The client in a nursing home became confused and climbed out of bed (over the siderails) without assistance, falling onto a vacuum cleaner temporarily left there by the cleaning staff

Question

Which respiratory assessment finding indicates to the nurse that the client may have a flail chest as a result of this incident? A. Wheezes are present and are heard more loudly when the client inhales compared with what is heard on exhalation.
B. An area on the client's left chest is sucked in during inhalation and puffs out dur-ing exhalation.
C. The client is coughing copious amounts of frothy white sputum.
D. The client cannot speak more than six words between breaths.

Answer 1

B
Flail chest is the inward movement of the thorax during inspiration, with outward movement during expiration. It usually involves one side of the chest and results from multiple rib fractures caused by blunt chest trauma, leaving a segment of the chest wall loose. The movement of this loose segment becomes paradoxical to the expansion and contraction of the rest of the chest wall. It occurs more commonly in older adults who experience chest trauma.