1840: Client presents with dyspnea and right-sided chest pain that is worse when he takes a deep breath and coughs. Pain rated 7 on a scale of 0 (no pain) to 10 (severe pain). The client arrived with his friends after playing baseball outdoors and was struck by a baseball bat on the right side of his chest. Immediately after he sustained the injury, he reported sharp chest pain. Vital signs: T 99° F (37.2° C) P 94, RR 25, BP 127/76, pulse oximetry reading 89% on room air. He has a medical history of hemophilia A and asthma. On assessment, the client is alert and oriented and anxious. The client has labored breathing using his accessory muscles, and lung sounds are absent in the right-sided bases. Dullness with chest percussion on the right side. Client reported tenderness in the right coastal area, and ecchymosis was noted. S1 and S2 heart tones were auscultated. Peripheral pulses 2+. Skin warm to the touch.

1909: Chest x-ray (radiograph)

• Medium-sized, right-sided hemothorax
• Complete fracture of the 9th and 10th ribs

1910: Chest x-ray results verbally discussed with the physician. A 20-gauge peripheral venous access device (VAD) was inserted into the left forearm. Oxygen at 4 L/min via nasal cannula applied. Pulse oximetry reading 94%. P 93, RR 28, BP 125/86.

Day 2

0755: Chest tube 24-hour output was 40 mL. Absence of bubbling in the water-seal chamber during expiration. Reports soreness at the insertion site, especially during ambulation. During the evaluation, the client appropriately splinted their chest with a pillow before coughing. No ecchymosis over the right side of the chest. Clear lung sounds bilaterally. Vital signs: T 98.6°F (37°C), P 81, RR 18, BP 130/85, pulse oximetry reading 95% on room air.