Medical Surgical Flail chest & Rib fracture #1

Question

A client arrives at the emergency department following an automobile accident and has multiple fractured ribs. The nurse suspects a flail chest because of which cardinal sign?

Answers

  1. Paradoxical chest movement.
    • Rationale:

      This answer is correct because with flail chest, broken rib segments move independently of the rest of the rib cage due to multiple rib fractures causing paradoxical chest movement. During inspiration, the fractured segment is pulled inward while the rest of the chest expands. During expiration, the segment spreads outward while the rest of the chest moves inward.

  2. Dyspnea on expiration.
    • Rationale:

      This answer is not correct because while dyspnea may be manifested in a client with flail chest, it is not the cardinal sign of flail chest. Dyspnea on exhalation can be associated with many other conditions.

  3. Blue nail beds.
    • Rationale:

      This answer is not correct because while cyanotic nail beds, a sign of hypoxemia may be manifested in a client with complications of flail chest, it is not the cardinal sign of this condition. Cyanotic nail beds are associated with many other conditions.

  4. Hypertension.
    • Rationale:

      This answer is not correct because hypertension is not a cardinal sign of flail chest. The client may experience hypertension due to pain associated with the condition, but hypertension can be caused by many other conditions.

Overview

The focus of this question is determining the classic manifestation of flail chest. Flail chest causes loss of stability within the chest wall due to broken ribs leading to paradoxical chest movement during inhalation and exhalation.

Explanation

Learning Outcomes

Flail chest occurs when the rib cage breaks due to trauma and detaches from the chest wall. It usually occurs when ribs in the same segment are broken in multiple places. Two of the common symptoms of flail chest include chest pain and dyspnea. Paradoxical chest movement occurs because the rib cage becomes unstable due to multiple breaks in the same segment. Paradoxical chest movement is when the chest moves inward upon expiration and outward upon inhalation.

Test Taking Tip

The key to answering questions like this correctly is to identify the manifestation unique to the disorder described in the question. Answer options # 2, 3, and 4 may be caused by many other disorders, however, paradoxical chest movement is unique to flail chest.

Video Rationale