.

Right tension pneumothorax; emergency oxygen and support; immediate decompression and drainage; monitor respiratory status and hemodynamic perfusion.

The abrupt unilateral ventilation loss with tracheal displacement and obstructive shock after thoracentesis identifies tension pneumothorax rather than pulmonary edema, hemothorax, or a vasovagal event.

The nurse stops the procedure, supports oxygenation, summons emergency help, and prepares immediate decompression. Routine imaging must not delay treatment in an unstable client with classic findings.

Improving oxygen saturation, breath sounds, work of breathing, blood pressure, heart rate, and perfusion demonstrate relief of intrathoracic pressure and obstructive shock.

For an immediately life-threatening breathing problem, treat first and reassess the physiologic response; do not choose a test that delays definitive treatment.

Positive pressure before decompression can worsen the tension physiology. Type and crossmatch, observation, infection markers, and serum osmolality do not address or measure the immediate response to decompression.

• Tension pneumothorax — Progressive pleural pressure that collapses the affected lung and impairs venous return, causing respiratory distress and obstructive shock.
• Pleural decompression — Emergency release of trapped pleural air followed by definitive chest drainage.