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a break in a bone of the thoracic skeleton caused by a blow or crushing injury or by violent coughing or sneezing. It may also be a pathological fracture secondary to metastatic disease. The ribs most commonly broken are the fourth to eighth; if the bone is splintered or the fracture is displaced, sharp fragments may pierce the lung, causing hemothorax or pneumothorax.
observations The patient with a fractured rib suffers pain, especially on inspiration, and usually breathes rapidly and shallowly. The site of the break is generally very tender to the touch, and the crackling of bone fragments rubbing together may be heard on auscultation. Breath sounds may be absent, decreased, or accompanied by rales and rhonchi. The location and nature of the fracture are determined by chest x-ray studies. The patient is observed for signs of hemoptysis, hemothorax, flail chest, atelectasis, pneumothorax, and pneumonia.
interventions Fractured ribs may be splinted with an elastic belt or bandage or adhesive strapping. To prevent irritation, the area may be shaved and painted with tincture of benzoin before the adhesive tape is applied. Increasingly, however, no splints are used, because they compromise chest expansion and predispose the patient to pulmonary complications. If hospitalization is required, the patient is placed in a semi-Fowler's position, and the blood pressure, pulse, temperature, respirations, and breath sounds are checked every 2 to 4 hours. An analgesic may be ordered, but morphine sulfate is avoided because it depresses respiration. If strapping and analgesic medication fail to relieve pain, the physician may perform a regional nerve block by infiltrating the intercostal spaces above and below the fracture site with 1% procaine.
nursing considerations The nurse assists in splinting the chest, administers the ordered medication, helps the patient to turn, and instructs the patient in how to perform deep breathing, coughing, and range-of-motion exercises of the extremities.