NSG 229 Exam 2 With
Complete Solution
Blunt Trauma - ANSWER Striking or being struck by an object
Appears minor
Penetrating Trauma - ANSWER Foreign object impales or passes through the
body
Open wound
Chest Injuries - ANSWER Pulmonary contusion
Rib fracture
Flail chest
Pneumothorax
Hemothorax
Tracheobronchial trauma
Chest Trauma Assessment/Findings - ANSWER Respiratory: dyspnea, cough,
hemoptysis, tracheal deviation, diminished breath sounds, hypoxemia
Cardiac: rapid thready pulse, hypotension, muffled heart sounds, asymmetric
blood pressure, narrowed pulse pressure
Skin: bruising, abrasions, wound, hypoxia, cyanosis, asymmetric chest
movement, subcutaneous emphysema
,Chest Trauma Initial Assessment - ANSWER Monitor & apply oxygen
SpO2 > 90%
IV access and fluid resuscitation
Remove clothing
Apply occlusive dressing
Stabilize impaled objects (DO NOT REMOVE)
Needle decompression: midclavicular line, 2nd/3rd intercoastal space
Pulmonary Contusion - ANSWER Bruise of the lung without puncture caused
by chest trauma
Capillary damage causes blood/fluids to seep into lung tissue
Pulmonary Contusion Signs & Symptoms - ANSWER Asymptomatic (early)
Respiratory failure
Hemoptysis
Diminished breath sounds
Crackles
Wheezes
Tachycardia
Tachypnea
Dry cough
Dullness to percussion
, Bruising over injury site
Pulmonary Contusion Diagnostics - ANSWER Visual assessment
Chest x-ray
Pulmonary Contusion Treatment - ANSWER Focused on maintaining
ventilation and oxygenation
Nursing Interventions: IV fluids, High fowler's or good lung down, frequent
respiratory assessment, prevent ARDS
Rib Fracture Signs & Symptoms - ANSWER Pain with movement
Splints chest defensively
Shallow breathing
Rib Fracture Complications - ANSWER Deep chest injury with poor prognosis
(if injury), 1st or 2nd rib, flail chest, > 7 ribs fractured
Pulmonary contusion
Pneumothorax
Hemothorax
Rib Fracture Treatment - ANSWER Uncomplicated rib fractures: ribs unite
spontaneously, chest usually not splinted
Pain: intercostal nerve block, patient-controlled analgesia
Rib Fracture Nursing Considerations - ANSWER Maintain ventilation and
decrease pain
Administer pain medications as ordered
Complete Solution
Blunt Trauma - ANSWER Striking or being struck by an object
Appears minor
Penetrating Trauma - ANSWER Foreign object impales or passes through the
body
Open wound
Chest Injuries - ANSWER Pulmonary contusion
Rib fracture
Flail chest
Pneumothorax
Hemothorax
Tracheobronchial trauma
Chest Trauma Assessment/Findings - ANSWER Respiratory: dyspnea, cough,
hemoptysis, tracheal deviation, diminished breath sounds, hypoxemia
Cardiac: rapid thready pulse, hypotension, muffled heart sounds, asymmetric
blood pressure, narrowed pulse pressure
Skin: bruising, abrasions, wound, hypoxia, cyanosis, asymmetric chest
movement, subcutaneous emphysema
,Chest Trauma Initial Assessment - ANSWER Monitor & apply oxygen
SpO2 > 90%
IV access and fluid resuscitation
Remove clothing
Apply occlusive dressing
Stabilize impaled objects (DO NOT REMOVE)
Needle decompression: midclavicular line, 2nd/3rd intercoastal space
Pulmonary Contusion - ANSWER Bruise of the lung without puncture caused
by chest trauma
Capillary damage causes blood/fluids to seep into lung tissue
Pulmonary Contusion Signs & Symptoms - ANSWER Asymptomatic (early)
Respiratory failure
Hemoptysis
Diminished breath sounds
Crackles
Wheezes
Tachycardia
Tachypnea
Dry cough
Dullness to percussion
, Bruising over injury site
Pulmonary Contusion Diagnostics - ANSWER Visual assessment
Chest x-ray
Pulmonary Contusion Treatment - ANSWER Focused on maintaining
ventilation and oxygenation
Nursing Interventions: IV fluids, High fowler's or good lung down, frequent
respiratory assessment, prevent ARDS
Rib Fracture Signs & Symptoms - ANSWER Pain with movement
Splints chest defensively
Shallow breathing
Rib Fracture Complications - ANSWER Deep chest injury with poor prognosis
(if injury), 1st or 2nd rib, flail chest, > 7 ribs fractured
Pulmonary contusion
Pneumothorax
Hemothorax
Rib Fracture Treatment - ANSWER Uncomplicated rib fractures: ribs unite
spontaneously, chest usually not splinted
Pain: intercostal nerve block, patient-controlled analgesia
Rib Fracture Nursing Considerations - ANSWER Maintain ventilation and
decrease pain
Administer pain medications as ordered
