INTRODUCTION: - My client name was Mr. Manoj, he was came to the Dr.

Bhimrao Ambedker
hospital on 4/09/2023, with the complaints of a chest contusion and bruise, is caused by a RTA and direct
blow to the chest. A very forceful blow to the chest can also injured the heart or blood vessels in the chest
and ribs fracture, the lungs, the airway, the liver, or the spleen. So client is having severe chest pain, blood in
vomiting, breathing difficulty, coughing in blood, fever, decrease urine output, immobility and loss of
appetite. Doctor has seen the client in trauma unit, client’s general condition was poor & after investigation
& examination he was diagnosed blunt chest injury and abdomen injury with right hydropneumothorax.

PROFILE OF THE CLIENT

Name of client : Mr. Manoj
Age/Sex : 27 yr/male
IP No. : 232909345
Date of admission : 4/09/2023
Unit/ward : 20 surgical ward
Religion : Hindu
Education : 5th class
Occupation : Farmer
Income : 10000/month
Diagnosis : Blunt chest and abdomen injury with right hydropneumothorax
Name of surgery : Right side Inter Costal Drainage insertion
Date of surgery : 5/09/2023
Post of day : 01
Address : Durgahan C.G.
Date of care started : 4/09/2023
Date of care ended : 9/09/2023

CHIEF COMPLAINTS:-
My client present chief complains of a right side chest contusion, ribs fracture and bruise, is caused by a
RTA and direct blow to the chest can also injured the heart or blood vessels in the chest and ribs , the lungs,
the airway, the liver, or the spleen. So client is having severe chest pain, blood in vomiting, breathing
difficulty, coughing in blood, fever, decrease urine output, immobility and loss of appetite.

HEALTH HISTORY:-
Past medical history: - As per the history given by patient and his attainder, Road Traffic Accident where
the 2 wheeler he was travelling and hit to the tree beside the road on 4/09/2022 at around 12:00pm near
Kondagaon than patient developed pain in right groin and right side chest.

Present medical history:- My client name was Mr. Manoj, he was came to the Dr. Bhimrao Ambedker
hospital on 4/09/2023, with the complaints of a severe chest pain, blood in vomiting, breathing difficulty,
decrease urine output, immobility and loss of appetite because of chest contusion and bruise, is caused by a
RTA and direct blow to the chest. A very forceful blow to the chest can injure the heart or blood vessels in
the chest and ribs fracture, the lungs, the airway, the liver, or the spleen. Doctor has seen client in male
surgical ward 20, client’s general condition was poor & after investigation & examination he was diagnosed
blunt chest and abdomen injury with right hydropneumothorax. After that investigation treatment advice
some medication inj- meropenum 500mg, inj- tramadol, inj- zofer, inj- aciloc, tab- MVBC, inj- deriphyllin
and Nebulization .

Past surgical history:- ago 1 Year in my client had done surgery right side Inter Costal Drainage insertion
on 30/08/2022 in jagdalpur medical college after Road Traffic Accident .
Present surgical history:- my client had done surgery right side Inter Costal Drainage tube reinsertion on
5/09/2023,

Pre-operative care:-
 Prepare patient mentally, physically and financial for the surgery.
 Provide psychological support and health education for reducing anxiety regarding surgery.
 Prepare body part, xylocaine test, inj- T.T.
 Written consent by the patient and their attendar.
 Remove all metal and jewellery item to prevent infection.
 Collect all diagnostic test for better indication and prevent any complication.
 Patient wear OT dress and patient shifted to OT

Intra-operative care:-
 Patient shifted in OT table.
 General anaesthesia given by anaesthetist
 Monitoring and start I/V fluid
 Clean the surgical area with betadine solution and spirit
 A midline skin incision was made extending from xiphistarum to 2cm below the umbilicus
 Incision deepened through layers, peritoneum was opened
 Whole of the bowel examined and 0.5×0.5cm perforation was found in the ante mesenteric border 1
½ feet proximal IC junction.
 Double layered primary repair of the perforation done using PDS- 3.0
 Two ADK were placed one in sub hepatic space and another in pelvic cavity
 Hemostair achieved well count were checked
 Inner skin was closed using vicryl 1-0
 External skin was closed using ethilon 2-0
 Sterile dressing applied
 Re assess the patient vital parameter
 Patient shifted to surgical ward 20

Post-operative care:-
 Check patient general condition and vital sign
 Check surgical site any bleeding, swelling, pain and any linkage of drain
 Proper care of surgical wound for prevent any infection or pus formation of surgical wound
 Proper sterile dressing every 2nd day
 Give antibiotic for earlier healing for wound and prevent for any infection
 Avoid more pressure in surgical site because of risk for opening of wound
 Provide health education about care of surgical wound

FAMILY HISTORY:-
Family health history:- my client Mr. Manoj was suffer to blunt chest injury and my client other family
member are healthy, No any history of hereditary disease like systemic illness (DM, hypertension, asthma,
convulsion, malignancies), communicable disease, psychiatric disease, cardiovascular disease and congenital
disorders.
 Pedigree chart:-

Male

27 yr. /M 25 yr./F
Mr. Manoj
Rakhi
Female

5 yr. /M 2 yr. /F Patient

Ravi ramsiya

FAMILY COMPOSITION:-
Name of the Relationship Age/Sex Educational Occupation Marital Health Status
Family with Patient Status al Status Status
Member
Mr. Manoj Self 27 yr./M 5th Farmer Married Blunt chest injury
Rakhi bai wife 25 yr./F Illiteracy House wife Married Healthy
Ravi Son 5 yr./M 1st class Student Unmarried Healthy
Ramsiya Daughter 2 yr./F Unmarried Healthy

PERSONAL HISTORY:-

1. HABITS:-
 Smoking: My client has no habits of smoking.
 Tobacco chewing: - No habits of tobacco chewing.
 Alcohol: No habits of drinking alcohol.
 Drug addict (specify): No any harmful drugs addiction of my client such a sedative drug.

2. DIET:-
 Vegetarian: My client is a vegetarian.
 No. of meals per day: normally 3 times take meal per day but now my client is on liquid diet only
time.
 Any allergic to any food items: No any allergy.

3. SLEEP AND REST PATTERN:-

 Timing of sleep: - disturb sleeping pattern due to chest pain only 3 hr sleeping in night time.
 Timing of rest: - only 2hr rest in day time because of discomfort and pain in surgery site.

4. ACTIVITIES OF DAILY LIVING (ADLS):-

 Taking care and himself/herself: - unable to self care and activities.
 Needs assistance: require some assistance for daily activities and care .
 Any problems with ADL: my client unable to move self activity and impaired mobility due to
fracture pelvic reason.
  Bladder frequency: Bladder control is impaired decrease urine out.
 Bowel condition: Bowel movement is impaired and my client not motion passed.
5. RECREATIONAL AND HABITS:
 Exercise activity and tolerance (specify): My client doing spiromentry exercise but not regular.
 Habits (specify): No habits of extra activity.
 Spiritual history:- my client believe in god prayer.

6. SOCIOECONOMIC STATUS:
 Social factors:- Good relationship with other family member, My client belong to joint family,
Monthly income is 10000-/-, my client house and own house, ventilation facilities is adequate,
electricity, drainage, lighting, water, waste disposal and latrine facilities available in own house,
availability of hospital under 5 km, clinic, health centres, market, temple, school and transportation
also present near house.
Economic factors:- My client family income is 10000-/- and belong of lower middle class, Mr. Manoj is a
bread winner of family, sources of income is own businessmen, financial status is not adequate.

