Fractured Ribs

  1. General information
    1. Most common chest injury resulting from blunt trauma
    2. Ribs 4-8 are most commonly fractured because they are least protected by chest muscles. Splintered or displaced fractured ribs may penetrate the pleura and lungs.
  2. Medical management: drug therapy consists of narcotics, intercostal nerve block (injection of intercostal nerves above and below the injury with an anesthetic agent) for pain relief
  3. Assessment findings
    1. Pain, especially on inspiration
    2. Point tenderness and bruising at injury site, splinting with shallow respirations, apprehensiveness
    3. Diagnostic tests
      1. Chest x-ray reveals area and degree of fracture
      2. pCO2 elevated; pO2 decreased (later)
  4. Nursing interventions
    1. Provide pain relief/control.
      1. Administer ordered narcotics and analgesics cautiously and monitor effects.
      2. Place client in semi- or high-Fowler's position to ease pain associated with breathing.
    2. Monitor client closely for complications.
      1. Assess for bloody sputum (indicative of lung penetration).
      2. Observe for signs and symptoms of pneumothorax or hemothorax.

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