Page 1576 - Saunders Comprehensive Review For NCLEX-RN

with the hands, arms, or a pillow.
g. Prepare the client for an intercostal
nerve block as prescribed if the pain is
severe.
B. Flail chest
1. Description
a. Occurs from blunt chest trauma
associated with accidents, which may
result in hemothorax and rib fractures.
b. The loose segment of the chest wall
becomes paradoxical to the expansion
and contraction of the rest of the chest
wall.
2. Assessment

a. Paradoxical respirations (inward

movement of a segment of the thorax
during inspiration with outward
movement during expiration)
b. Severe pain in the chest
c. Dyspnea
d. Cyanosis
e. Tachycardia
f. Hypotension
g. Tachypnea, shallow respirations
h. Diminished breath sounds
3. Interventions

a. Maintain the client in a Fowler’s

position.
b. Administer oxygen as prescribed.
c. Monitor for increased respiratory
distress.
d. Encourage coughing and deep
breathing.
e. Administer pain medication as
prescribed.
f. Maintain bed rest and limit activity to
reduce oxygen demands.
g. Open reduction and internal fixation of
the ribs (rib plating) may be done.

h. Prepare for intubation with

mechanical ventilation, with positive
end-expiratory pressure (PEEP) for
severe flail chest associated with
respiratory failure and shock (see

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