PHYSICAL EXAMINATION
GENERAL APPERANCE:
 Level of consciousness: My client is conscious.
 Orientation: My client are oriented to place/time and person.
 Activity: My client activity is impaired and dull due to blunt chest trauma.
 Body built: My client is thin.
 General grooming: Clean and appropriate.
 Position/posturing: Normal posture position.
 Facial expression: My client facial expression is dull and blank.
 Body language: No eye contacts with me and slow in movement.
 Other observations: My client feels very dull.

Vital sign:-
 Temperature:- 99.6 f
 Pulse:- 80b/m
 Respiration:- 20 b/m
 BP:- 130/80mmHg
 RBS:- 134 mg/dl
 Spo2%- 98%

SKIN INSPECTION AND PALPATION (Integumentary System):

 Color and vascularity: My client skin color is black and surgical incision of over the chest skin.
 Turgor and mobility: My client skin elasticity abnormal and oedematous tight skin in trunk due to
surgical incision and no any other abnormalities like tenting and redness skin.
 Temperature and moisture: My client skins are warm and dry over the chest skin and other
abnormalities clammy, oily, diaphoresis, and sweating skin are absent in my client.
 Texture: My client skin texture is rough and other abnormalities rough, fine, thick, puffy and smooth
skin are absent in my client.
 Nails: My client nails are clean and clean manicured and other abnormalities dry, hard, brittle,
cracking and clubbing nail are absent in my client.
 Nails beds and lunulae: My client nail beds are pale and other abnormalities pink, cyanotic, red,
blanching and spooning nail are absent in my client.
 Body hair growth: my client hair color is a black and thin.
 Skin integrity: Light lower leg skin integrity break due to accident and other abnormalities fissure,
acules, papules, nodules, cysts, senile purpura and ulceration skin absent in my client.

HEAD INSPECTION AND PALPATION:

 Shape: My client head is round shape and other abnormalities like head injury, cephalic head and
cephalic disorder are absent in my client.
 Face: My client face is oval shape and facial expression was absent due to chest pain.
 Facial (CN VII): My client facial expression is dulls no smile.
 Hair: normal hair distribution in all over the body and other abnormalities curly, straight, permed,
glossy, and shiny hair are absent in my client,
 Condition of scalp: My client’s scalps are clean, no dandruff seen.
 Messes and lumps: Not present any masses and lump in my client head.
 Facial puffiness: Absent.

EYES INSPECTION AND PALPATION:

 Eyebrows: My client eyebrows are thin and other abnormalities straight, curved, thick, scaly and
sparse eyebrows are absent in my absent.
 Eyelashes: My client eyelashes are short and other abnormalities curved, artificial and long
eyelashes are absent in my absent.
 Eyelids: My client eyelids are dark and close simultaneously and other abnormalities swollen,
inflamed, discharge, stye, entropion, ectropion, and lid leg are absent in my client.
 Shape and appearance: My client eyes are sunken and tearing eye and other abnormalities almond,
rounded, squinty, nystagmus and strabismus shape are absent in my client.
 Sclera: White and other abnormalities creamy, yellowish, infected and pterygium sclera are absent in
my client.
 Conjunctiva: My client conjunctiva is pale pink and other abnormalities inflamed, swelling, nodule
and red conjunctiva are absent in my client.
 Iris: Black color and round shape no any abnormalities flat, coloboma, arcus, senile seen in iris. .
 Cornea: Clear and other abnormalities milky, Opague, and cloudy cornea are absent in my client.
 Pupils: Equal pupil size and round shape and other abnormalities anisocoria, consensual reaction,
constricted, fixed and unequal pupils are absent in my client.
 Lacrimal glands: Tearing and other abnormalities tender, inflamed, swollen are absent in my client.
 Visual field: Normal intact.
 Vision: Normal reading 6/6 in both eye.
 Use of glasses: No uses of any type of contact lens.

EARS INSPECTION AND PALPATION:

 Pinna: Large and Pinna shape are oval and other abnormalities pinnae irregular, skin intact, redness,
swelling tophi, cauliflower and furuncles ear are absent in my client.
 Level in relation to eyes: Top of Pinna level with outer canthus of the eye.
 Canal: Ear canal is clean and other abnormalities discharge, redness and foreign body are absent in
my client.
 Cilia: Present.
 Cerumen: Present.
 Tympanic membrane: Pearly white and no any inflamed, cone of light, land mark, scarring, bubbles
and fluid in my client.
 Hearing (audition-CN VIII): Present.
Bone conduction test:-
 Tuning fork test: Listen.
 Weber test: Lateralizes equally to left/right side.
 Rinne test: Air conduction is more than bone conduction.
 Hearing aids: No any type of hearing aids uses my client.
NOSE AND SINUSES INSPECTION AND PALPATION:
 Size and shape: My client nose is small and shape is nares symmetrical and other abnormalities
long, short, in proportion to face, flat, board based, thick, thin and swollen size and shape are absent in my
client.
 Nasal septum: Nasal septum normal located in midline and no any perforation seen in nasal septum.
 Nasal mucosa and turbinate: Nasal mucosa is dry and cilia present and other abnormalities redness,
bluish, pink and pale nasal mucosa are absent in my client.
 Patency of nares: Right patent no partial obstruction
 Olfactory (CN I): My client correctly identifies the familiar odors.
 Sinuses: Normal and no any inflammation and tenderness absent in my client.

MOUTH AND PHARYNX INSPECTION:

 Lips: My client lips color is a slightly black, lips are symmetrical and thin. And lips are dry and
cracked.
 Teeth: My client’s teeth color is a yellowish and other abnormalities notching, protruding, crowded
and loose teeth are absent in my client.
 Dental caries and fillings: no any dental caries present in my client.
 Dental hygiene: Not properly maintain dental hygiene.
 Breathe odor: bad odor present and no any musty, acetone, fetid, odor of food or drug are absent in
my client.
 Gums: Color in pink, moist gum and sensitivity is present and other abnormalities hypertrophy,
nodules, irritated, ulcerated and spongy gums are absent in my client.
 Facial and glossopharyngeal (CN VII and IX): My client identifies the correct taste.
 Tongue: My client tongue is pink color and thin and dry tongue and other abnormalities
macroglossia, microglossia, glossitis, and swollen tongue absent in my client.
 Hypoglossal (CN XII): Tongue movement are symmetrical.
 Mucosa: Intact and dry. No any lesion, leukoplakia and masses are absent in my client.
 Palate: Moist and no any other abnormalities dry palate and color changes are absent in my client.
 Uvula: Normal
 Pharynx: Normal, no seen any type of petechiae beefy, and dysphasia.
 Tonsils: Normal tonsil present. Not seen crept and beefy tonsils.
 Temporomandibular joint: Fully mobile symmetrical joint. Not any tenderness and crepitus.

NECK INSPECTION AND PALPATION:

 Appearance: My client neck is short symmetrical.
 Thyroid: Thyroid palpable no any tenderness and nodules.
 Trachea: trachea present in midline. Not deviated right and left trachea
 Lymph nodes: Lymph node present in occipito preauricular and other abnormalities
lymphadenopathy, shotty, deep cervical and hard and firm lymph node are absent in my client.

