Nursing Care Plan (NCP) for Blunt Chest Trauma

Patients with rib fractures tend to take more frequent, shallow breaths instead of steady, deep breaths. This is typically due to the pain on inspiration.

Shallow breaths can lead to atelectasis and pneumonia.

Patients with pulmonary contusions are at risk for developing excessive fluid and swelling within their lungs. This can impair oxygenation and gas exchange. Often this condition is worse on days 2-4, so we must monitor for possible decompensation.

Crackles or wheezes may be heard with pulmonary contusions or if the patient develops pneumonia.

Diminished breath sounds may be an initial indicator of the development of atelectasis

Patients are at risk for impaired oxygenation. We should support them with supplemental oxygen as needed, starting with the least invasive method (nasal cannula).

Pain can cause the patients to take more shallow breaths, which can lead to atelectasis. Addressing their pain can make it easier for them to take deep breaths and perform chest expansion exercises.

Splinting can help decrease the pain associated with deep breathing and coughing, especially for patients with rib fractures.

Incentive Spirometry and Deep breathing/coughing can help to open any collapsed alveoli and prevent further atelectasis. Incentive spirometry should be done every hour while awake.

Patients with pulmonary contusions may decompensate on days 2 – 4. If you feel your patient is getting worse, call a Rapid Response and advocate to get them transferred to a higher level of care if appropriate.