Medical Surgical Flail chest & Rib fracture #4

Question

A client arrives into the ER with a flail chest. Which nursing interventions should be implemented for flail chest? Select all that apply.

Answers

  1. Administered humidified oxygen via facemask.
    • Rationale:

      This answer is correct because clients with flail chest are immediately placed on 100% oxygen using a facemask. Flail chest has little impact on oxygenation. However, most clients have a pulmonary contusion, which would indicate the need for oxygenation.

  2. Prepare for possible intubation and mechanical ventilations.
    • Rationale:

      This answer is correct because mechanical ventilation will help stabilize the chest cavity. Mechanical ventilation is reserved in clients with flail chest who experience shock, severe pulmonary dysfunction, need for immediate surgery, or respiratory failure.

  3. Administer pain medication as prescribed.
    • Rationale:

      This answer is correct because the client with a flail chest will experience acute pain. The client will receive a local anesthetic via epidural. Analgesic pain medications are also used as treatment for flail chest. Opioids in high doses can produce respiratory depression.

  4. Maintain bedrest to reduce oxygen demands.
    • Rationale:

      This answer is correct because keeping the chest cavity stable is high priority. With multiple rib fractures causing a flail chest, maintaining bed rest is indicated to reduce oxygen demands. This will help prevent stressing the heart.

  5. Place the client in the high Fowler’s position.
    • Rationale:

      This answer is correct because placing a client in high Fowler’s position promotes lung expansion. Gravity pulls the diaphragm downward, allowing for greater lung expansion. This position also alleviates compression of the chest.

Overview

Flail chest occurs from chest trauma when a segment of the rib cage breaks and detaches from the rest of the chest wall. This is a medical emergency.

Explanation

Learning Outcomes

Flail chest occurs from chest trauma when a segment of the rib cage breaks and detaches from the rest of the chest wall. This is a life-threatening emergency. Flail chest has little impact on oxygenation. However, most clients have a pulmonary contusion, which would indicate the need for oxygenation. For this reason, clients with a flail chest are placed on 100% oxygen using a facemask. Mechanical ventilation is reserved in clients with flail chest who experience shock, severe pulmonary dysfunction, need for immediate surgery, or respiratory failure. Analgesic pain medications and epidural anesthetics are used as treatment for flail chest. Maintaining bed rest is indicated to reduce oxygen demands and prevent stress on the heart. The high Fowler’s position promotes lung expansion and alleviates compression of the chest.

Test Taking Tip

Know interventions for life-threatening illnesses.

Video Rationale