Use appropriate delivery method (nasal cannula, face mask, non-rebreather) based on severity of hypoxemia.

Rationale: Supplemental oxygen increases the oxygen concentration in the alveoli, improving diffusion across the alveolar-capillary membrane and enhancing tissue oxygenation.

Position patient with uninjured lung down when unilateral injury is present, if not contraindicated.

Rationale: Positioning uses gravity to optimize blood flow to the uninjured lung, improving the match between ventilation and perfusion.

Perform or assist with postural drainage, percussion, and vibration as appropriate.

Rationale: Chest physiotherapy helps mobilize secretions, prevent atelectasis, and improve ventilation in functional lung tissue.

Assist with intubation and initiation of mechanical ventilation for severe respiratory failure.

Rationale: Mechanical ventilation provides respiratory support when patient’s spontaneous breathing is inadequate to maintain gas exchange, allowing time for healing.

Give bronchodilators, mucolytics, or diuretics as ordered to improve ventilation and reduce pulmonary edema.

Rationale: Pharmacological therapy addresses specific underlying causes of impaired gas exchange, such as bronchospasm, thick secretions, or fluid overload.

Ensure proper functioning of chest drainage systems to evacuate air or fluid from pleural space.

Rationale: Properly functioning chest tubes allow re-expansion of the lung by removing accumulated air or fluid, improving ventilation and gas exchange.

Schedule regular sessions (e.g., every 1-2 hours while awake) for deep breathing exercises.

Rationale: Deep breathing promotes alveolar expansion, prevents atelectasis, and improves gas exchange by recruiting more functional alveolar units.

Give pain medications on schedule rather than PRN for severe pain, transitioning to PRN as pain improves.

Rationale: Scheduled administration maintains therapeutic blood levels of medication, providing more consistent pain control. This is especially important for chest injuries where pain can significantly impair breathing.

Prepare for and support regional anesthesia techniques such as intercostal nerve blocks, thoracic epidural analgesia, or paravertebral blocks.

Rationale: Regional anesthesia techniques provide excellent pain control while minimizing systemic side effects of opioids. They have been shown to improve pulmonary outcomes in patients with chest wall injuries.

Instruct patient to hold a pillow or folded blanket firmly against the chest when coughing or moving.

Rationale: External support of the injured area reduces movement of fractured ribs and decreases pain during necessary respiratory maneuvers.

Assist in finding positions that minimize pain while still allowing optimal respiratory function.

Rationale: Proper positioning can reduce strain on injured areas while maintaining good chest expansion.

Use cold therapy for 15-20 minutes every 2-3 hours during the acute phase.

Rationale: Cold therapy reduces inflammation, tissue edema, and pain sensation by decreasing nerve conduction and muscle spasm.

Teach and encourage relaxation techniques, guided imagery, distraction, and controlled breathing.

Rationale: Non-pharmacological approaches activate the body’s internal pain modulation systems and can enhance the effectiveness of medications.

Administer pain medication 30 minutes before activities like dressing changes, chest physiotherapy, or ambulation.

Rationale: Anticipatory pain management improves participation in necessary activities and prevents pain escalation, which is harder to control.

Use sterile technique for all invasive procedures, dressing changes, and chest tube management.

Rationale: Aseptic technique prevents cross-contamination and introduction of pathogens to susceptible sites, reducing infection risk.

Clean wounds according to protocol, change dressings as needed, and assess healing progress.

Rationale: Proper wound care removes contaminants, promotes healing, and allows early detection of infection.

Ensure secure connections, proper positioning, and sterile occlusive dressings at insertion sites.

Rationale: Maintaining a closed, sterile system reduces the risk of external contamination and subsequent infection.

Encourage deep breathing, effective coughing techniques, and incentive spirometry to clear secretions.

Rationale: Respiratory hygiene prevents stasis of secretions that can serve as a medium for bacterial growth, reducing the risk of pneumonia.

Give antibiotics at scheduled times and monitor for effectiveness and adverse effects.