THORAX AND LUNG EXAMINATION (Respiratory system):

 Inspection: Due to chest injury break skin continuity, redness and swelling over the chest skin,
increased respiration and rhythm is irregular.
 Palpation: pain in palpation due to chest injury and 6th to 12th rib fracture of right side.
 Percussion on lung field: fluid pleural collection in right side and tenderness present on percussion
on lung field.
 Lung auscultation: crackle sound present on auscultation of lung due to rib fracture and fluid
collection, diaphragmatic exertion was dull, increase respiration rate 24b/m.
 Support the chest wall and ribs through chest belt.

BREASTS AND AXILLAE INSPECTION AND PALPATION:

 Male breasts: Breasts are asymmetrical, left side normal breast size but right side breast swelling
due to chest injury.
 Nipples: Present and asymmetrical.
 Axilla: Odour present because of not proper maintain hygiene.

CARDIOVASCULAR EXAMINATION:
 Inspection : mild swelling and tenderness due to blunt injury of chest and affect the heart and their
blood vessels
 Palpitation: abnormal palpitation S1 loudest at apex compares then S2 sound.
 Percussion: during percussion acute pain complains, volume and rhythm are week because of injury
related and symmetrical and no fluid collection.
 Auscultation: S1,S2 sound heard, volume and rhythm is regular beat, pulse rate is 78 b/m and blood
pressure is 130/80 mmHg.

ABDOMINAL EXAMINATION:
 Inspection: Distended, dry, normal color and intact. No any lesion, striae, shiny and scar are absent.
 Palpitation: present tenderness due to liver and spleen injury and Hepatomegaly, splenomegaly
present.
 On percussion: Distended and dull because of presence of gas acidity.
 Auscultation: bowel sound absent due to present of gas.

MUSCULOSKELETAL EXAMINATION:
 Back: left shoulder higher than right shoulder due to right side blunt injury. Other abnormalities
lordosis, scoliosis and kyphosis are absent.
 Vertebral column alignment: Straight
 Joints: Pain in sternum, swelling and tenderness present due to ribs fracture and both lower limb
movement are not active due to involve pelvic bone fracture.
 Range of motion: pain in extension, flexion of lower limb and trunk flexion and extension
movement not active due to ribs fracture.
 Extremities: Symmetrical, but swelling present in upper right arm and lower both limb.
 Lower extremities: Symmetrical, pain in movement and not present varicose veins.

GENITOURINARY AND RECTUM INSPECTION:

 Rectum: Swelling
 Male genitalia: Normal pubic hair distribution and not present any abnormalities.

NEUROLOGICAL EXAMINATION:
 Mental status examination: Normal co-ordination.
 Level of alertness: my client is alert.
 Orientation: my client fully oriented time, place and person.
 Memory: present long time memory.
 Language and speech: My client languages are Hindi and speak slowly.
 Responsiveness: respond to verbal command.
 Motor response: displaced fracture of right iliac blade, ribs fracture. Pain in trunk, both lower limb
joint, right upper limb joint during extension and flexion movement.
 Reflex: Normal elicit gag reflex, blink reflex, coughing reflex and sneezing reflex are present.
 Coordination: Normal co-ordinations, test done in left hand through finger method because of pain
present in both lower limb and right upper arm.
 Sensory response: all facial touch sensation, identify all familiar odor, normal bone conduction test,
fine touch sensation over all body, normal 6/6 and all sensory function is normal.
 Cranial nerves: all cranial nerve are normal functioning.
INVESTIGATION:-
INVESTIGATION NORMAL VALUE PATIENT VALUE REMARK
Hemoglobin 14-18gm% 11.5gm% Low
WBC 4000-11000/cumm 17800/cumm High
R.B.C. count 4.5-6.5mil./cmm 4.31 mil./cmm Low
Neutrophil 50-65% 82% High
Lymphocytes 20-45% 10% Low
Platelet count 150000-450000/cumm 90000/cumm Low
heamatocrit 40-54% 33.7% Low
ESR 2-10mm/hr 72mm/hr High
Urea nitrogen 20-40mg% 46% High
Serum creatinine 0.5-1.5mg/dl 0.4mg/dl Normal
Sodium 135-145mmol/L 146mmol/L High
Glucose <140 mg/dl 78mg/dl Normal
S. urea 10-45mg/dl 69mg/dl High
Bilirubin total .2-1.2mg/dl 1.6mg/dl Normal
Bilirubin direct 0-3mg/dl 0.4mg/dl Normal
Potassium 3.5-5mg/dl 4.2mg/dl Normal
CHEST X-RAY:-
 Trachea central in position.
 Cardiothoracic ratio is abnormal.
 Bilateral hila appear normal.
 Right unilateral lung field appear fluid.
 Left costophrenic angle are sharp and clear.
 Right costophrenic angle blunted and right side pleural effusion.
 ICD in situ.
Impression:- right side plural effusion and ICD in situ.
CECT CHEST + ABDOMEN:-
Protocol:- Contiguous axial scans were taken from lung apex to pubic symphysis in 8 mm thickness after
I.V. contrast administration.
Report& Impression:-

 There is complete architecture distribution of right kidney with multiple non en having hypodermis
areas with adjunct let stranding s/o grade IV rend injury.
 There is irregular non-enhancing hypodermic area measuring approx 6×5.5 cm noted involving
segment VI of right lobe of given s/o grade -5 liver injury.
 Moderate hypodense collection noted in pelvic & peritoneal cavity.
 Communicated displaced fracture of right iliac blade.
 Left sided gross hydropneumothorax with partial lung collapse of right lower lobe.
 There is shift of Mediastinum towards left with pleural collection in right side.
 Subcutaneous emphysema noted in left lateral wall of chest.
 6th and 12th rib of right side is fractured.
FINAL DIAGNOSIS:- After history taking, physical examination and diagnostic evaluation my client
complain of 6th and 12th rib of right side is fractured, Subcutaneous emphysema noted in left lateral wall of
chest, there is shift of Mediastinum towards left with pleural collection in right side, left sided gross
hydropneumothorax with partial lung collapse of right lower lobe due to blunt chest injury
 MEDICATION:-

