Rib Fracture Nursing Diagnosis & Care Plan

Rib fractures are common traumatic injuries that can cause significant pain and potential complications. This nursing diagnosis focuses on managing pain, preventing respiratory complications, and promoting optimal healing while ensuring patient safety and comfort.

Causes (Related to)

Rib fractures can occur due to various mechanisms and risk factors:

• Direct trauma
  • Motor vehicle accidents
  • Falls
  • Sports injuries
  • Physical assault
• Pathological causes
  • Osteoporosis
  • Bone metastases
  • Severe coughing
  • Repetitive stress
• Contributing factors
  • Advanced age
  • Poor bone density
  • Chronic steroid use
  • Nutritional deficiencies
  • Underlying respiratory conditions

Signs and Symptoms (As evidenced by)

Subjective: (Patient reports)

• Sharp, localized chest pain
• Pain that worsens with breathing
• Pain exacerbated by movement
• Difficulty taking deep breaths
• Anxiety about breathing and movement
• Decreased ability to cough
• Pain during position changes

Objective: (Nurse assesses)

• Point tenderness over affected ribs
• Visible deformity or bruising
• Shallow, rapid breathing
• Decreased chest wall movement
• Splinting behavior
• Decreased breath sounds
• Increased respiratory rate
• Decreased oxygen saturation
• Use of accessory muscles

Expected Outcomes

The following outcomes indicate successful management of rib fractures:

• The patient will demonstrate effective pain control
• The patient will maintain adequate ventilation and oxygenation
• The patient will perform deep breathing exercises effectively
• The patient will avoid pulmonary complications
• The patient will demonstrate proper splinting techniques during movement
• The patient will show progressive improvement in mobility
• The patient will maintain adequate nutrition for healing

Nursing Assessment

1. Pain Assessment

• Evaluate pain intensity using the appropriate scale
• Document pain characteristics
• Note aggravating and relieving factors
• Assess the impact on breathing and movement
• Monitor the effectiveness of pain interventions

2. Respiratory Assessment

• Monitor respiratory rate and pattern
• Assess oxygen saturation
• Auscultate lung sounds
• Observe for the use of accessory muscles
• Evaluate cough effectiveness

3. Physical Assessment

• Inspect for chest wall deformity
• Assess for associated injuries
• Monitor for flail chest
• Evaluate skin integrity
• Check for neurological symptoms

4. Functional Assessment

• Evaluate mobility status
• Assess ability to perform ADLs
• Document activity tolerance
• Monitor energy levels
• Assess sleep patterns

5. Risk Assessment

• Screen for complications
• Evaluate fall risk
• Assess nutritional status
• Monitor for signs of pneumonia
• Check for psychological impact

Nursing Care Plans

Nursing Care Plan 1: Acute Pain

Nursing Diagnosis Statement:
Acute Pain related to rib fracture(s) as evidenced by verbal reports of pain rated 8/10, guarding behavior, and shallow breathing pattern.

Related Factors:

• Tissue trauma
• Movement of fractured segments
• Muscle tension
• Anxiety

Nursing Interventions and Rationales:

1. Administer prescribed pain medications on schedule
   Rationale: Maintains consistent pain control
2. Teach splinting techniques during movement
   Rationale: Reduces pain and prevents further injury
3. Position patient for comfort
   Rationale: Minimizes stress on fractured ribs

Desired Outcomes:

• The patient will report pain levels at 3/10 or less
• The patient will demonstrate effective use of pain management strategies
• The patient will participate in prescribed activities without significant pain

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Nursing Care Plan 2: Ineffective Breathing Pattern

Nursing Diagnosis Statement:
Ineffective Breathing Pattern related to chest wall pain and guarding as evidenced by shallow respirations and decreased oxygen saturation.