Rationale: Prophylactic antibiotics may be indicated for penetrating chest trauma, open pneumothorax, or following surgical interventions to prevent infection.

Perform hand hygiene before and after patient contact and encourage all healthcare providers and visitors to do the same.

Rationale: Hand hygiene is the single most important practice for preventing healthcare-associated infections.

Ensure adequate protein, calorie, vitamin, and mineral intake to support immune function and healing.

Rationale: Proper nutrition supplies the resources necessary for optimal immune function and tissue repair.

Administer IV fluids or blood products as prescribed to restore circulating volume in hypovolemia; restrict fluids if cardiac tamponade or heart failure is present.

Rationale: Adequate preload is essential for cardiac output. Hypovolemia requires volume replacement, while excess fluid can worsen cardiac tamponade or heart failure.

Place in supine position with legs elevated for hypovolemia; elevate head of bed for cardiac tamponade or heart failure.

Rationale: Positioning affects venous return. Trendelenburg position increases preload in hypovolemia, while semi-Fowler’s position decreases preload when indicated.

Gather equipment, assist provider, monitor patient during and after procedure for cardiac tamponade.

Rationale: Pericardiocentesis removes fluid from the pericardial sac, relieving pressure on the heart and restoring cardiac filling and output in cardiac tamponade.

Give inotropes, chronotropes, antiarrhythmics, or vasopressors as ordered based on the underlying cardiac dysfunction.

Rationale: Pharmacological support can improve contractility, normalize heart rate, or restore rhythm to improve cardiac output.

Ensure proper chest tube function to evacuate blood from hemothorax or air from pneumothorax, relieving pressure on the heart and great vessels.

Rationale: Properly functioning chest tubes allow lung re-expansion and decrease intrathoracic pressure, improving venous return and cardiac filling.

Administer supplemental oxygen to ensure adequate oxygenation of myocardial tissue.

Rationale: Optimal oxygenation improves myocardial function and prevents further injury from hypoxia, particularly important with myocardial contusion.

Ready patient for emergent thoracotomy or sternotomy for severe cardiac or great vessel injuries.

Rationale: Immediate surgical intervention may be necessary to repair injuries to the heart or great vessels, control bleeding, or relieve tamponade that cannot be managed by pericardiocentesis.

Use calm, reassuring approach, active listening, and demonstrate genuine concern.

Rationale: A therapeutic relationship builds trust and provides emotional safety, helping to reduce anxiety and fear.

Explain procedures, treatments, and patient’s condition in understandable terms.

Rationale: Knowledge reduces fear of the unknown and gives patients a sense of control, which can significantly reduce anxiety.

Instruct in deep breathing, progressive muscle relaxation, guided imagery, or mindfulness practices.

Rationale: Relaxation techniques activate the parasympathetic nervous system, counteracting the physiological stress response and reducing anxiety symptoms.

Reduce unnecessary noise, limit visitors if overwhelming, adjust lighting, and minimize disruptions when possible.

Rationale: Environmental factors can significantly impact anxiety levels. A calm, controlled environment promotes relaxation and reduces sensory overload.

Provide opportunities for patient to verbalize fears, concerns, and questions.

Rationale: Expressing emotions rather than suppressing them can reduce anxiety and help the patient process their experience.

Give anti-anxiety medications when indicated, monitoring for effectiveness and side effects.

Rationale: Pharmacological management may be necessary when anxiety is severe or interfering with necessary treatments and procedures.

Encourage family presence if comforting to patient and include them in education and support plans.

Rationale: Family support can provide emotional security and help the patient cope with anxiety and stress.

Advance activity gradually from bed mobility to sitting edge of bed, to standing, to ambulation as tolerated.

Rationale: Progressive mobility prevents deconditioning, improves respiratory function, and promotes psychological well-being while allowing monitoring of tolerance.

Administer prescribed analgesics 30 minutes before planned activity or therapy sessions.

Rationale: Preemptive pain control facilitates movement, reduces fear of pain, and encourages participation in mobility activities.