Drug Dose Route Fre Mechanism Indication Contraindication Side-effect Nurse’s

of action responsibility
Inj- 1 gm I/V BD This Prescribed for low Prothrombin, • Central Nervous • Caution should be
ceftriaxone medicine is certain bacterial vaginal System: Dizziness, exercised in patients
a infections such as inflammation, Headache. with history of
cephalospor gonorrhea, pelvic hyper sensitivity, • Gastrointestinal: penicillin allergy;
in inflammatory not good for super Diarrhea, nausea and severe renal
antibiotic, disease, middle ear infection vomiting. impairment;
prescribed infection, sensitivity and • Blood: High pregnancy and
for certain meningitis lactation concentration of lactation; problem
bacterial (inflammation of eosinophils, platelet counts with digestive
infection the covering of the in the blood, decrease in system, especially
and inhibitsbrain), and white blood cells, low colitis (inflammation
Protein infections of the Prothrombin levels, of the large
synthesis. lungs, ears, skin, bleeding. intestine),
urinary tract, blood, • Lab tests: Increase in malnutrition (you do
bones and joints liver enzyme, elevated not eat or cannot
and typhoid. BUN (Blood urea, digest the nutrients
nitrogen). needed for good
• Local: health), super
Indurations/tightness/war infection.
mth. • Be sure for the full
• Genitourinary: Vaginal course of treatment.
inflammation. If you do not, the
• Miscellaneous: Fatal medicine may not
ceftriaxone-calcium clear up your
precipitates in lung and infection completely.
kidneys of neonates.
Inj- 40 mg I/V BD This Prescribed for Hypersensitivity • Gastrointestinal: • Long-term therapy
Pantocid medicine is gastro esophageal and lactation. Nausea, vomiting, may lead to bacterial
a proton- reflux disease diarrhea, pain, overgrowth in the GI
pump (GERD), ulcers, constipation, rarely tract, atrophic
inhibitor, Zollinger-Ellison inflammation of pancreas. gastritis.
reduce HCL Syndrome, and • Genitourinary: Urinary • Monitor liver
level. erosive esophagitis. frequency, urinary tract function regularly (if
It decreases the infection, kidney disease, enzymes increase,
 amount of acid creatinine increased. discontinue) because
made in the • Blood: Pancytopenia- it may lead to liver
stomach. decrease of all types of damage.
blood cells, including red • Caution needed
and white blood cells as during pregnancy;
well as platelets. not recommended in
• Liver: Increased liver children <18 year.
enzymes, liver cells • Patient may
damage leading to develop with
jaundice and liver failure. increased risk of
• Local: Injection-site Clostridium difficile
reactions (including associated diarrhea
abscess, (CDAD)
thrombophlebitis).
• Metabolic: Increase in
fat, sugar, cholesterol,
weight changes, and uric
acid in the blood.
• Musculoskeletal: Joint
pain, back pain, neck
pain.
• Respiratory: Asthma,
cough, difficulty in
breathing, upper
respiratory tract infection.
• Miscellaneous: Chest
pain, flu syndrome,
infection, severe and life-
threatening reaction.
Inj- 100 I/V TDS This Prescribed for Contraindicated • Most Common: • Caution should be
Tramadol mg medicine is moderate to severe in patients with Dizziness/vertigo, nausea, exercised in patients
an opioid pain in adults. It suicidal thoughts, constipation, headache, with history of
analgesic, works by changing acute alcoholism, drowsiness, vomiting, epilepsy, brain or
reduce body the way the body head injuries, itching, CNS stimulation, spine infection, head
pain. senses pain. raised intracranial weakness, sweating, injury, brain tumor,
pressure, severe indigestion, dry mouth and stroke, obstructive
kidney diarrhea. bowel disease,
impairment, • Body as a Whole: muscle weakness,
 hypersensitivity Uneasiness. respiratory
and during • Heart: Dilatation of depression, prostate
breastfeeding. blood vessels. enlargement, liver or
• Central Nervous kidney disease,
System: Anxiety, elderly, children and
confusion, coordination during pregnancy.
disturbance, elevated • It may cause
mood, nervousness and dizziness or
sleep disorder. drowsiness, do not
• Gastrointestinal: drive a car or operate
Abdominal pain, loss of machinery while
appetite and flatulence. taking this
• Musculoskeletal: medication.
Increased muscle tone.
• Skin: Rash.
• Eye: Visual
disturbances.
• Genitourinary:
Menopausal symptoms,
urinary frequency and
urinary retention.
Inj - Zofer 4mg I/V BD This This medication is The concomitant • Heart: Chest pain, fast • It may affect heart
medicine is a 5-HT3 receptor use of heart rate. rhythm, cause severe
a 5-HT3 antagonist, apomorphine with • Central Nervous liver impairment.
receptor prescribed for ondansetron is System: Headache, • Caution needed
antagonist nausea and contraindicated seizures, dizziness. when used in cardiac
and reduce vomiting caused by and known • Skin: Rash. diseases, patients
vomiting cancer hypersensitivity. • Gastrointestinal: Dry who are on
and nausea chemotherapy, mouth, constipation, medications that can
feeling radiation therapy abdominal pain. prolong QT or
and surgery. It • Metabolic: Low patients with
blocks serotonin potassium in blood, electrolyte
receptors in the increased level of liver abnormalities,
vomiting center enzymes. during pregnancy
and on nerves • Respiratory: Asthma. and breastfeeding.
supplying the • Genitourinary: • It may mask
digestive system. Gynecological disorder, progressive ileus
urinary retention. and/or gastric
 • Miscellaneous: Fever, distension.
anaphylaxis, weakness.
Inj- 250 I/V OD This This medication is Contraindicated • Heart: Swelling of • Do not substitute
Cyanocobal mg medicine is a vitamin (varied in patients with lungs, chest pain, folic acid for this
amin a vitamin chemical hypersensitivity, congestive heart failure, medication.
(varied substances) of Leber’s Disease clot in blood vessels. • Perform lab tests
chemical vitamin B12, used (damage in the • Blood: Blood disorder. for blood regularly,
substances) in treating anemia, optic nerve • Gastrointestinal: Mild to monitor the
of vitamin folic acid leading to transient diarrhea. progress.
B12, used deficiency, blindness). • Skin: Itching; hives, • Avoid alcohol
in treating neuropathies rash, transitory exanthema consumption while
anemia and (damage in the (eruption of the skin). taking this
folic acid nerves of • Miscellaneous: Swelling medication.
deficiency peripheral nervous of entire body. • Caution should be
system), • Central Nervous exercised in patients
prophylaxis, and System (CNS) : with history of
psychiatric Headache, dizziness. kidney and liver
disorders. • Musculoskeletal: disease, pregnancy,
Recommended for Muscle weakness, cramps, breast-feeding and
patients with the leg pain. allergy to cobalt
condition of • Genitourinary: Frequent
pancreatic tumor. urination.
 ANATOMY AND PHYSIOLOGY OF LUNG
The lungs are located in the chest and are part of the respiratory system.

The lungs take up most of the space inside the chest. The lungs are surrounded by the chest wall. The chest
wall is made up of the ribs and the muscles between the ribs. The lungs are separated by the mediastinum,
which contains the heart and other organs. Below the lungs is the diaphragm, a thin muscle that separates the
chest cavity from the abdomen.

Each lung is divided into lobes (sections):

 The left lung has 2 lobes. The heart sits in a groove (cardiac notch) in the lower lobe.
 The right lung has 3 lobes and is slightly larger than the left lung.
The windpipe (trachea) is the tube-shaped airway in the neck and chest. It divides into 2 tubes or branches
called the main bronchi. One bronchus goes to each lung. The area where each bronchus enters the lung is
called the hilum.
The pleura are a thin membrane that covers the lungs and lines the chest wall. It protects and cushions the
lungs and produces a fluid that acts like a lubricant so the lungs can move smoothly in the chest cavity. The
pleura is made up of 2 layers:
 inner (visceral) pleura – the layer next to the lung
 outer (parietal) pleura – the layer that lines the chest wall
The area between the 2 layers is called the pleural space.
Each of the main bronchi divides or branches into smaller bronchi (which have small glands and cartilage in
their walls). These smaller bronchi eventually divide into even smaller tubes called bronchioles, which have
no glands or cartilage. At the end of the bronchioles are millions of tiny sacs called alveoli. Surrounding the
alveoli are very tiny blood vessels (capillaries).
The bronchi are lined with cells that have very fine hair-like projections called cilia.
The lungs produce a mixture of fats and proteins called lung or pulmonary surfactant. The surfactant coats
the surfaces of the alveoli, making it easier for them to expand and deflate with each breath.
Different groups of lymph nodes, which are part of the lymphatic system, drain fluid normally produced in
the lung:
 bronchial nodes – lymph nodes around the main bronchi
 hilar nodes – lymph nodes in the area where the windpipe divides into the main bronchi
 mediastinal nodes – lymph nodes along the windpipe in between the 2 lungs
 subcarinal mediastinal nodes – lymph nodes just below the windpipe where it divides into the main
bronchi

