Nursing Management or Care Plan of Chest Trauma

Definition of Chest Trauma:

A chest trauma or injury is any form of physical injury to the chest including the ribs, heart and lungs. Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused by blunt mechanisms such as motor vehicle collisions or penetrating mechanisms such as stabbings.

Nursing Management of Chest Trauma:

Nursing Assessment:

1. Assess for history of the injury.
2. Assess presences of signs and symptoms of impaired respiratory function (dyspnea, chest pain, asymmetric chest movements, signs of paradoxical breathing, cyanosis, anxiety, bloody sputum).
3. Assess chest wall for presence of wounds and fractures.
4. Assess signs of increased intra-thoracic pressure (mediastinal shift, trachea shift, progressive signs of respiratory and cardiovascular insufficiency).
5. Lung auscultation shows diminution or absence of breathing sounds on the affected side.
6. Assess vital signs, CVP, ECG, fluid balance.
7. Assess diagnostic tests and procedures for abnormal values (chest x-ray, CT, pleural puncture).

Nursing Diagnosis of Chest Trauma:

1. Increased risk of hypoxia and respiratory failure related to injury.
2. Increased risk of hypovolemia and shock related to hemorrhage and impaired cardiac function.
3. Pain related to injury.
4. Anxiety related to the symptoms of disease and fear of death.

Nursing Plan and Interventions:

Goal:

1. Maintain respiratory and cardiovascular function.
2. Prevent avoidable injury and complications.
3. Then surgical intervention prescribed, prevent postoperative complications.
4. Relief or diminish symptoms.
5. Decreased anxiety with increased knowledge.

Nursing Interventions of Chest Trauma:

1. Assess, report, and record signs and symptoms and reactions to treatment.
2. Observe respiratory status, closely, report immediately if changed.
3. Monitor vital signs, fluid balance, and level of consciousness closely.
4. Administer oxygen and other medications as prescribed, monitor for side effects.
5. Maintain patency of chest tubes; observe appropriate connections and presence of negative pressure in system.
6. Administer blood transfusions and IV therapy as prescribed, monitor for side effects.
7. Place client in the high-Fowler position then has chest injury, on a side of the chest tube insertion then hemothorax presents to provide drainage.
8. Monitor laboratory tests results for abnormal values.
9. Prepare client and his family for surgical intervention.
10. For client after surgical intervention provide postoperative care and observe possible postoperative complications.
11. Encourage the client to turn and cough and breathe deeply.
12. Observe signs of possible secondary pulmonary infection, report immediately.
13. Provide appropriate skin care to prevent pressure sores.
14. Provide emotional support to client; explain all procedures to decrease anxiety and to obtain cooperation.
15. Instruct client regarding disease, diagnostic procedures, treatment and its complications, home care, daily activities, restrictions and follow-up.

Evaluation:

1. Maintain adequate respiratory function and gas exchange.
2. Tolerates progressive activity, verbalize reduction in anxiety and pain.
3. No evidence of complications.
4. Maintains stable vital signs, fluid balance, and nutritional state.
5. Laboratory tests results shows no abnormalities.
6. Demonstration of understanding of situation, diagnostic and treatment procedures, and need for follow-up.

Discharge and Home Healthcare Guidelines:

1. Review all follow-up appointments, which often involve chest x-rays, arterial blood gas analysis, and a physical exam. If the injury was alcohol-related, explore the patient’s drinking pattern.
2. Refer for counseling, if necessary. Teach the patient when to notify the physician of complications (infection, an unhealed wound, and anxiety)> and to report any sudden chest pain or difficulty breathing.

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”