Question

PN 200 Fundamentals of Nursing II Concept Map - Pneumonia The sister of Calvin Kline called to report that her 71 year-old brother came down with a fever 2 days ago. Now he has down to sleep because "He cannot stop coughing" Mr. Kline is examined at the hospital's Primary Care Clinic, and is diagnosed with community acquired pneumonia (CAP) and now is admitted to your floor. The intern is busy and asks you to complete your routine admission assessment and call him with your findings. Your assessment findings are as follows: Mr. Kline's vital signs are B/P 154/82. P. 105, R. 32, and T. 103 F. on room air. 02 sats on room air are 84%. You auscultate decreased breath sounds in the LLL interiorly and posteriorly, course crackles LUL. His nail beds are dusky on fingers and toes. He has a cough productive of rust-colored sputum and complains of pain in his left chest when he coughs. Mr. Kline appears to be well nourished and adequately well hydrated. He is a lifetime non-smoker, non-drinker. Past medical history CAD/MI X 2/stent X 3. On metropolol, amiodipine, Lisinopril, furosemide, type 2 diabetes mellitus on metformin and roliglitazone. He reports that he has not been sexually active for 15 years but was always monogamous with his wife of 49 years. He has never gotten a flu or the Pneumovax vaccines. He does report getting hives when he took an antibiotic pill a few years ago but does not remember the name of the antibiotic 2. Which of these assessment findings concerns you? (State what each symptom represents) 3. What do the abbreviations CAD and MI mean? 4. Why would each of the medications listed would be prescribed for this patient (state the action of each medication listed)? Revised 9/12

Answer 1

2. The assessment findings that concerns me are :-

- saturation of 84% indicates decrease in oxygen level in blood

- decreased breath sounds indicates lung parenchyma are inflammed

- crackles indicates inflammation in lungs

- dusky nail beds indicate low oxygen in blood

3. The abbreviation CAD means coronary artery disease and MI means Myocardial infarction

4. The medication metropolol ( antihypertensive ) , amiodipine ( antihypertensive ) ,lisnopril ( antihypertensive ) ,furesomide ( diuretics), metformin and roliglitazone ( Anti -diabetics )

Actions of each drug :-

Metropolol - Inhibits stimulation of beta1-receptor sites, located mainly in the heart, resulting in decreased cardiac excitability, cardiac output, and myocardial oxygen demand. These effects help relieve angina. Metoprolol also helps reduce blood pressure by decreasing renal release of renin.

Amiodipine - Inhibits calcium ion influx across cell membrane during cardiac depolarization. Dialates coronary vascular arteries. Produces relaxation of coronary vascular smooth muscle and peripheral vascular smooth muscle.

Lisnopril - inhibits angiotensin converting enzyme (ACE) in human subjects and animals. Inhibition of ACE results in decreased plasma angiotensin II which leads to decreased vasopressor activity and to decreased aldosterone secretion.

Furesomide - prevents the reabsorption of sodium & chloride by blocking the symporter in the loop of helena

Metformin - Inhibits lipolysis in adipose tissue Resulting in reduced free fatty acid release (elevated FFAs cause insulin resistance in the liver and are preferentially absorbed and oxidized by muscle tissues, resulting in decreased glucose utilization

Roliglitazone - 1. Increases cellular sensitivity to insulin and 2. decreases gluconeogenesis by the liver

5. Nursing care plan for pneumonia :-

#. Nursing diagnosis - Ineffective airway clearance related to increased production of secretions and increased viscosity.

#. Nursing interventions :-

Administer oxygen as prescribed.

Monitor respiratory status.

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

Encourage coughing and deep breathing and use of incentive spirometer.

Position client in semi-Fowler position to facilitate breathing and lung expansion.

Change client’s position frequently and ambulate as tolerated to mobilize secretions

Provide CPT

Perform nasotracheal suctioning if the client is unable to clear secreations.

Monitor pulse oximetry.

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

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

Encourage fluids up to 3 L a day to thin secretions unless contraindicated.

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

Administer antibiotics as prescribed.

Administer antipyretics, bronchodilators, cough suppressants, mucolytic agents, and expectorants as prescribed.

Prevent the spread of infection by hand washing and the proper disposal of secretions.