Which intervention should the nurse implement to help prevent atelectasis in a client with fractured ribs as a result of chest trauma?

Appeared in: BHU NO-2019

Explanation

Clients with rib fractures experience pain on inspiration, leading to shallow breathing (splinting).
Shallow breathing results in decreased lung expansion and pooling of secretions, increasing the risk of alveolar collapse (atelectasis).
Encouraging coughing and deep breathing exercises directly counteracts this by promoting full alveolar expansion and mobilizing secretions to keep airways clear.

Option A: Stopping pain medication is contraindicated. Uncontrolled pain is a primary reason for the shallow breathing that leads to atelectasis. Effective pain control is necessary to enable the patient to perform deep breathing exercises.
Option B: Applying a thoracic binder restricts chest wall expansion. This limitation on breathing depth directly increases the risk of atelectasis and pneumonia.
Option D: Positioning a client face-down (prone) on a soft surface can restrict chest and abdominal movement, making it harder to breathe deeply. It does not facilitate lung expansion in this context.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Atelectasis prevention in clients with rib fractures in acute care settings.
A nurse's primary role in managing rib fractures is to balance pain relief with the need for effective respiratory function. Failure to do so can lead to pneumonia, a life-threatening complication.
Patient education on splinting techniques (e.g., holding a pillow against the chest) is a critical nursing action that empowers the patient to participate in their own recovery while managing pain.
What if the patient refuses to cough due to severe pain despite oral analgesics? The nurse must escalate care by notifying the healthcare provider to explore alternative pain management, such as an intercostal nerve block or patient-controlled analgesia (PCA), to facilitate necessary lung expansion.

How to Approach the Question

First, identify the core problem: a patient with fractured ribs is at risk for a complication.
Next, identify the specific complication to be prevented: atelectasis.
Recall the pathophysiology of atelectasis in this context: pain from fractures leads to shallow breathing, which causes alveoli to collapse.
Evaluate each option based on its effect on lung expansion. The correct intervention must promote, not hinder, deep breathing.
Eliminate options that restrict breathing (binder) or fail to address the root cause (stopping pain meds, improper positioning).
Select the option that directly addresses the need for lung expansion and secretion clearance, which is encouraging coughing and deep breathing.

Concept Tested & Keywords

Concept Tested: Atelectasis prevention in clients with rib fractures
Stem keywords: atelectasis, fractured ribs, chest trauma
Lead-in keywords: prevent
Clinical cues: The patient has fractured ribs, which implies significant pain with breathing.
Negative lead-in flag: false

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Practise the full BHU NO-2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.