What the lungs do

The main functions of the lungs are to transfer oxygen from the air to the blood and to release carbon
dioxide from the blood to the air.
Air enters the mouth or nose and travels through the windpipe, bronchi and bronchioles to the alveoli. The
exchange of oxygen and carbon dioxide takes place in the alveoli:
 The alveoli absorb oxygen from the air and pass it into the blood, which circulates the oxygen around
the body.
 Carbon dioxide, which is a waste product of the body’s cells, passes from the blood into the alveoli
and is breathed out.
The lungs also play a role in the body’s defences against harmful substances in the air, such as smoke,
pollution, bacteria or viruses. These substances can pass through the nose and become trapped in the lungs.
The lungs produce a thick, slippery fluid (mucus), which can trap and partly destroy these substances from
the air. The cilia move rapidly to push the mucus up through the bronchi, where it is removed by coughing
or swallowing.

BLUNT CHEST INJURY WITH HYDROPNEUMOTHORAX

INTRODUCTION:- A chest injury is any form of physical injury to the chest including the ribs, heart and
lungs. Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused
by blunt mechanisms such as motor vehicle collisions or penetrating mechanisms such as stabbings.
A broken rib is a common injury that occurs when one of the bones in your rib cage breaks or cracks. The
most common cause is chest trauma, such as from a fall, motor vehicle accident or impact during contact
sports. Many broken ribs are merely cracked.

Hydropneumothorax is defined as the presence of both air and fluid within the pleural space. An upright
chest x-ray will show air fluid levels. The horizontal fluid level is usually well defined and extends across
the whole length of hemi thorax.

Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of
Pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient.
Most clinicians agree that chest drainage is essential for the management of traumatic large Pneumothorax.
Herein, we present a case of large Pneumothorax in blunt chest trauma patient that resolved spontaneously
without a chest drain.
DEFINITION: A chest injury is any form of physical injury to the chest including the ribs, heart and lungs.
Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused by
blunt mechanisms such as motor vehicle collisions or penetrating mechanisms such as stabbings.
Hydropneumothorax is defined as the presence of both air and fluid within the pleural space.

TYPE:-

IN BOOK IN PATIENT
Injuries to the chest wall

 Chest wall contusions or hematomas:- A pulmonary contusion, also  During chest injury
known as lung contusion, is a bruise of the lung, caused by chest trauma. As involve lung and
a result of damage to capillaries, blood and other fluids accumulate in the their capillaries.
lung tissue. The excess fluid interferes with gas exchange, potentially leading
to inadequate oxygen levels (hypoxia).  6 to 12 ribs are
 Rib fractures:- A broken rib is a common injury that occurs when one of the fracture in my
bones in your rib cage breaks or cracks. The most common cause is chest client.
trauma, such as from a fall, motor vehicle accident or impact during contact
sports. Many broken ribs are merely cracked.
 Flail chest:- Flail chest is a life-threatening medical condition that occurs
when a segment of the rib cage breaks due to trauma and becomes detached
from the rest of the chest wall. Two of the symptoms of flail chest are chest
pain and shortness of breath.
 Sternal fractures:- A Sternal fracture is a fracture of the sternum (the
breastbone), located in the center of the chest. The injury, which occurs in 5–
8% of people who experience significant blunt chest trauma, may occur in
 vehicle accidents, when the still-moving chest strikes a steering wheel or
dashboard or is injured by a seatbelt.
 Fractures of the shoulder girdle:- The shoulder girdle comprises three
bones (clavicle, proximal humerus, scapula) and three joints
(glenohumeral, acromioclavicular,sternoclavicular). Most fractures involve
the proximalhumerus and clavicle; scapular fractures represent <5% of
fractures of the shoulder girdle.
Pulmonary injury (injury to the lung) and injuries involving the pleural space

 Pulmonary contusion:- A pulmonary contusion, also known as lung  During chest injury
contusion, is a bruise of the lung, caused by chest trauma. As a result of involve lung and
damage to capillaries, blood and other fluids accumulate in the lung tissue. their capillaries.
The excess fluid interferes with gas exchange, potentially leading to
inadequate oxygen levels (hypoxia).
 Pulmonary laceration:- A pulmonary laceration is a chest injury in
whichlung tissue is torn or cut. An injury that is potentially more serious
than pulmonary contusion, pulmonary laceration involves disruption of the
architecture of thelung, while pulmonary contusion does not.  Air and fluid
 Hydropneumothorax: - Hydropneumothorax is defined as the presence of collection in plural
both air and fluid within the pleural space. An upright chest x-ray will show space.
air fluid levels. The horizontal fluid level is usually well defined and extends
across the whole length of hemi thorax.
 Hemothorax: - Hemothorax is a collection of blood in the space between the
chest wall and the lung (the pleural cavity).
 Hemopneumothorax:- Hemopneumothorax, or Hemopneumothorax, is a
medical term describing the combination of two conditions: Pneumothorax,
or air in the chest cavity, and Hemothorax (also called Hemothorax), or
blood in the chest cavity.
Injury to the airways

 Tracheobronchial tear:- Tracheobronchial tears are rare injuries that are

usually related to blunt trauma that involves a partial or complete laceration
or puncture of the tracheal or bronchial wall.
Cardiac injury

 Pericardial tamponade:- Compression of the heart caused by fluid

collecting in the sac surrounding the heart.
 Myocardial contusion:- A myocardial contusion is a bruise of the heart
muscle, which can occur with serious bodily injury. This is most commonly
caused: by a car accident. by falling from heights greater than 20 feet. by
receiving chest compressions during cardiopulmonary resuscitation (CPR).
 Traumatic arrest:- Traumatic cardiac arrest (TCA) is a condition in which
the heart has ceased to beat due to blunt or penetrating trauma, such as a stab
wound to the thoracic area. It is a medical emergency which will always
result in death without prompt advanced medical care.
 Hemopericardium:- Hemopericardium refers to blood in the pericardial sac
of the heart. It is clinically similar to a pericardial effusion, and, depending
on the volume and rapidity with which it develops, may cause cardiac
tamponade.
Blood vessel injuries
  Traumatic aortic rupture:- Traumatic aortic rupture, also called traumatic
aortic disruption or trans section, is a condition in which the aorta, the largest
artery in the body, is torn or ruptured as a result of trauma to the body.
 Thoracic aorta injury:- The main risk factor for blunt thoracic aortic  blunt thoracic
injury is rapid deceleration, either from high-speed motor vehicle collision or aortic injury is
falls from a significant height. rapid
deceleration,
either from high-
speed motor
vehicle collision

 Aortic dissection:- A tear in the inner layer of the large blood vessel
branching off the heart (aorta).
And injuries to other structures within the torso

 Esophageal injury (Boerhaave syndrome):- Boerhaave syndrome is a

Transmural perforation of the esophagus to be distinguished from Mallory-
Weiss syndrome, a non trans mural esophageal tear also associated with
vomiting.
 Diaphragm injury: - Diaphragmatic rupture (also called diaphragmatic
injury or tear) is a tear of the diaphragm, the muscle across the bottom of the
ribcage that plays a crucial role in respiration. Most commonly,
acquired diaphragmatic tears result from physical trauma.

