A client is admitted to the hospital with suspected rheumatic endocarditis. Which of the following laboratory tests would assist in confirming the diagnosis?

Choice A reason: Occasional bubbling in the water-seal chamber can indicate an air leak, which is not necessarily a sign of lung re-expansion. It could suggest that the lung has not fully re-expanded or that there is a persistent air leak.

Choice B reason: While the absence of pleuritic chest pain is a positive sign, it is not a definitive indicator of lung re-expansion. Pleuritic chest pain can subside even if the lung has not fully re-expanded.

Choice C reason: No tidaling in the water-seal chamber is a strong indicator that the lung has re-expanded. When the lung is fully expanded, it presses against the chest wall, eliminating the space where air could collect and thus stopping the water level from fluctuating with respiration.

Choice D reason: An oxygen saturation of 95% is within normal limits and suggests adequate oxygenation, but it does not specifically indicate lung re-expansion. Oxygen saturation can be maintained with supplemental oxygen or other supportive measures even if the lung has not fully re-expanded.

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.