Use proper stabilization techniques for chest tubes while moving, ensuring collection systems remain below insertion sites.

Rationale: Proper management of tubes and drains prevents accidental dislodgement, tissue trauma, or air entry while enabling safe mobility.

Instruct patient to support chest with pillow or hands during movement and position changes.

Rationale: Splinting provides support to painful or unstable chest areas, reducing discomfort and increasing confidence with movement.

Implement physical therapy recommendations for strengthening, range of motion, and safe mobility exercises.

Rationale: Physical therapy provides specialized assessment and interventions to maximize recovery of mobility and function.

Use pulse oximetry to assess oxygenation before, during, and after mobility activities.

Rationale: Oxygen saturation monitoring ensures activity does not compromise respiratory status and guides appropriate activity pacing.

Assist with repositioning at least every 2 hours to prevent complications of immobility.

Rationale: Regular position changes prevent pressure injuries, promote pulmonary toilet, and maintain joint mobility even when ambulatory activity is limited.

Implement postural drainage, percussion, and vibration appropriate to patient condition.

Rationale: Chest physiotherapy helps mobilize secretions from peripheral airways to central airways where they can be more easily expectorated.

Instruct in controlled coughing, quad coughing, or huff coughing while splinting chest.

Rationale: Proper coughing techniques maximize effectiveness while minimizing pain and energy expenditure, facilitating removal of secretions.

Administer analgesics before airway clearance activities to reduce pain with coughing.

Rationale: Adequate pain control allows for deeper breathing and more effective coughing, improving secretion clearance.

Ensure fluid intake of at least 2-3 liters daily unless contraindicated.

Rationale: Proper hydration thins secretions, making them easier to mobilize and expectorate.

Instruct and assist with incentive spirometry every 1-2 hours while awake.

Rationale: Incentive spirometry promotes deep breathing, prevents atelectasis, and improves lung expansion, which helps mobilize secretions.

Place patient in positions that facilitate drainage from affected lung segments based on injury location.

Rationale: Strategic positioning uses gravity to assist in moving secretions from smaller airways to larger airways for easier clearance.

Give bronchodilators, mucolytics, or expectorants as ordered.

Rationale: Pharmacological agents can reduce bronchospasm, thin secretions, or stimulate expectoration, improving airway clearance.

Explain type of injury, expected healing process, and approximate timeline in simple terms.

Rationale: Understanding the nature of the injury and recovery process establishes realistic expectations and reduces anxiety about the unknown.

Demonstrate deep breathing, incentive spirometry, controlled coughing, and splinting techniques.

Rationale: Proper respiratory techniques prevent pulmonary complications and promote healing. Demonstration and return demonstration ensure understanding and correct technique.

Explain pain medication regimen, non-pharmacological pain management techniques, and proper reporting of pain.

Rationale: Effective pain management improves respiratory function, mobility, and overall recovery. Understanding pain management options empowers the patient to participate actively in care.

Provide clear guidelines on activity limitations, lifting restrictions, and gradual return to normal activities.

Rationale: Clear understanding of activity guidelines prevents complications from overexertion while encouraging appropriate mobility for optimal recovery.

Teach recognition of increased pain, fever, shortness of breath, coughing up blood, or chest tube site changes.

Rationale: Early recognition of complications allows for prompt intervention, preventing serious adverse outcomes.

Supply printed information at appropriate reading level, with visual aids when possible.

Rationale: Written materials reinforce verbal education and serve as a reference after discharge when questions arise.

Involve support persons in teaching sessions, particularly for patients who may need assistance at home.

Rationale: Family involvement increases adherence to treatment plans and provides an additional resource for the patient during recovery.

Use recommended securing method with sutures, tape, and dressing; coil excess tubing on bed, not hanging.

Rationale: Proper securing techniques prevent accidental dislodgement, which could cause pneumothorax, subcutaneous emphysema, or infection.

Keep bed in low position, side rails up as appropriate, call bell within reach, and use fall risk alerts.

