Lesson Objective for Nursing Care Plan: Blunt Chest Trauma:

Upon completion of this nursing care plan for Blunt Chest Trauma, nursing students will be able to:

• Understand the Mechanisms and Types of Blunt Chest Trauma:
  • Develop a comprehensive understanding of the mechanisms and types of blunt chest trauma, including the impact on various structures within the chest cavity and potential injuries to the thoracic organs.
• Recognize Signs and Symptoms of Blunt Chest Trauma:
  • Recognize and interpret the signs and symptoms associated with blunt chest trauma, such as chest pain, difficulty breathing, altered breath sounds, and potential life-threatening complications. Develop skills in conducting a focused assessment to promptly identify and prioritize interventions.
• Implement Immediate Interventions for Stabilization:
  • Demonstrate proficiency in implementing immediate nursing interventions to stabilize individuals with blunt chest trauma. This includes airway management, respiratory support, pain management, and monitoring for signs of respiratory distress or cardiovascular compromise.
• Collaborate in Multidisciplinary Care:
  • Develop collaboration skills to work effectively within a multidisciplinary healthcare team, including physicians, respiratory therapists, and radiologists, to provide comprehensive care for individuals with blunt chest trauma. Collaborate in the interpretation of diagnostic tests and implementation of treatment plans.
• Provide Patient and Family Education:
  • Provide education to patients and their families on the nature of blunt chest trauma, potential complications, and the importance of adherence to prescribed treatments. Empower individuals to recognize warning signs and seek timely medical attention.

Pathophysiology of Blunt Chest Trauma:

• Mechanical Compression and Deceleration Forces:
  • Blunt chest trauma results from mechanical compression and deceleration forces applied to the thoracic region. These forces can occur in various scenarios, such as motor vehicle accidents, falls, or direct blows to the chest.
• Rib Fractures and Chest Wall Injuries:
  • The impact of blunt force can lead to rib fractures and injuries to the chest wall. Fractured ribs can cause sharp edges to penetrate the pleural space, potentially damaging underlying structures.
• Pulmonary Contusions:
  • Blunt chest trauma may cause pulmonary contusions, which are bruised areas within the lung tissue. These contusions can impair gas exchange, leading to hypoxemia and respiratory distress.
• Injuries to Mediastinal Structures:
  • Severe blunt chest trauma can result in injuries to mediastinal structures, including the heart, great vessels, and esophagus. Disruption of these structures can lead to life-threatening conditions such as cardiac tamponade or aortic injury.
• Pneumothorax and Hemothorax:
  • Blunt force can cause the rupture of alveoli, leading to pneumothorax (air in the pleural space) or hemothorax (blood in the pleural space). These conditions can further compromise respiratory function and require prompt intervention.

Etiology of Blunt Chest Trauma:

• Motor Vehicle Accidents:
  • Motor vehicle accidents, including collisions and crashes, are a common cause of blunt chest trauma. Rapid deceleration or direct impact during accidents can lead to chest injuries.
• Falls:
  • Falls from heights or accidents involving a significant impact to the chest can result in blunt chest trauma. The force of the fall can cause injuries to the chest wall, ribs, and underlying thoracic structures.
• Assault or Physical Altercations:
  • Blunt chest trauma can occur as a result of physical altercations or assaults where direct blows to the chest are sustained. Intentional or accidental violence can lead to injuries such as rib fractures or contusions.
• Sports Injuries:
  • Certain sports activities, especially those with a high risk of collision or contact, can result in blunt chest trauma. Athletes may experience injuries such as rib fractures or contusions during play.
• Occupational Accidents:
  • Individuals involved in certain occupations, such as construction or manual labor, may be at an increased risk of blunt chest trauma due to workplace accidents involving heavy machinery, falling objects, or other occupational hazards.

Desired Outcomes for Blunt Chest Trauma Nursing Care Plan:

• Pain Management and Comfort:
  • Achieve effective pain management and comfort for the individual with blunt chest trauma, minimizing pain associated with rib fractures, chest wall injuries, and other traumatic conditions.
• Optimal Respiratory Function:
  • Ensure optimal respiratory function by addressing and resolving complications such as pulmonary contusions, pneumothorax, or hemothorax. Improve oxygenation and prevent respiratory distress.
• Stabilization of Cardiovascular Status:
  • Stabilize cardiovascular status by promptly identifying and managing injuries to mediastinal structures. Prevent and address conditions such as cardiac tamponade or aortic injury to maintain adequate blood circulation.
• Prevention of Complications:
  • Prevent complications associated with blunt chest trauma, such as infections, atelectasis, or respiratory failure. Implement measures to reduce the risk of secondary complications and promote overall recovery.
• Facilitate Psychological and Emotional Support:
  • Provide psychological and emotional support to the individual and their family. Assist in coping with the emotional impact of the traumatic event and facilitate communication about the recovery process.