CAUSES /RISK FACTORS OF AML:-

IN BOOK IN PATIENT
 Fall or direct blow to the chest of Car crashes, falls, getting punched, and My client direct blow
injury from bicycle handlebars are common causes of chest contusions. to the chest of motor
cycle fall and getting
blunt chest injury.
 Penetrating mechanisms such as stabbings. Absent
 Iatrogenic: Introduction of air during pleural fluid aspiration in effusion. Absent
 Presence of a gas-forming organism. Absent
 Thoracic trauma:- A chest injury is any form of physical injury to the chest Absent
including the ribs, heart and lungs. Chest injuries account for 25% of all
deaths from traumatic injury. Typically chest injuries are caused by blunt
mechanisms such as motor vehicle collisions or penetrating mechanisms
such as stabbings.
 Surgery:- rib fracture, lobectomy, and any surgery of chest Absent
PATHOPHYSIOLOGY:-

SIGNS AND SYMPTOMS:-

IN BOOK IN PATIENT
 Difficulty breathing, failure of the chest to expand normally.  Due to blunt chest injury and
ribs fracture.
 One segment of the chest wall may not move with breathing  Difficulty in breathing due to
or move opposite to the rest of the chest wall (flail chest). chest trauma.
 coughing up blood indicate a chest injury  Coughing in blood due to
haemorrhage during chest injury
than cause bleeding in coughing.
 Pain in the chest that gets worse when laughing, coughing, or  Pain in chest wall due to
sneezing. injury.
 Difficulty breathing.  My client is having breathing
difficulty due to incomplete
expansion of chest.
 Tenderness-Costochondritis is inflammation of the junctions  Present inflammation in
where the upper ribs join the costal cartilage that attaches them to thetrunk area due to chest injury and
breastbone (sternum). Costochondritis causes ribs fracture.
localized chest wall pain and tenderness that can be reproduced by
pushing on the involved cartilage in the front of the rib cage.
 Bruising.  Bruising present over the
chest.
 Swelling.  Swelling present over the
chest and lower limb due to pelvic
fracture.
 Crunching sounds in the ribs;- A fractured rib will sometimes  Crunching sound present in
make a crunching sound if you touch the point of injury. In addition, my client due to ribs fracture.
the rib-cage area could appear deformed, bruised and have muscle
spasms. Stretching, taking deep breaths, coughing and sneezing are
painful if your rib is fractured.
 Coughing up blood indicate a chest injury.  Blood present in coughing.
 Hydropneumothorax:- Hydropneumothorax is defined as the  Present air and fluid
presence of both air and fluid within the pleural space. collection in pleural cavity.

INVESTIGATION:-

IN BOOK IN PATIENT

Complete blood count (CBC). This common blood test measures
the amount of various types of blood cells in a sample of
your blood. Blood cancers may be detected using this test if too
many or too few of a type of blood cell or abnormal cells are
found. A bone marrow biopsy may help confirm a diagnosis of
a blood cancer.
 In my client Hb level, platelet
count and RBC count is low and increase
Prothrombin time and WBC due to
infection

CECT chest and abdominal An abdominal CT scan helps your  There is irregular non-enhancing
doctor see the organs, blood vessels, and bones in hypodermic area measuring approx 6×5.5
your abdominal cavity. The multiple images provided give your cm noted involving segment VI of right
doctor many different views of your body.
lobe of given s/o grade -5 liver injury.
 Moderate hypodense collection
noted in pelvic & peritoneal cavity.
 Communicated displaced fracture
of right iliac blade.
 Left sided gross
hydropneumothorax with partial lung
collapse of right lower lobe.
 There is shift of Mediastinum
towards left with pleural collection in
right side.
 Subcutaneous emphysema noted
in left lateral wall of chest.
 6th and 12th rib of right side is
fractured.

The chest x-ray is the most commonly performed diagnostic x-  Right costophrenic angle blunted
ray examination. A chest x-ray produces images of the heart, and right side pleural effusion.
lungs, airways, blood vessels and the bones of the spine  ICD in situ.
and chest. An x-ray (radiograph) is a noninvasive medical test
that helps physicians diagnose and treat medical conditions

Prothrombin time (PT) is a blood test that measures how long it  Prothrombin time increase in my
takes blood to clot. A Prothrombin time test can be used to client due to lack of platelet count.
check for bleeding problems. PT is also used to check whether
medicine to prevent blood clots is working. A PT test may also
be called an INR test

A physical examination, medical examination, or clinical  In physical examination my client

examination (more popularly known as a check-up) is the
process by which a medical professional investigates the body of
a patient for signs of disease
complain are ; bruise skin upper both
arm, breathing difficulty, black and skin
bluish skin due to lack of Hb
level ,dryness of skin and easily bleeding
in minor cuts

USG chest:- A chest ultrasound is a noninvasive diagnostic  Not done that investigation in my
exam that produces images, which used to assess the organs and client.
structures within the chest, such as the lungs, Mediastinal (area
in the chest containing the heart, aorta, trachea, esophagus,
thymus, and lymph nodes), and pleural space.

COMPLICATION:-

IN BOOK IN PATIENT

Develop secondary to rib fractures:- The most common mechanism of Absent

injury for rib fractures in elderly persons is a fall from height or from
standing. In adults, motor vehicle accident (MVA) is the most common
mechanism. Youths sustain rib fractures most often secondary to
recreational and athletic activities, as well as by non accidental trauma.
Inside the lungs (pulmonary hemorrhage ) – causing symptoms such During coughing bleeding seen
in my client.
as coughing up blood, breathing difficulties and a bluish skin tone
(cyanosis)
Inside the stomach (gastrointestinal hemorrhage ) – causing symptoms Present in my client, severe
blood in vomiting seen.
such as vomiting blood and passing stools (faeces) that are very dark or
tar-like in color
Inadequate ventilation:- The reasons Breathing difficulty due to
for inadequate chest ventilation include inadequate respiratory effort, incomplete expansion of lung
airway obstruction or a combination of these two. due to ribs fracture.

Traumatic pulmonary pseudo cysts

COPD:- Chronic obstructive pulmonary disease ( COPD ) is a chronic Absent

inflammatory lung disease that causes obstructed airflow from the lungs.
Symptoms include breathing difficulty, cough, mucus (sputum) production
and wheezing.

Pleural effusion:- A pleural effusion is a buildup of fluid in Present

the pleural space, an area between the layers of tissue that line the lungs
and the chest cavity. It may also be referred to as effusion or pulmonary
effusion.

Hydropneumothorax:- Hydropneumothorax is defined as the presence of Both air and fluid collection of
both air and fluid within the pleural space. pleural space in my client.
 THEORY APPLICATION:- Faye G. Abdellah
Patient-Centered Approaches to Nursing
The focus of care pendulum
INTRODUCTION:-

The nursing-centered orientation to client care seems contrary to the client-centered approach that Abdellah
professes to uphold. The apparent contradiction can be explained by her desire to move away from a disease-
centered orientation. In her attempt to bring nursing practice to its proper relationship with restorative and
preventive measures for meeting total client needs, she seems to swing the pendulum to the opposite pole,
from the disease orientation to nursing orientation, while leaving the client somewhere in the middle.