Rationale: Standard fall prevention measures reduce risk of trauma, especially important for patients on pain medications or with limited mobility due to chest injury.

Help with position changes, transfers, and ambulation; use gait belt when walking.

Rationale: Appropriate assistance prevents falls and ensures chest tubes remain undisturbed during movement.

Instruct patient to move drainage system when changing position and keep it below chest level.

Rationale: Patient education regarding chest tube management increases safety and prevents complications when staff are not present.

Remove obstacles, secure cords and tubing, ensure adequate lighting, particularly at night.

Rationale: A clear, well-organized environment reduces trip hazards and potential for trauma.

Maintain vigilant assessment for signs of deterioration or complications requiring intervention.

Rationale: Early detection of complications allows for prompt intervention before serious injury occurs.

Provide clear instructions on lifting limitations, avoiding strenuous activity, and protecting chest wall.

Rationale: Understanding activity restrictions prevents reinjury to healing tissue and ensures compliance with safety precautions.

Provide supplemental oxygen via appropriate delivery method to maintain saturation ≥95%.

Rationale: Supplemental oxygen increases arterial oxygen content, improving tissue oxygenation and cardiopulmonary function, particularly in patients with impaired gas exchange.

Administer IV fluids and blood products as prescribed for hypovolemia from hemothorax.

Rationale: Adequate intravascular volume is essential for tissue perfusion. Blood component therapy restores oxygen-carrying capacity and clotting factors in patients with significant blood loss.

Place in semi-Fowler’s position (30-45 degrees) unless contraindicated.

Rationale: Semi-Fowler’s position decreases oxygen demand, improves ventilation-perfusion matching, and reduces cardiac workload.

Administer prescribed medications to improve cardiac output (inotropes, chronotropes, vasopressors).

Rationale: Pharmacological support can improve contractility, maintain adequate blood pressure, and enhance cardiac output and tissue perfusion.

Ensure chest drainage system functions properly to evacuate blood or air from pleural space.

Rationale: Functioning chest tubes allow lung re-expansion, improving ventilation and gas exchange, which enhances tissue perfusion.

Be ready for pericardiocentesis, chest tube insertion, or thoracotomy if condition deteriorates.

Rationale: Rapid intervention for cardiac tamponade, tension pneumothorax, or massive hemothorax can be life-saving when tissue perfusion is critically compromised.

Evaluate changes in perfusion indicators following interventions and adjust care accordingly.

Rationale: Ongoing assessment of treatment effectiveness allows for timely adjustments to the plan of care to optimize tissue perfusion.

Administer prescribed analgesics approximately 30 minutes before bedtime.

Rationale: Pain is a significant barrier to sleep. Proactive pain management before sleep onset helps maintain comfort throughout the night and reduces awakenings.

Reduce noise, dim lights, maintain comfortable room temperature, and minimize disruptions.

Rationale: Environmental factors significantly impact sleep quality. Modifying the environment can promote natural sleep onset and maintenance.

Use pillows for support, elevate head of bed 30-45 degrees, and secure chest tubes to prevent pulling.

Rationale: Proper positioning reduces discomfort from chest injury and prevents tension on chest tubes, allowing for more restful sleep.

Organize nursing interventions to allow for uninterrupted sleep periods of at least 90 minutes.

Rationale: Clustering care minimizes disruptions and allows patients to complete full sleep cycles, improving sleep quality.

Instruct in progressive muscle relaxation, deep breathing, guided imagery, or meditation.

Rationale: Relaxation techniques reduce anxiety and muscle tension, promoting the physiological state necessary for sleep onset.

Reduce fluid intake in evening hours and ensure patient voids before bedtime.

Rationale: Managing fluids helps prevent nighttime awakenings for urination, allowing for longer uninterrupted sleep periods.

Give prescribed sleep aids as appropriate, monitoring for effectiveness and side effects.

Rationale: Pharmacological sleep aids may be beneficial when non-pharmacological approaches are insufficient, but should be used cautiously due to potential respiratory depression in chest injury patients.