Question

Mr. S, 70, was admitted to your medical-surgical unit 3 days ago with a diagnosis of pneumonia. He has a 1-week history of fever, chills, poor appetite, productive cough, and weakness. His past medical history includes being an ex-smoker (he quit 1 year ago, before that he smoked 2 packs a day for 40 years), hypertension controlled by one medication, no previous surgeries, and no allergies.

Yesterday, Mr. S had a cough and some pain with coughing, requiring 2 L of oxygen via nasal cannula to maintain his oxygen saturation at 98%. He was a bit confused, but his vital signs were within normal limits. When you go to introduce yourself and start your assessment today (day 3), you find he’s drowsy and lethargic, and he responds with one-word answers or grunts. You note that he’s using pursedlip breathing. You complete a set of vital signs and discover he’s febrile (100.2° F [37.9 C]), with a BP of 110/60; heart rate, 90 beats/ minute; respiratory rate, 24 breaths/minute; and oxygen saturation, 95% on 2 L of oxygen via nasal cannula.

would would be the clinical approach... include everything that a nurse should do

Answer 1

Nursing assessment is critical in detecting pneumonia.Fever,chills or night sweats in a patient who also has respiratory symptoms should alert the nurse to the possibility of bacterial pneumonia.Respiratory assessment further identifies the clinical manifestations of pneumonia such as pleuritic -type pain,fatigue,tachypnea,use of acessory muscles for breathing,bradycardi,coughing and pureulent sputum..The nurse monitors the patient for the following change.

• Changes in temperature and pulse.
• Amount,odour and color of secretions.
• Frequency and severity of coughs,
• Degree of tachypnea.
• Changes in physical assessment findings.
• Changes in X-ray findings

Inaddition it isimportant to assess elderly patients for unusual behaviours,altered mental status,dehydration,excessive fatigue and concomittant heart failure.Therefore the major goals may include .

Improve airway patency

• Removing secretions.
• The nurse encourages hydration.
• Coughing is initiated by using lung expansion maneouvers.
• Changing the posiion at frequent intervals
• Chest physiotherapy is initiated.

Monitoring Superinfection

• Monitoring of patient for manifestations of super infection such as increase in temperature with increasing cough,increasing fremitus and adventitious breath sounds on auscultation of lungs..
• A Patient with pneumonia is assessed for confusion as these are poor prognostic signs,as it is often related to fever ,dehydration,sleep deprivation or hypoxaemia.
• Address the underlying factors and ensuring patient safety are important nursing interventions.

Promoting fluid intake

• The respiratory rate of patients with pneumonia increase because of the increased workload imposed by the laboured breathing ad fever.This result in an increase in fluid loss during exhalation and can lead to dehydration.Therefore nurses encurage the patient to increase fluid intake.

Maintaining nutrition and promoting rest and conserving energy

• Administration of IV fluids as per doctors order.
• The nurse encourages the debilitated patient to rest and avoid overexertion and possible exacerbration of symptoms.
• The patient should assume a comfortable position to promote rest and breathin and should change positions frequently to enhance secretion clearance and ventilation and perfusion in the lungs.
• Nurses instruct the patient not to over exert themselves and to engage in only moderate activity dring the initial phases of treatment.
• The nurse also monitors for other symptoms such as shock,multisystem failure and atlectasis which may develop during the first fewddays of antibiotic treatment.