Question

SITUATION: Johti Singh is a 39-year-old secretary who was admitted to the hospital with an elevated temperature, fatigue, rapid, labored respirations; and mild dehydration. The nursing history reveals that Ms. Singh has had a “bad cold” for several weeks that just wouldn’t go away. She has been dieting for several months and skipping meals. Ms. Singh mentions that in addition to her full-time job as a secretary she is attending college classes two evenings a week. She has smoked one package of cigarettes per day since she was 18 years old. Chest x-ray confirms pneumonia.

Physical Examination

Height: 167.6 cm (5960)

Weight: 54.4 kg (120 lb)

Temperature: 39.4°C (103°F)

Pulse: 68 beats/min

Respirations: 24/min

Blood pressure: 118/70 mmHg

Skin pale; cheeks flushed; Chills; use of accessory muscles; inspiratory crackles with diminished breath sounds right base; expectorating thick, yellow sputum

Diagnostic Data

Chest x-ray: right lobar infiltration

WBC: 14,000

pH: 7.49

PaCO2: 33 mmHg

HCO3 -: 20 mEq/L

PaO2: 80 mmHg

O2 SAT: 88%

Applying Critical Thinking and provide a thorough explanation:

1.The care plan appropriately focuses on the acute care of this client. Once she is significantly improved, the nurse will perform discharge teaching. What areas should be included?

THANK YOU!

Answer 1

Name of the patient-Joti Singh, 39yr old.

From the physical examination and diagnostic data it is confirmed that the patient is having pneumonia.

Pneumonia

A. Description

1. Infection of the pulmonary tissue, including the interstitial spaces, alveoli, and the bronchioles.

2. The edema associated with inflammation stiffness the lung, decreses lung compliance and vital capacity, and causes hypoxemia.

3. Pneumonia can be community-acquired or hospital-acquired.

4. The chest x-ray film shows labor or segmental consolidation, pulmonary infiltrates, or pleural effusions.

5. A sputum culture identifies the organism.

6. The white blood cell count and the erythrocyte sedimentation rate are elevated.

B. Assessment

1. Chills

2. Elevated temperature

3. Pleuritic pain

4. Rhonchi and wheezes

5. Tachypnea

6. Use of accessory muscles for breathing

7. Mental status changes

8. Sputum production

C. Interventions

1. Administer oxygen as prescribed.

2. Monitor respiratory status.

3. Monitor for labored respirations, cyanosis, and cold and clammy skin.

4. Encourage coughing and deep breathing and use of the incentive spirometer.

5. Place the client in a semi- Flower's position to facilitate breathing and lung expansion.

6. Change the client's position frequently and ambulate as tolerated to mobilize secretions.

7. Perform nasotracheal suctioning if the client is enable to clear secretions.

8. Monitor pulse oximetry

9. Monitor and record color, consistency, and amount of sputum.

10. Provide a high-calorie, high-protein diet with small frequent meals.

11. Encourage fluids upto 3 L/day, to thin secretion unless contraindicated.

12. Provide a balance of rest and activity, increasing activity gradually.

13. Administer antibiotics as prescribed

14. Administer antipyretics, bronchodilators, cough suppressants, mucolitic agents, expectorants as prescribed.

15. Prevent the spread of inspection by handwashing, and the proper disposal of secretions.

D. Client Education

1. Instruct the client about the importance of rest, proper nutrition, and adequate fluid intake.

2. Instruct the client regarding medications and the use of inhalants as prescribed.

3. Instruct the client to notify the phulysician if chills, fever, dyspnea, hemoptysis, or increased fatigue occurs.

4. Instruct the client bin the importance of receiving immunization as recommended.

Diagnosis, Planning, IntervInterveIntervention

Diagnoses are deficient fluid volume related to fever,diaphoresis, and mouth breathing; imbalance nutrition : less than body requirements related to dyspnea;pain related to frequent coughing; and impaired oral muccous membrane related to mouth breathing and frequent cough.collabrative problems include risk of hypoxemia, respiratory failure,and sepsis.

Diagnosis :ineffective airway clearence.

The inflammation and increased secretions seen with pneumonia make it difficult to maintain a patent airway.

Outcomes....The client will maintain effective airway clearence,as evidenced by keeping a patent airway and effectively clearing secretions.

Diagnosis: ineffective breathing pattern.

Many clients experience compensatory tachypnea because of an inability to meet metabolic demands.This occurs because affected alveoli cannot effectively exchange oxygen and carbon dioxide. Higher respiratory rates can also develope as result of chest pain and increased body temperature.

Outcomes : The client will hvae improved breathing patterns, as evidenced by;

* A respiratory rate within normal limits

* Adequate chest expansion

* Clear breath sounds

* Decreased dyspnea