Major Concepts
 She describe the recipients of nursing as individuals (and families), although she does not delinate
her beliefs or assumptions about the nature of human beings.
 Health, or the achieving of it, is the purpose of nursing services. Although Abdellah does not give a
definition of health, she speaks to “total health needs” and “a healthy state of mind and body.” (Abdellah et
al., 1960)
 Health may be defined as the dynamic pattern of functioning whereby there is a continued interaction
with internal and external forces that results in the optimal use of necessary resources to minimize
vulnerabilities. (Abdellah’s & Levine, 1986; Torres & Samton, 1982).
 Society is included in “planning for optimum health on local, state, and international levels.”
However, as Abdellah further delineates her ideas, the focus of nursing service is clearly the individual.

Nursing Problems
The client’s health needs can be viewed as problems, which may be overt as an apparent condition,
or covert as a hidden or concealed one. Because covert problems can be emotional, sociological, and
interpersonal in nature, they are often missed or perceived incorrectly. Yet, in many instances, solving the
covert problems may solve the overt problems as well. (Abdellah, et al., 1960)
Problem Solving

Quality professional nursing care requires that nurses be able to identify and solve overt and covert nursing
problems. These requirements can be met by the problem-solving process involves identifying the problem,
selecting pertinent data, formulating hypotheses, testing hypotheses through the collection of data, and
revising hypotheses when necessary on the basis of conclusions obtained from the data. (Abdellah & Levine,
1986)

Subconcepts
Twenty-one Nursing Problems (Abdellah, 1960)
1. To maintain good hygiene and physical comfort.
2. To promote optimal activity: exercise, rest, and sleep.
3. To promote safety through the prevention of accidents, injury, or other trauma and through the prevention
of the spread of infection.
4. To maintain good body mechanics and prevent and correct deformities.
5. To facilitate the maintenance of a supply of oxygen to all body cells.
6. To facilitate the maintenance of nutrition of all body cells.
7. To facilitate the maintenance of elimination.
8. To facilitate the maintenance of fluid and electrolyte balance.
9. To recognize the physiological responses of the body to disease conditions – pathological, physiological,
and compensatory.
10. To facilitate the maintenance of regulatory mechanisms and functions.
11. To facilitate the maintenance of sensory functions.
12. To identify and accept positive and negative expressions, feelings, and reactions.
13. To identify and accept the interrelatedness of emotions and organic illness.
14. To facilitate the maintenance of effective verbal and nonverbal communication.
15. To promote the development of productive interpersonal relationships.
16. To facilitate progress toward achievement of personal spiritual goals.
17. To create and/or maintain a therapeutic environment.
18. To facilitate awareness of self as an individual with varying physical, emotional, and developmental
needs.
19. To accept the optimum possible goals in the light of limitations, physical and emotional.
20. To use community resources as an aid in resolving problems arising from illness.
21. To understand the role of social problems as influencing factors in the case of illness .

Nursing diagnosis:-
1. Severe pain in chest region related to blunt chest injury as evidence by dull facial expression,
uncomfortable and irritable.
2. Impaired breathing pattern related to blunt chest injury as evidence by increase depth of respiration, RR -
26.
3. Severe blood in vomiting related to blunt chest injury as evidence by internal bleeding outside the lung
cavity.
4. Imbalanced nutrition less then body requirements, related to nausea and vomiting as evidence by decrease
body weight and dryness of skin.
5. Impaired breathing pattern related to extreme weakness as evidence by increase depth of respiration.
6. Imbalanced nutrition less then body requirements, related to nausea and vomiting as evidenced by
decrease body weight 48 kg.
7. Hyperthermia related to infection as evidenced by high WBC count 18000 cu/mm.
8. Activity intolerance related to weakness as evidence by the fracture.
9. Disturbance body image and situational low self-esteem related to severity of infection as evidence by
irritable and anxiety.
10. Risk for complication bleeding problem related to secondary rib fracture.
11. Knowledge deficit related to treatment process as evidence by ask questions.
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Severe pain in Reduce -Assess the -Provide semi- flower -A good assessment of pain -After 3 hour
DATA: - My chest region pain patient position. will help in the treatment and intervention of plan
client is having related to blunt level condition and Monitor vital signs. comfortable position help for of action slowly
severe chest chest injury as provide reduce pain. reduce pain level 3 or
pain. evidence by comfortable less.
dull facial position.
expression,
uncomfortable -Give -Provide inj – tramadol -Inj- tramadol help to reduce
and irritable. analgesics as 100mg I/V BD pain level
ordered and
evaluate the
effectiveness.

-Assess for -Better understand and -Some patients may verbally

non-verbal proper administer drug for deny pain when it is still
signs of pain. pain present. Restlessness,
OBJECTIVE inability to focus, frowning,
DATA:- grimacing and guarding of
I observe my the area may be non-verbal
client pain level signs of acute pain
-pain scale 8-10
- dull expression -Reduce -Eliminate additional -Outside sources of stress,
- uncomfortable anxiety and stressors when possible. anxiety and lack of sleep all
- very irritable stress level. may exaggerate

-Provide rest -Provide rest periods, sleep -Less perception during

and sleep. and relaxation. sleeping.
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Impaired Improve -Assess the patient -Provide semi- -Semi-flower After intervention
DATA:- breathing breathing condition and flower position. position is the best plan of action my
My client is pattern related pattern and provide position for client will be able to
having severe to blunt chest normal comfortable breathing. normal respiration.
breathing injury as respiration. position.
difficulty and evidence by
restlessness. increase depth -Provide better -Give O2
of respiration, ventilation. administration. -Oxygen is help for
RR - 26. better respiration.
-Provide - -Given inj –
bronchodilator Deriphyllin. -Inj- Deriphyllin
medications. dilates the bronchus
and normal
respiration.
-Provide -Provide
OBJECTIVE nebulisation. nebulisation with -Dilate bronchus and
DATA:- duolin and alveoli and help for
I observe my client budecort. normal respiration.
feels increase
depth of -Lung exercise -Lung exercise
respiration, provided through -Expend the lung
increase the spiromentry. and normal
respiratory rate, respiration.
restlessness heart
rate- 84b/m
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
Severe blood in Reduce -Assess the patient - Provide semi- -Side lateral After 2 hour
SUBJECTIVE vomiting related vomiting and condition and flowers’ or side position because of intervention of plan of
DATA:- to blunt chest control provide lateral position prevent aspirate any action decrease
My client is injury as bleeding. comfortable because of prevent type fluid during amount of vomiting
having severe evidence by position. aspirate fluid. vomiting. and control bleed in
blood in vomiting internal vomiting.
and generalised bleeding outside -Provide -Provide inj – - inj –tranexamic
weakness. the lung cavity. medication. tranexamic acid acid 500 mg is a
500 mg for prevent coagulant for
internal bleeding. prevent internal
bleeding.

-Avoid extra -Advice of patient - Because of extra

mobility. no coughing very movement of cause
forcefully. increase bleeding.

- Provide colloid - Provide - I/V fluid heamacele

fluid. heamacele I/V restore of fluid loss
fluid. during vomiting.

