The nurse receives morning report on 4 clients who were admitted 24 hours earlier for injuries incurred in motor vehicle collisions. Which client should the nurse assess first?

Question

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A lung contusion (bruised lung) caused by blunt force can occur when an individual's chest hits a car steering wheel. This injury is potentially life-threatening because bleeding into the lung and alveolar collapse can lead to acute respiratory distress syndrome. Clients should be monitored for 24-48 hours as symptoms (eg, dyspnea, tachypnea, tachycardia) are usually absent initially but develop as the bruise worsens. Inspiratory chest pain can lead to hypoventilation, and an oxygen saturation of 90% (normal: 95%-100%) indicates hypoxemia. Therefore, the nurse should assess this client with lung contusion first and then notify the health care provider as immediate interventions to decrease the work of breathing and improve gas exchange (eg, supplemental oxygen, medications, ventilatory support) may be necessary. (Option A) Ecchymosis and bruising due to trauma would be expected. (Option B) Skin irritation under rough cast edges is common; oval strips of adhesive or moleskin tape applied to the cast edge (petals) can provide padding. Neurovascular assessment and elevation are necessary as swelling can indicate venous compression. This is not a life-threatening priority. (Option D) In a client with a pneumothorax, intermittent bubbling in the water-seal chamber consistent with respirations (due to air escaping from the pleural space) is expected until the lung has fully expanded. Educational objective: A lung contusion (bruised lung) caused by a blunt force to the chest is potentially life-threatening. Clients should be monitored for 24-48 hours after the injury for manifestations of hypoventilation and hypoxemia as these are usually absent initially but develop as the bruise worsens.

The Nurse Receives Morning Report on 4 Clients Who Were