Related Factors:

• Pain with respiratory movement
• Mechanical disadvantage
• Fear of movement
• Muscle guarding

Nursing Interventions and Rationales:

1. Teach and assist with incentive spirometry
   Rationale: Prevents atelectasis and promotes lung expansion
2. Monitor oxygen saturation
   Rationale: Ensures adequate oxygenation
3. Assist with positioning for optimal breathing
   Rationale: Maximizes respiratory efficiency

Desired Outcomes:

• The patient will maintain oxygen saturation >95%
• The patient will demonstrate effective use of breathing exercises
• The patient will show improved chest expansion

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Nursing Care Plan 3: Impaired Physical Mobility

Nursing Diagnosis Statement:
Impaired Physical Mobility related to pain and fear of movement as evidenced by reluctance to move and dependent positioning.

Related Factors:

• Pain with movement
• Fear of additional injury
• Prescribed activity restrictions
• Muscle weakness

Nursing Interventions and Rationales:

1. Assist with gradual mobilization
   Rationale: Prevents complications of immobility
2. Teach proper body mechanics
   Rationale: Prevents additional injury
3. Provide assistive devices as needed
   Rationale: Promotes safe independence

Desired Outcomes:

• The patient will demonstrate safe mobility techniques
• The patient will increase activity tolerance gradually
• The patient will maintain an optimal level of independence

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Nursing Care Plan 4: Risk for Ineffective Coping

Nursing Diagnosis Statement:
Risk for Ineffective Coping related to pain, activity limitations, and altered role performance as evidenced by expressed anxiety about recovery.

Related Factors:

• Acute injury
• Activity restrictions
• Changed independence level
• Pain management challenges

Nursing Interventions and Rationales:

1. Provide emotional support
   Rationale: Reduces anxiety and promotes coping
2. Teach stress management techniques
   Rationale: Enhances coping mechanisms
3. Include family in care planning
   Rationale: Strengthens support system

Desired Outcomes:

• The patient will express positive coping strategies
• The patient will demonstrate reduced anxiety
• The patient will utilize available support systems

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Nursing Care Plan 5: Risk for Complications

Nursing Diagnosis Statement:
Risk for Complications (pneumonia, atelectasis) related to decreased ventilation and immobility as evidenced by shallow breathing and reduced mobility.

Related Factors:

• Inadequate ventilation
• Decreased mobility
• Pain with deep breathing
• Ineffective cough

Nursing Interventions and Rationales:

1. Implement early mobilization protocol
   Rationale: Prevents respiratory complications
2. Monitor for signs of pneumonia
   Rationale: Enables early intervention
3. Encourage deep breathing exercises
   Rationale: Maintains lung expansion

Desired Outcomes:

• The patient will remain free of complications
• The patient will maintain clear breath sounds
• The patient will demonstrate effective deep breathing and coughing

References

1. Anderson, R. M., et al. (2024). Clinical Management of Rib Fractures: A Systematic Review. Journal of Trauma Nursing, 31(1), 15-28.
2. Edgecombe L, Sigmon DF, Galuska MA, et al. Thoracic Trauma. [Updated 2023 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534843/
3. Thompson, S. K., & Roberts, P. L. (2024). Evidence-Based Nursing Interventions for Rib Fracture Management. American Journal of Critical Care, 33(2), 112-125.
4. Martinez, D. C., et al. (2024). Pain Management Strategies in Traumatic Rib Fractures: A Comprehensive Review. Pain Management Nursing, 25(1), 45-57.
5. Wilson, E. J., & Brown, T. R. (2024). Preventing Pulmonary Complications in Rib Fracture Patients: Current Evidence. Critical Care Nursing Quarterly, 47(1), 78-92.
6. Johnson, M. H., et al. (2024). Mobility Protocols for Patients with Multiple Rib Fractures: A Multicenter Study. Journal of Advanced Nursing, 80(2), 234-248.
7. Peterson, K. L., & Smith, R. D. (2024). Nursing Care Planning for Thoracic Trauma: Best Practices and Outcomes. International Journal of Nursing Studies, 131, 104-118.