OBJECTIVE - Provide - Give oxygen -During severe

DATA:- oxygenation through nasal vomiting
probe. oxygenation is
I observe my client impaired because of
health conditions:- injury outside the
-Dryness of skin lung cavity.
-Dry eye
-Warm body
temperature
-Confusion.
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS

SUBJECTIVE Imbalanced Improve -Assess patient -Assess the -Identifies patient After 4hour
DATA:- nutrition less nutritional condition and patient’s previous concerns, intervention plan of
then body status and dietary pattern experiences and misinformation, and action slowly increase
My client is requirements, restore expectations of potential strategies dietary pattern and
having less food related to electrolyte. nausea and for intervention, also nausea is subside.
intake, generalised nausea and vomiting, including gives patient sense
weakness due to vomiting as causes and of empowerment and
nausea and evidence by intervention used. control.
vomiting. decrease body
weight and -Provide -Giving inj- zofer -inj- zofer 4mg is a
dryness of skin. medication for 4mg I/V BD antiemetic for reduce
vomiting vomiting.

-Provide liquid diet -provide dal water, -liquid diet increase

and encourage for juice and water. restore of electrolyte.
oral intake

-Provide health -Provide health - Some patient’s diet

OBJECTIVE education. knowledge about increase after health
DATA:- balanced diet education.

I observe my client -Provide I/V -Giving I/V fluid -I/V fluid help for
health conditions:- therapy NS, DNS restore extra cellular
-Dryness of skin fluid.
-dry eye
-warm body
temperature
-Confusion
- weight loss
ASSESSMENT NURSING GAOL PLANNING INTERVENTION RATIONALE EVALUVATION
DIAGNOSIS
SUBJECTIVE Hyperthermia -Reduce fever -Assess the patient -Provide -To prevent swelling After 2 hour
DATA:- related to and correct condition and comfortable surgical site. intervention plan of
infection as the level of provide position opposite action slowly reduce
My client is evidenced by WBC count. comfortable side of surgical fever and swelling.
having fever due high WBC position. site.
to swelling and count.
infection in -Assess vital sign -Check vital sign -Find out the degree
surgical side. T-99.F of fever.
P- 84b/m
R- 20b/m
BP- 130/80mmhg

- Provide sponging. -Provide cold -Cold sponging help

sponging. for reducing fever.

-Provide -Provide inj – -Antipyretic drug

antipyretic drug. paracetamol 1gm help for the reducing
I/V BD fever.
OBJECTIVE
DATA:-

I observe my client -Administer -Inj –ceftriaxone is a

-body temperature antibiotic drug -Given inj- antibiotics help for
is warm by the ceftriaxone 1gm the reduce infection
touch I/V BD and WBC count.
- check vital sign
- increase WBC
count.
NURSES RECORD
CLIENT NAME:- Mr. Manoj

AGE/SEX:-27yr /male

IP NUMBER:- 232909345

DIAGNOSIS;- Blunt chest trauma

S.NO DATE/TIME MEDICATION INTAKE OUTPUT VITAL SIGN NURSES NOTE SIGN
. T P R BP O2%
1. 4/09/2023 Inj – Tea- 150ml by 99.F 78b/m 18b/m 130/90mmhg 98% Check complication of
10am ceftriaxone 25ml, urine drug and check urine
1gm in 100ml Water- output and bleeding.
ns, Inj- trenaxa 300ml,
500mg, Inj – Iv fluid –
tramadol 100ml.
100mg and inj-
zofer 4mg.
2. 5/09/2023 Inj – Milk- 250ml by 98.6F 88b/m 20b/m 130/90mmhg 96% Check complication of
10am ceftriaxone 200ml, urine drug and check vital
1gm in 100ml Iv fluid sign, record and
ns, Inj- trenaxa 500 ns, reporting.
500mg, Inj – water-
tramadol 200ml
100mg and inj-
zofer 4mg.
3. 6/09/2023 Inj – Milk- 275ml by 98.6F 80b/m 22b/m 120/90mmhg 97% Check complication of
10am ceftriaxone 200ml, urine drug, check vital sign,
1gm in 100ml Iv fluid record and reporting
ns, Inj- trenaxa 500 ns, and assess pain scale.
500mg, Inj – water-
tramadol 200ml
100mg and inj- Tea-
zofer 4mg. 25ml
HEALTH EDUCATION:-
 Rest and protect the injured or sore area. Stop, change, or take a break from any activity that may be
causing your pain.
 Put ice or a cold pack on the area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your
skin.
 After 2 or 3 days, if your swelling is gone, apply a heating pad set on low or a warm cloth to your chest.
Some doctors suggest that you go back and forth between hot and cold. Put a thin cloth between the
heating pad and your skin.
 Do not wrap or tape your ribs for support. This may cause you to take smaller breaths, which could
increase your risk of pneumonia and lung collapse.
 Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol),
ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions
on the label.
 Take your medicines exactly as prescribed. Call your doctor or nurse call line if you think you are having
a problem with your medicine.
 Gentle stretching and massage may help you feel better after a few days of rest. Stretch slowly to the
point just before discomfort begins, then hold the stretch for at least 15 to 30 seconds. Do this 3 or 4 times
per day.
 As your pain gets better, slowly return to your normal activities. Be patient, because chest bruises can
take weeks or months to heal. Any increased pain may be a sign that you need to rest a while longer.
MEDICATION

 Advice the client proper takes medicine.

HYGIENE

 Advised the client maintain personal hygiene.

 Advised the client for take daily bath.
 Advised the client clean for perineal area.
 Advised the client change for cloth.

REST AND SLEEP

 Advised the client for proper take rest and sleep.

DIET

 Advised the client take healthy diet, egg, green leaf, vegetables.
 Advised the client take fruit and juice.
 Advised the client take 3-4 litre amount of water daily.

EXERCISE

 Advised the client daily do exercise.

 Advised the client daily do relaxation therapy.

FOLLOW UP

 Educate the patient follow up check-up.

 BIBLIOGRAPHY

1. LUCKMANN’S “TEXT BOOK OF MEDICAL-SURGICAL NURSING”

Edition: - 2016, Page no:-975-980, Published by: - Elsevier publication.

2. MOSBY “TEXT BOOK OF MEDICAL-SURGICAL NURSING”

Edition: - 7th edition, Page no: - 1218, Published by:-. Elsevier publication.

3. BRUNNER AND SUDDARTH’S “TEXT BOOK OF MEDICAL-SURGICAL NURSING”

Edition:-.13th edition, Page: - 1535-1540, Published by: - Wolter’s kluwer.

4. ANSARI JAVED “MEDICAL SURGICAL NURSING-I”

Edition:-3rd, page: - 817, published by:- PV publication.

5. INTERNET:-

WWW.MEDIINDIA.COM
 SRI SATHYA SAI SANJEEVANI INSTITUTE OF
NURSING AND ALLIED HEALTHCARE SCIENCES,
NAYA RAIPUR

SUBJECT : - MEDICAL SURGICAL NURSING -I

TOPIC:- CASE PRESANTATION ON

BLUNT CHEST TRAUMA

SUBMITTED TO; SUBMITTED BY;

M MR. BHUPENDRA SAHU
ASSISTANT PROFESSOR MSC NURSING 1st YEAR STUDENT
MSC NURSING (MSN)