A client is admitted to the emergency department after sustaining multiple rib fractures in a motor vehicle accident. Upon assessment, the nurse notes that the client has flail chest. Which of the following signs and symptoms are associated with this condition? (Select all that apply.)
Bradycardia
Anxiety
Dyspnea
Unequal chest expansion
Paradoxical chest movement
Correct Answer : B,C,D,E,F
Choice A: Bradycardia Bradycardia, or a slower than normal heart rate, is not typically a direct symptom of flail chest. While traumatic injuries can lead to various cardiac responses, bradycardia is not commonly associated with the respiratory distress seen in flail chest. Flail chest is a serious condition that occurs when a segment of the rib cage breaks due to trauma and becomes detached from the rest of the chest wall. This can severely affect breathing and lead to other complications.
Choice B: Anxiety Anxiety is a common response in patients with flail chest due to the pain and difficulty in breathing associated with the condition. The stress of the injury and the body’s response to the trauma can lead to feelings of anxiety and panic.
Choice C: Dyspnea Dyspnea, or difficulty breathing, is one of the primary symptoms of flail chest. The instability of the chest wall and the paradoxical movement of the flail segment impair the normal mechanics of breathing, leading to shortness of breath.
Choice D: Unequal chest expansion Unequal chest expansion is a hallmark sign of flail chest. The affected area of the chest wall moves in the opposite direction to the rest of the chest during the respiratory cycle, which can be observed as an abnormal movement during inhalation and exhalation.
Choice E: Hypotension Hypotension, or low blood pressure, can occur in flail chest cases, especially if there is associated trauma such as bleeding or if the patient is in shock. The body’s response to the injury and the potential for compromised venous return due to the chest wall’s dysfunction can lead to hypotension.
Choice F: Paradoxical chest movement Paradoxical chest movement is a definitive sign of flail chest. It occurs when the broken section of the rib cage moves inward during inhalation and outward during exhalation, opposite to the normal chest movement. This is due to the loss of stability in the chest wall and is easily observable during a physical examination. Flail chest is a critical condition that requires immediate medical attention. The signs and symptoms associated with this condition include anxiety, dyspnea, unequal chest expansion, hypotension, and paradoxical chest movement. These symptoms reflect the underlying pathophysiology of the condition, which is the instability of the chest wall and the resulting impairment of normal respiratory function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E","F"]
Explanation
Choice A: Shortness of breath Shortness of breath can occur with a TAA due to the aneurysm compressing the trachea or the lung tissue. As the aneurysm enlarges, it can impinge on respiratory structures, leading to difficulty in breathing. A thoracic aortic aneurysm (TAA) is a bulging or dilation in the wall of the aorta as it passes through the chest cavity. TAAs can be life-threatening if they rupture or dissect and are often difficult to detect because they tend to grow slowly and usually do not cause symptoms until they become large or rupture.
Choice B: Difficulty swallowing Difficulty swallowing, or dysphagia, may be experienced if a TAA exerts pressure on the esophagus. This can happen when the aneurysm is located in the aortic arch, where the esophagus is in close proximity.
Choice C: Upper chest pain Upper chest pain is a common symptom of TAA and may be described as a deep, steady pain that can radiate to the back, neck, or jaw. The pain is caused by the stretching of the aortic wall and may be a warning sign of an impending rupture.
Choice D: Diaphoresis Diaphoresis, or excessive sweating, is not typically a direct symptom of a TAA. However, it can be associated with acute aortic syndromes, such as aortic dissection or rupture, which are medical emergencies.
Choice E: Cough A persistent cough can be a sign of a TAA, especially if the aneurysm is pressing against the trachea or bronchial tubes. The cough may sometimes produce blood if the aneurysm is causing erosion into these structures.
Choice F: Hoarseness Hoarseness can result from a TAA if the aneurysm compresses the recurrent laryngeal nerve, which controls the muscles of the voice box. This is known as Ortner’s syndrome or cardiovocal syndrome.
Correct Answer is A
Explanation
Choice A: Hyperglycemia The reason hyperglycemia is a risk when the prescribed dwell time is not maintained is due to the glucose present in the dialysate. The dialysate used in PD often contains glucose, which acts as an osmotic agent to facilitate fluid removal from the blood. If the dwell time is too short, there may not be enough time for the glucose to be absorbed, leading to higher levels of glucose in the blood. Conversely, if the dwell time is too long, excessive glucose absorption can occur, also leading to hyperglycemia. For patients with diabetes mellitus, maintaining the prescribed dwell time is essential to manage their blood glucose levels effectively. The normal range for fasting blood glucose is typically between 70 to 99 mg/dL, and for diabetes patients, maintaining blood glucose levels as close to the normal range as possible is crucial to prevent complications.
Choice B: Disequilibrium Syndrome Disequilibrium syndrome is characterized by neurological symptoms resulting from rapid changes in the composition of extracellular fluids during dialysis. This condition is more commonly associated with hemodialysis due to the rapid shifts that can occur with this modality. In PD, the risk of disequilibrium syndrome is significantly lower because the exchange of solutes and fluids is more gradual. Therefore, while important to consider, it is not the primary complication associated with the maintenance of dwell time in PD.
Choice C: Peritonitis Peritonitis, an infection of the peritoneal cavity, is a serious complication of PD but is not directly related to the duration of dwell time. It is typically caused by contamination during the exchange process or catheter-related infections. While proper technique and hygiene are critical in preventing peritonitis, the dwell time itself does not influence the risk of developing this infection.
Choice D: Hyperphosphatemia Hyperphosphatemia refers to elevated levels of phosphate in the blood and is a concern in patients with renal failure due to the kidneys’ inability to excrete phosphate effectively. The dwell time in PD may affect the removal of phosphate to some extent; however, it is not the primary concern related to the maintenance of dwell time. Phosphate binders and dietary restrictions are commonly used to manage phosphate levels in PD patients.
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