Rib fracture: Nursing

Definitions & Key takeaways

A rib fracture is a break or crack in one or more of the bones that make up the rib cage. Rib fractures can occur in one or more ribs as a result of direct trauma or repetitive injury. Risk factors include osteoporosis, engagement in contact sports, malignant bone tumors, and older age.

Symptoms of rib fractures include pain that gets worse with breathing, moving, coughing, or sneezing; as well as shallow breathing. Complications include damage to other internal organs from splintered ribs, pneumonia, or flail chest. The diagnosis involves history, physical assessment, chest X-ray, chest CT or bone scans. Some rib fractures can heal on their own, while others may require surgical stabilization of the displaced ribs.

Chapters:

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Introduction0:00–0:09

Rib fractures happen when one or more ribs break, and usually result from direct trauma or repetitive injury. Now, there are 12 ribs on each side of the chest, with each rib attaching posteriorly to the thoracic vertebrae, and ending anteriorly as costal cartilage.

Physiology0:09–0:59

There are three types of ribs: true, false, and floating ribs. The first seven pairs of ribs are true ribs, and they attach directly to the sternum through costal cartilages.
The 8th, 9th, and 10th pairs of ribs are false ribs, and they attach indirectly to the sternum through the costal cartilage of the 7th rib.
The last two pairs of ribs are called floating ribs because they don’t attach to the sternum at all. Now, the ribs form the side component of the thoracic cage, which provides support and protection for the thoracic structures, such as the heart, lungs, and blood vessels.
Other functions of ribs include increasing or decreasing the thoracic volume to facilitate breathing, in addition to providing attachment points for muscles.The main cause of rib fractures is direct trauma to the chest, which can be caused by falls, child abuse, and car crashes.

Causes & risk factors0:59–1:28

Rib fractures can also be caused by repetitive chest trauma, which might be due to recurrent cough or engagement in certain sports, such as golf or tennis.
Risk factors for rib fractures include modifiable ones, such as osteoporosis, engagement in contact sports, and malignant bone tumors involving the ribs; as well as non-modifiable ones, such as advanced age.Regardless of the cause, fractures typically happen in ribs four through ten, and can be associated with several complications.

Pathology1:28–2:28

A fractured rib that’s sharp, splintered, or displaced may damage or pierce nearby organs and tissues, such as the pleura or lungs, leading to pneumothorax, which is when there’s air from the injured lung leaking into the pleural cavity, and that doesn’t allow the lung on that side to expand properly.
This may lead to atelectasis or collapse of the alveoli in the lung. Since clients with rib fractures have trouble breathing or coughing up airway secretions, they are also at an increased risk of developing pneumonia.
In severe cases, the broken rib can tear the aorta, injure internal organs, such as the spleen, liver, or kidneys or damage the diaphragm.
Another complication is a flail chest, which is when three or more ribs fracture in two or more places, which can allow a big segment of the thoracic wall to move freely.
This is an extremely painful injury that impairs ventilation, and, as a consequence, blood isn’t properly oxygenated. Clients with rib fractures typically present with pain at the site of the fracture, which intensifies with breathing, moving, coughing, or even sneezing.

Clinical manifestations2:28–2:46

Some clients also splint, meaning that they support the area when deep breathing or coughing in an effort to limit chest movement and reduce pain.The diagnosis of rib fractures starts with the client's history and physical assessment, followed by a chest X-ray.

Diagnosis2:46–3:14

This can help look for complications, particularly pneumothorax, and sometimes also shows the site of fracture. A CT scan can also help detect the fractures missed on X-ray.
In cases of fractures resulting from repetitive trauma, a bone scan might also be useful. This is where a nuclear substance is injected into the body and then taken up by bones at the site of the fracture.
All right, now the treatment of rib fractures typically involves pain management, supplemental oxygen, as well as chest physiotherapy to prevent pneumonia.

Treatment3:14–3:45

With these measures, rib fractures typically heal on their own within six weeks. Clients with a complex fracture can be treated with rib-stabilization surgery, where plates and screws are used to stabilize the ribs while they heal.
Lastly, clients with severe or chronic pain may benefit from intercostal nerve block, where a local anaesthetic is injected around a nerve to temporarily block the sensation of pain Now, let's talk about nursing care of a client with a rib fracture.

Management and care3:45–4:59

Priority goals of nursing care include managing the client’s pain, as well as promoting adequate ventilation and clearing of secretions.
First, assist your client into a comfortable position, and help them promote lung expansion by encouraging them to take deep breaths, cough, and use their incentive spirometer while splinting the fracture area with their hands, arms, or a pillow.
Then assess your client’s respiratory status, including respiratory rate, depth, effort, breathing pattern, breath sounds, and oxygen saturation.
Report concerning assessment findings, like a respiratory rate below 12 or above 20 breaths per minute, an oxygen saturation below 92%, abnormal chest movement, or reduced or absent breath sounds; and administer supplemental oxygen therapy.
Next, perform a pain assessment, noting the onset, quality, severity, location, aggravating or relieving factors, and how frequently your client experiences pain.
Then administer the prescribed analgesics as needed, and apply an ice pack over the fracture site. If their pain is unrelieved with medication, report these findings to the healthcare provider, and be prepared to assist with intercostal nerve block administration.
All right, now let’s talk about client and family teaching. Remind your client that it will take several weeks for the ribs to heal, and instruct them on self-administration of their prescribed pain medication.

General client and family teaching4:59–6:14

Let them know that they can ease back into their regular activities, while avoiding anything that could put pressure on the injured area.
In addition, stress the importance of splinting, deep breathing, and coughing every hour to keep their lungs expanded. Instruct your client to contact their healthcare provider if their pain gets worse and prevents them from deep breathing, coughing, or engaging in their normal activities of daily living; and advise them to seek medical attention right away if they develop shortness of breath, fever, or if their cough produces mucus or blood.Finally, remind your client of the importance of preventing future fractures.
Teach them to promote bone health by following a balanced diet that includes protein, calcium, and vitamin D; and provide them with a list of dietary sources of calcium and vitamin D.
Also, stress the importance of instituting safety measures at home to prevent falls, including keeping walkways unobstructed, avoiding using throw rugs, and maintaining adequate lighting, as well as installing grab bars in their shower or bathtub, as needed; and lastly, prompt them to wear protective gear during sports.
All right, as a quick recap… Rib fractures occur in one or more ribs as a result of direct trauma or repetitive injury. Risk factors include osteoporosis, engagement in contact sports, malignant bone tumors, and older age.

Review6:14–7:17

Clinical manifestations of rib fractures include pain that gets worse with breathing, moving, coughing, or sneezing; as well as shallow breathing.
Complications include damage to other internal organs from splintered ribs, pneumonia, or flail chest. Rib fractures are diagnosed by client history, physical assessment, chest X-ray, chest CT or bone scans; and they typically heal on their own, but some clients may benefit from treatments like pain management, supplemental oxygen, chest physiotherapy, surgical stabilization of the displaced ribs, or intercostal nerve block.
Priority goals of nursing care are to manage pain, as well as promote adequate ventilation and clearing of secretions. Client and family teaching focuses on care at home, continuing to promote lung expansion, prevention of future fractures, and when to contact the healthcare