Unit 4 Chapter 29 Chest Trauma; Flail Chest, Rib Fractures, Pulmonary Contusion

Question 1

Example of chest Trauma

Answer 1

-Pulmonary contusion
-Rib fractures
-Flail chest
-Pneumothorax
-Tension pneumothorax
-Hemothorax

Question 2

What is the first emergency approach? to ALL chest injuries?
A. assess neurological status
B. assess pupil dilation
C. assess airway patency
D. assess the level of consciousness

Answer 2

C. assess airway patency

The first emergency approach to all chest injuries is ABC ( a irway, b reathing, c circulation), a rapid assessment and treatment of life-threatening conditions.

Question 3

Which of the patients should the nurse assess for?
A. the patient with kussmal respirations
B. the patient with tension pneumothorax with absent left lung sounds
C. The patient with a heart rate of 56 post administration of Atenolol
D. The patient with auditory wheezing

Answer 3

B. the patient with tension pneumothorax with absent left lung sounds

the priority patient is the one with absent lung sounds

Question 4

What is Pulmonary Contusion

Answer 4

Pulmonary contusion, a potentially lethal injury, is a common chest injury and occurs most often by rapid deceleration during car crashes.

Question 5

Which of these patients are at high risk for pulmonary contusion?
A. The patient fell off a 2 feet ladder.
B. The patient who has been in a 4-car collision accident.
C. The patient who has sepsis
D. The patient who has pneumonia

Answer 5

B. The patient who has been in a 4-car collision accident.

Pulmonary contusion, a potentially lethal injury, is a common chest injury and occurs most often by rapid deceleration during car crashes.
or gun shot wound

Question 6

S/s of Pulmonary Contusion

Answer 6

Patients may be asymptomatic at first and can later develop various degrees of respiratory failure and possibly pneumonia
-decreased breath sounds
-crackles
-wheezes over the affected area.
-bruising over the injury,
-dry cough,
-tachycardia,
-HEMORHAGE
-hemoptosis
-tachypnea,
-dullness to percussion.
If there is no disruption of the parenchyma, bruise resorption often occurs without treatment.

Question 7

Management and plan of care of Pulmonary Contusion

Answer 7

Management includes maintenance of ventilation and oxygenation.

Provide oxygen PRIORITY
IV fluids as prescribed
Moderate-Fowler position.
If a high FiO 2 is needed, oxygen may be
administered using a high-flow nasal cannula (HFNC).
When side-lying, the “good lung down” position may be helpful.

Question 8

What is a Rib fracture?

Answer 8

Rib fractures are a common injury to the chest wall, often resulting from direct blunt trauma to the chest.

The force applied to the ribs fractures them and drives the bone ends into the chest.

Thus there is a risk for deep chest injury such as pulmonary contusion, pneumothorax, and hemothorax.

Question 9

S/s of Rib fractures

Answer 9

-splinting of the chest
has pain on movement and splints the chest defensively
-Splinting reduces breathing depth and clearance of secretions.

Question 10

Managment of Rib Fractures

Answer 10

fractured ribs reunite spontaneously.

The chest is usually not splinted by tape or other materials.

The main focus is to decrease pain so adequate ventilation is maintained.

An intercostal nerve block may be used if pain is severe.

Opioids are effective analgesics that allow for coughing and effective incentive spirometry use; however, they can cause respiratory depression.

NSAIDs, epidural anesthesia, and patient-controlled analgesia (PCA) are other available options.

Question 11

What is Flail Chest?

Answer 11

Flail chest is the result two or more places causing paradoxical chest wall movement (inward movement of the thorax during inspiration, with outward movement during expiration)

Question 12

What is a cardinal sign of flail chest?

Answer 12

Paradoxical Chest Movement

(inward movement of the thorax during inspiration, with outward movement during expiration)**

Flail part is “puffed out” or blown out with expiration instead of collapsing normally inward.
Can increase the work and pain involved in breathing.
HARD TIME BREATHING

Question 13

S/s of Flail chest

Answer 13

Hypoxia * Decreased tidal volume * Decreased ability to cough * Hypoventilation
Assess the patient with a flail chest for paradoxical chest movement, dyspnea, cyanosis, tachycardia, and hypotension. The patient is often anxious, short of breath, and in pain. Work of breathing is increased from the paradoxical movement of the involved segment of the chest wall.

Question 14

Interventions for Flail Chest?

Answer 14

Humidified oxygen,
pain management,
Promotion of lung expansion through deep breathing and positioning
secretion clearance by coughing and tracheal suction.

Question 15

Goals for flail chest

Answer 15

Give psychosocial support to the anxious patient by explaining all procedures, talking slowly, and allowing time for expression of feelings and concerns.

PROVIDE HUMIDIED OXYGENATION

-Reduce incidence of Respiratory failure
-Reduce pain

Question 16

Vigilant respiratory care

Answer 16

Vigilant respiratory care
* Adequate ventilation
* Reduce pain to allow for improved ventilation

Mechanical ventilation is needed if respiratory failure or shock occurs. Monitor ABG values and vital capacity closely. With severe hypoxemia and hypercarbia, the patient is intubated and mechanically ventilated with PEEP. With lung contusion or an underlying pulmonary disease, the risk for respiratory failure increases. Usually flail chest is stabilized by positive-pressure ventilation. Surgical stabilization is used only in extreme cases of flail chest.

Question 17

Nursing Intervention for Flail chest

Answer 17

-Monitor vital signs
-fluid and electrolyte balance closely so hypovolemia or shock can be managed immediately.
- If he or she has a lung contusion, provide oxygen as needed and give IV fluids as prescribed.
-Assess for and relieve pain with prescribed analgesic drugs by IV, epidural, or nerve block route.
-Give psychosocial support to the anxious patient by explaining all procedures, talking slowly, and allowing time for the expression of feelings and concerns.