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A nurse is caring for a 76-year-old male client in the medical unit

 

History and Physical

The client is a 76-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension. He presented to the emergency department with a 3-day history of productive cough, fever, and shortness of breath. He has a 40-pack-year smoking history and lives alone. He denies recent travel or sick contacts.

 

Nurses’ Notes

Day 1, 1800: The client was admitted to the medical unit with suspected pneumonia. Crackles were auscultated bilaterally in the lower lung fields, and breath sounds were diminished. A saline infusion was initiated at 50 mL/hour. Vancomycin IV piggyback (IVPB) was started. Sputum and blood cultures were obtained and sent to the lab.

 

Diagnostic Results

Day 2: Sputum culture positive for pneumococcus. Chest x-ray showed focal consolidation in the bilateral lower lobes, suggestive of pneumonia.

 

Vital Signs

• Temperature: 38.5°C
• Heart Rate: 110 bpm
• Respiratory Rate: 24 breaths/min
• Blood Pressure: 150/90 mmHg
• Oxygen Saturation: 88% on room air

 

Physical Examination Results

On physical examination, the client appeared in moderate respiratory distress. He had crackles bilaterally in the lower lung fields and diminished breath sounds throughout. His skin was warm and diaphoretic. He was using accessory muscles to breathe and had a productive cough with greenish sputum.

 

Provider’s Prescriptions

• Continue saline infusion at 50 mL/hour
• Discontinue vancomycin
• Start ceftriaxone 1g IV every 24 hours
• Albuterol treatments by nebulizer every 4 to 6 hours
• Increase oral fluids
• Obtain arterial blood gas (ABG)

 

Imaging Studies

Chest x-ray showed focal consolidation in the bilateral lower lobes, suggestive of pneumonia.

 

Question: Which of the following does the nurse anticipate the healthcare provider to prescribe during morning rounds? Select 4 findings.

Choice A rationale:

 A computerized tomography (CT) scan of the chest is not typically required for routine pneumonia cases unless there are complications or the pneumonia is not responding to standard treatment. CT scans provide more detailed images but are usually reserved for more complex cases.

Choice B rationale:

 Albuterol treatments by nebulizer every 4 to 6 hours are appropriate for managing wheezing and bronchospasm associated with pneumonia, especially in a patient with a history of COPD. Albuterol helps open the airways, making it easier for the patient to breathe.

Choice C rationale:

 A chest x-ray is a standard diagnostic tool for pneumonia. It helps assess the extent of lung involvement and monitor the progression or resolution of the infection. Repeating the chest x-ray can help evaluate the effectiveness of the treatment.

Choice D rationale:

 Increasing oral fluids is essential for patients with pneumonia to help thin mucus, making it easier to expectorate. Adequate hydration also supports overall health and recovery.

Choice E rationale:

 Obtaining an arterial blood gas (ABG) is important for assessing the patient’s oxygenation and acid-base status. This information is crucial for managing respiratory distress and ensuring adequate oxygen delivery.