Musculoskeletal - Chest Trauma

Question 1

Pulmonary Contusion

Answer 1

Bleeding & bruising to lungs

Question 2

Pulmonary Contusion - Patho

Answer 2

• Lung injury due to blunt trauma
• Rapid deceleration
• Resp failure
  > immediate or over-time
• Affects gas exchange
  > blood & edema between & around alveoli

Question 3

Pulmonary Contusion - CMs

Answer 3

• Crackles
• Wheezes
• Cough
• Tachycardia
• Tachypnea
• Dullness to percussion

Question 4

Pulmonary Contusion - Diagnosis

Answer 4

• Early: CXR negative
  > if bleeding hasn’t happened yet; cxr will be black
• Late: CXR hazy opacity over affected area

Question 5

Pulmonary Contusion - Nursing Implications

Answer 5

• Maintain airway & breathing
• Maintain IV fluids
• Moderate-Fowler’s position
• BiPAP or PEEP

Question 6

Pulmonary Contusion - Nursing Diagnosis

Answer 6

• Impaired gas exchange
• Outcome:
  > Condition can lead to acute resp distress syndrome (ARDS)

Question 7

Flail Chest - Pathophysiology

Answer 7

• Neighboring rib fractures causing paradoxical chest wall movement
• More than 1 fraction on same rib
• Common: blunt chest trauma
• Look for other injuries bc flail chest requires a great deal of force
• Common after ACLS (CPR)

Question 8

Flail Chest - CMs

Answer 8

• Paradoxical chest movements
• Dyspnea
• Cyanosis
• Tachycardia
• Hypotension
• SOA
• Anxiety
• Pain

Question 9

Flail Chest - Nursing Interventions

Answer 9

• Pain management
• Oxygen
• Lung expansion
  > deep breathing
  > positioning
• Resp assessment
• Mechanical ventilation - PEEP
• ABGs
• Surgery only in extreme cases

Question 10

Flail Chest - Nursing Diagnosis

Answer 10

• Impaired gas exchange
• Pain
• Impaired communication

Question 11

Rib Fracture - Nursing Implications

Answer 11

• Assist w/ gas exchnage
• Treat pain, but avoid meds tht suppress the resp drive
• Assess for pneumothorax, tracheal movement, hemothorax, resp failure