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1. Question
A client with a chest injury has suffered flail chest. The nurse assesses the client for which most distinctive sign of flail chest?
Correct
Option C is the correct answer: Rationale: Flail chest results from multiple rib fractures. This results in a “floating” section of ribs. Because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical chest movement. This means that the force of inspiration pulls the fractured segment inward, while the rest of the chest expands. Similarly, during exhalation, the segment balloons outward while the rest of the chest moves inward. This is a characteristic sign of flail chest. Test-Taking Strategy: Note the strategic word, most. Cyanosis and hypotension occur with many different disorders, so eliminate options 1 and 2 first. From the remaining options, choose paradoxical chest movement over dyspnea on exhalation by remembering that a flail chest has broken rib segments that move independently of the rest of the rib cage.
Incorrect
Option C is the correct answer: Rationale: Flail chest results from multiple rib fractures. This results in a “floating” section of ribs. Because this section is unattached to the rest of the bony rib cage, this segment results in paradoxical chest movement. This means that the force of inspiration pulls the fractured segment inward, while the rest of the chest expands. Similarly, during exhalation, the segment balloons outward while the rest of the chest moves inward. This is a characteristic sign of flail chest. Test-Taking Strategy: Note the strategic word, most. Cyanosis and hypotension occur with many different disorders, so eliminate options 1 and 2 first. From the remaining options, choose paradoxical chest movement over dyspnea on exhalation by remembering that a flail chest has broken rib segments that move independently of the rest of the rib cage.
Flail chest is frequently a complication of blunt chest trauma from a steering wheel injury. It usually occurs when three or more adjacent ribs (multiple contiguous ribs) are fractured at two or more sites, resulting in free-floating rib segments. It may also result as a combination fracture of ribs and costal cartilages or sternum (Owens, Chaudry, Eggerstedt & Smith, 2000). As a result, the chest wall loses stability and there is subsequent respiratory impairment and usually severe respiratory distress.
Regardless of the type of treatment, the patient is carefully monitored by serial chest x-rays, arterial blood gas analysis, pulse oximetry, and bedside pulmonary function monitoring. Pain management is key to successful treatment. Patient-controlled analgesia, intercostal nerve blocks, epidural analgesia, and intrapleural administration of opioids may be used to control thoracic pain.