Blunt Chest Trauma Nursing Care Plan

Nursing Assessment for Blunt Chest Trauma:

• Primary Survey and ABCs:
  • Conduct a rapid primary survey focusing on Airway, Breathing, and Circulation (ABCs). Ensure airway patency, assess respiratory rate and depth, and monitor circulation to identify and address life-threatening issues promptly.
• Focused Respiratory Assessment:
  • Perform a focused respiratory assessment to identify signs of respiratory distress, such as increased respiratory rate, use of accessory muscles, and diminished breath sounds. Monitor oxygen saturation and assess for chest wall movement.
• Pain Assessment:
  • Assess the individual’s pain using a pain scale and inquire about the location, intensity, and characteristics of chest pain. Evaluate the impact of pain on respiratory function and overall comfort.
• Chest Wall Examination:
  • Conduct a thorough examination of the chest wall, palpating for tenderness, swelling, or deformities. Assess for crepitus, which may indicate rib fractures, and monitor for signs of paradoxical chest movement.
• Cardiovascular Assessment:
  • Evaluate cardiovascular status by monitoring vital signs, assessing heart sounds, and checking for signs of hypovolemic shock or cardiovascular compromise. Detect any abnormalities related to injuries to the heart or great vessels.
• Neurological Assessment:
  • Perform a neurological assessment to evaluate the individual’s level of consciousness, orientation, and neurological function. Changes in mental status may indicate potential head or neurological injuries.
• Diagnostic Tests and Imaging:
  • Collaborate in obtaining and interpreting diagnostic tests and imaging studies, such as chest X-rays or CT scans, to identify and assess the extent of injuries to the chest structures.
• Psychosocial Assessment:
  • Conduct a psychosocial assessment to understand the emotional impact of the traumatic event. Identify coping mechanisms, support systems, and any signs of anxiety, fear, or emotional distress.

Nursing Interventions and Rationales

• Auscultate the patient’s lungs

• Administer supplemental O2 as needed

• Administer analgesics

• Educate the patient on the use of a pillow for splinting

• Educate the patient on chest expansion exercises:
  • Incentive Spirometry
  • Turn, Cough, Deep Breathe

• Advocate for a higher level of care if the patient decompensating

• Monitor chest tube, if in place

Patients with blunt chest trauma may need a chest tube inserted to treat a pneumothorax or hemothorax. Monitor the chest tube for air leaks, characteristics and amount of drainage. Assess the insertion site for signs of crepitus or infection.

Evaluation for Blunt Chest Trauma Care Management:

• Pain Management Effectiveness:
  • Evaluate the effectiveness of pain management interventions, assessing whether the individual’s reported pain is adequately controlled and whether there are improvements in comfort and respiratory effort.
• Respiratory Status:
  • Monitor and evaluate the individual’s respiratory status, including the resolution of complications such as pneumothorax, hemothorax, or pulmonary contusions. Assess for improved oxygenation, decreased respiratory distress, and overall respiratory function.
• Cardiovascular Stability:
  • Evaluate cardiovascular stability by monitoring vital signs and assessing for signs of hypovolemic shock or cardiovascular compromise. Ensure that interventions aimed at stabilizing cardiovascular status have been effective.
• Complication Prevention:
  • Assess the success of measures taken to prevent complications associated with blunt chest trauma, such as infections, atelectasis, or respiratory failure. Evaluate the effectiveness of preventive strategies and early interventions.
• Psychosocial Well-being:
  • Evaluate the individual’s psychosocial well-being by assessing their emotional response to the traumatic event and the support systems in place. Monitor for signs of psychological distress and ensure appropriate referrals for counseling or support services.

References

• http://www.trauma.org/archive/thoracic/bluntthoracic.html
• Mancini, M. (2017). Blunt chest trauma. Retrieved from
• Unsworth, A., Curtis, K., & Asha, S. E. (2015). Treatments for blunt chest trauma and their impact on patient outcomes and health service delivery. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23, 17.