The nurse assesses a client admitted for chest trauma who reports dyspnea. The nurse finds tracheal deviation and a pulse oximetry reading of 86%. What is the nurse's priority intervention?
a. Notify the health care provider and docu-ment the symptoms.
b. Intubate the client and prepare for me-chanical ventilation.
c. Administer oxygen and prepare for chest tube insertion.
d. Administer an intermittent posi-tive-pressure breathing treatment.
C
Blunt chest trauma can cause an air leak into the thoracic cavity, collapsing the lung on the side with the air leak (pneumothorax). More air enters the pleural space with each breath, increasing intrathoracic pressure on the affected side, moving the trachea to the unaffected side, and leading to decreased cardiac output. This condition (tension pneumothorax) is life threatening without intervention. The client will need oxygen administration right away and a chest tube inserted.
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