Rib Fracture Basics
Most commonly fractured ribs because they are the least protected by the chest muscles.
Ribs 5-9
(Harding, 2020)
The type of pain management approach where multiple classes of medications are utilized to help treat the patient's pain.
Multimodal Approach
(International Association for Surgical Pain, 2017)
Pneumonia
Respiratory Failure
Hemothorax
Empyema
Fracture Non-Union
Chronic Pain
Vascular Injuries
Organ Injuries
Atelectasis
Flail Chest
Rib fracture complications
(Sarani, 2019)
Most common mechanisms of injury leading to multiple rib fractures
Front and side impact motor vehicle collisions
Two interventions that play a huge part in prevention of pneumonia in patients with rib fractures
1. Adequate pain management
2. Aggressive pulmonary hygeine
(Harding, 2020; Sarani, 2019)
This may accompany rib fractures when there is an anterior blow to the chest, such as an impact with the steering wheel in a motor vehicle accident.
Sternal Fracture
(Sarani, 2019)
Example of a non-narcotic medications typically used in treating pain in rib fracture patients
1. Tylenol
2. NSAIDs
3. Muscle Relaxers
4. Lidoderm Patches
The most common complications of traumatic rib fracture
Pneumonia
(Harding, 2020; Sarani, 2019)
This is the leading cause of death in individuals less than 44 years of age & and in the top 5 causes of death in individuals over the age of 45.
Trauma
(Sarani & Martin, 2020)
Nursing intervention to prevent pneumonia and atelectasis
aggressive pulmonary hygiene
- Incentive spirometry
- Vibratory PEP
(Karlson & French, 2021; Legome, 2020; Martin et al., 2019; Sarani, 2020; Zhe et al., 2019)
Physical findings that are indicative of rib fractures
- Rib pain on palpation
- Rib step-off on palpation
- Crepitus
- Visible chest wall deformity
- Paradoxical respiratory motion
- Clicking sensation with inspiration or coughing
(Harding, 2020; Sarani, 2019)
30 degrees
Examples of intrathoracic injury that are common in patients with multiple rib fractures
1. Pneumothorax,
2. Hemothorax,
3. Pulmonary Contusion
(Sarani, 2019)
Transmission of blunt force trauma through the chest wall to the underlying lung parenchyma.
Pulmonary Contusion
Nursing intervention that helps the patient mobilize secretions more effectively
Vibratory PEP
(Smiths Medical, 2018)
This type of management is reserved for severe cases of non-unions, significant chest wall deformity/defect, or severe fail chest
Surgical fixation
1. ambulation
2. adequate fluids
3. utilization of multimodal pain management
4. limiting use of narcotics and using non-narcotic methods to help with pain
What can the unit nurse help the patient do to prevent pulmonary complications?
1. Ambulate
2. Use the I.S. or Vibratory PEP (at least 10x an hour while awake)
3. Cough & Deep Breathe
(EBSCO Dynamic Health, 2021b; Martin et al., 2019).
Adequate pain management in the rib fracture patient should focus on this type of approach.
Multimodal approach to pain
(Karlson & French, 2021; Legome, 2020; Martin et al., 2019; Sarani, 2020; Zhe et al., 2019)
Your patient demonstrated their I.S use to you once while you were in the room with them and was able to achieve 1500ml. What should the nurse’s next action be?
Have the patient demonstrate their I.S. use again a few more times in order to identify if they are able to consistently pull the same volume or even achieve a higher volume and document each shift. Documentation is necessary to see good and dangerous trends.
(EBSCO Dynamic Health, 2021b; Martin et al., 2019).
Physical examination presentation of a patient with flail chest
- Rapid, shallow respirations
- Tachycardia
- Asymmetric and uncoordinated thorax movement
(Harding, 2020)
5 interventions that nursing can do to help to prevent constipation.
1. ambulation
2. adequate fluids
3. use of multimodal pain management
4. limiting use of narcotics (instead using non-narcotic methods to help with pain)
5. Using bowel medications when needed
__________ a patient's use of their I.S. helps identify problems early and should stimulate potential need for more interventions to prevent complications.
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