Medical Surgical Flail chest & Rib fracture #5

Question

A client is brought to the ER with an open chest wound and multiple rib fractures and a suspected pneumothorax. Which interventions would be performed STAT by the nurse at the moment the client is brought in?

Answers

  1. Administer oxygen as prescribed.
    • Rationale:

      This answer is correct because oxygen is required for proper ventilation. It also helps the client breathe better and assists with pain from the rib fractures. If the client has a pneumothorax, there will be increased CO2 in the blood and supplemental oxygen will be needed.

  2. Apply a dressing over the chest wound.
    • Rationale:

      This answer is correct because an open chest wound would require a dressing to prevent additional air from entering the pleural cavity during inhalation and to allow trapped air to escape on exhalation.

  3. Place the client in 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 greater lung expansion. This position also alleviates compression of the chest.

  4. Encourage coughing and deep breathing.
    • Rationale:

      This answer is not correct because coughing and deep breathing would not be indicated when the client arrives into the ER. This would be encouraged during the recovery phase.

  5. Suction fluids from the lungs.
    • Rationale:

      This answer is not correct because suctioning of fluids would be by a chest tube drainage system. Inserting a chest tube drainage system is an invasive procedure performed by a medically trained provider, not a nurse.

Overview

An open chest wound would require a dressing to prevent additional air from entering the pleural cavity during inhalation and to allow trapped air to escape on exhalation. With multiple rib fractures, a pneumothorax should always be suspected, and oxygen and High Fowler’s positioning are indicated to promote proper ventilation and lung expansion.

Explanation

Learning Outcomes

An open chest wound would require a dressing to prevent additional air from entering the pleural cavity during inhalation and to allow trapped air to escape on exhalation. With multiple rib fractures, a pneumothorax should always be suspected. If the client has a pneumothorax, there will be increased CO2 in the blood and supplemental oxygen will be needed. High Fowler’s positioning is indicated to promote proper ventilation and lung expansion. After physical examination by the provider, a chest tube drainage system may be indicated for the pneumothorax. This is an invasive procedure performed by the provider of care. Once the client is on the floor and in the recovery phase, cough and deep breathing exercises will be encouraged.

Test Taking Tip

Understand comprehensive emergency steps to take during life-threatening illnesses.

Video Rationale