NCLEX-RNPhysiological AdaptationEasy
A client arrives in the emergency department after a fall from a ladder with visible chest wall movement that is asymmetric, moving inward during inspiration and outward during expiration. The client is tachypneic with oxygen saturation of 88%. Which condition does the nurse suspect?
- APulmonary contusion
- BHemothorax
- CSimple pneumothorax
- DFlail chest
Show answer & explanationAnswer & explanation
Correct answer: D. Flail chest
Flail chest occurs when multiple adjacent ribs are fractured in two or more places, creating a free-floating segment that moves paradoxically inward on inspiration and outward on expiration, impairing ventilation and causing hypoxia.
Why the other options are wrong
- A. Pulmonary contusion causes hypoxia and crackles but not the characteristic paradoxical chest movement.
- B. Hemothorax presents with dullness to percussion and decreased breath sounds from blood accumulation, not paradoxical movement.
- C. Simple pneumothorax presents with decreased breath sounds and hyperresonance, not paradoxical chest wall movement.
Flail Chest
A segment of the chest wall becomes detached due to multiple rib fractures, causing paradoxical movement during breathing.
- Caused by 3+ adjacent ribs fractured in 2+ places
- Paradoxical movement impairs effective ventilation
- Often associated with underlying pulmonary contusion
- Treatment includes oxygen, pain control, and possible ventilatory support
Memory trick: Flail chest Flips the wrong way when you breathe