Chest injuries can occur from penetrating or crushing wounds to the chest wall caused by violence or accidents. A flail chest involves multiple broken ribs which causes an unstable chest wall that moves in the opposite direction of the lung during breathing, resulting in hypoxia. Symptoms of a chest injury include dyspnea, anxiety, pain with breathing or inspiration, paradoxical chest wall movements, tachycardia, and cyanosis. Diagnostic tests include blood gases, chest x-ray, and pulmonary function tests. Treatment involves wound care, oxygen therapy, antibiotics, analgesics, intubation if needed, and monitoring for complications like cardiac tamponade or pulmonary contusion.

1. CHEST INJURIES
NURSING CARE

2. DEFINITION
• Penetrating or crushing wounds of the
chest wall generally caused by act of
violence or motor vehicle accidents

3. Etiology and Pathophysiology
• Flail Chest
- Multiple rib fractures or sternal fracture
- The chest wall on the injured side becomes unstable
• On inspiration the flail section retracts the rest of the chest
expands
• On expiration the flail section bulges out while the rest of the
chest retracts
• The portion of lung below the injury moves in the opposite
direction to the remainder of the lung, which results in hypoxia

4. Clinical Manifestations
• Dyspnea
• Anxiety
• Presence of a wound with a sucking sound on inspiration
• Sharp local pain over injury which increases with inspiration
• Rapid shallow respiration
• Cyanosis or pallor
• Paradoxical movements of the chest wall
• Tachycardia
• Shock
• Absence of breath sounds on the affected side

5. Diagnostic Evaluation
• Arterial blood gas analysis
• Chest x-ray
• Pulmonary function test

6. Management
• Pressure dressing over the wound
• Water seal suction drainage
• Bed rest and limitation of activity
• Oxygen therapy
• Antibiotics and analgesics
• Endotracheal intubation and mechanical ventilation as needed
• Treatment for shock and hemorrhage
• Continuing monitoring

7. Nursing Assessment
• Respiratory status
• Pulse for tachycardia
• Skin for change in colour
• Presence of paradoxical chest movements
• Signs of shock
• Level of pain

8. Nursing Diagnosis
• Risk of activity intolerance related to oxygen
deprivation
• Anxiety related to oxygen deprivation
• Ineffective breathing pattern related to anxiety
• Ineffective breathing pattern related to pain
• Fatigue related to oxygen deprivation
• Fear related to air hunger
• Fear related to pain impaired gas exchange related to
loss of functional lung tissue

9. Nursing Intervention
1).Observe patient’s respiratory status
2).Maintain adequate tissue perfusion
a). Administer oxygen as ordered
b). Elevate the head of the bed
c). Encourage to use incentive spirometry
d). Suck out secretion as needed
e). Care for chest tubes
f). Turn the patient every 2 hours
g). Administer analgesics as ordered

10. Nursing Intervention
3). Alleviate pain and provide comfort
a). Assist the patient to be in a comfortable position
b). Assess the level of pain and offer pain medication
4). Monitor fluid and electrolyte status
5). Explain the purpose and functions of water seal
drainage
6). Maintain gastric decompression by inserting
nasogastric tube and maintaining drainage

11. Nursing Intervention
7). Monitor for complications
a). Cardiac tamponade
b). Pulmonary contusion
c). Myocardial contusion
d). Rupture of the esophagus and diaphragm
e). Rupture of the aorta
f). Monitor cardiovascular status