Discharge Instructions for an 88-Year-Old Female with Right-Sided Rib Pain
For optimal recovery and prevention of complications, the patient should use the incentive spirometer 10 times every hour while awake, along with deep breathing exercises and early mobilization to prevent respiratory complications.
Pain Management
- Regular administration of oral acetaminophen every 6 hours is recommended as first-line treatment for rib fracture pain 1
- NSAIDs may be added for severe pain but should be used cautiously in elderly patients due to potential adverse events and drug interactions 1, 2
- Application of ice packs to the affected area for 15-20 minutes several times daily helps reduce pain and inflammation 2
- Opioids should be reserved only for breakthrough pain, administered at the lowest effective dose for the shortest possible duration to avoid respiratory depression, sedation, and delirium 2
Proper Use of Incentive Spirometer
- Sit upright when using the incentive spirometer for optimal lung expansion 3
- Take a slow, deep breath through the mouthpiece, holding it for 3-5 seconds before exhaling 3
- Aim to use the incentive spirometer 10 times every hour while awake 4
- Record the highest volume achieved during each session to track progress 4
- Continue using the incentive spirometer for at least 2-4 weeks to prevent respiratory complications 1
Activity Recommendations
- Early mobilization is crucial - walk for at least 20 minutes three times daily as tolerated 4
- Gradually increase activity levels as pain improves 1
- Avoid heavy lifting, pushing, or pulling for 6-8 weeks to allow proper healing 1
- Sleep with the head of the bed elevated to improve breathing and reduce pain 2
Breathing Exercises
- Perform deep breathing exercises (inhale slowly through the nose, hold for 3-5 seconds, exhale slowly through pursed lips) 10 times every hour while awake 3
- Combine deep breathing with gentle coughing exercises to clear secretions, supporting the painful area with a pillow when coughing 3
Expected Recovery Timeline
- Rib fractures typically heal within 6-8 weeks, but complete recovery with resolution of pain and return to normal function may take longer 1
- Pain should gradually improve over the first 4 weeks with appropriate management 1
- Respiratory function should show progressive improvement over 2-4 weeks 1
- Long-term morbidity can occur, with chronic pain, deformity, and respiratory compromise persisting for up to 2 years post-injury in some patients 3, 1
Return Precautions - Seek Immediate Medical Attention For:
- Worsening shortness of breath or difficulty breathing 3
- Fever above 100.4°F (38°C) 3
- Increasing pain not controlled by prescribed medications 1
- Productive cough with yellow, green, or bloody sputum 3
- Decreased incentive spirometry volumes (drop of 20% or more from baseline) 4, 5
- Chest pain different from the rib pain, especially if associated with shortness of breath or dizziness 1
- Confusion or significant change in mental status 2
Follow-up Care
- Schedule a follow-up appointment with your primary care physician within 1-2 weeks 1
- Continue monitoring your incentive spirometry volumes daily and bring your records to your follow-up appointment 4
- Consider pneumococcal vaccination if not previously received, as patients over 65 years are at higher risk for pneumococcal disease 3
Prevention of Complications
- Maintain good pulmonary hygiene through regular use of incentive spirometer, deep breathing exercises, and early mobilization 3, 6
- Avoid smoking and secondhand smoke exposure as these can worsen respiratory function and delay healing 1
- Stay well-hydrated to help keep secretions thin and easier to clear 2
- Ensure adequate pain control to allow for deep breathing and effective coughing 1, 6