Question

Abdo, 70 years of age, is a male patient who is admitted to the medical-surgical unit with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3 years ago.

The patient smoked cigarettes one pack per day for 55 years and quit 3 years ago. The patient has a history of hypertension, and diabetes controlled with oral diabetic agents. The patient presents with confusion as to time and place. The family stated that this is a new change for the patient. The admission vital signs are as follows: blood pressure, 90/50 mm Hg; heart rate, 101 bpm; respiratory rate, 28 breaths/min; and temperature, 101.5°F. The pulse oximeter on room air is 85%. The CBC is as follows: WBC, 12,500; platelets, 350,000; HCT, 30%; and Hgb, 10 g/dL. ABGs on room air are: pH, 7.30; PaO2, 55; PaCO2, 50; and HCO3, 25. Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung auscultation reveals severely diminished breath sounds in the right lower lobe and absence of breath sounds at the base. The breath sounds in the rest of the lungs are slightly decreased. The patient complains of fatigue and shortness of breath and cannot finish a short sentence before the respiratory rate increases above the baseline and his nail beds and lips turn a bluish tinge and the pulse oximetry decreases to 82%. The patient is diaphoretic and is using accessory muscles. The patient coughs weakly, but he does not raise any sputum.

Questions:

5. What overall interventions should the nurse provide?

Answer 1

Interventions of CAP:

1. Hospitalisation
2. Blood culture for finding the presence of sepsis or pathogens
3. pleural fluid check for pathogen identification and followed by antibiotics. But antibiotics to be started immediately. such
4. Bronchodilators & steroids can be given
5. efforts to increase alveolar ventilation and minute ventilation
6. Mucolytics and expectorants
7. Analgesics to be given
8. prognosis include 7 to 10 days
9. we need to check for sepsis due to pneumonia
10. Cyanosis and confusion is due to pnemonia induced symptoms.
11. respiratory acidosis can be improved by O2 therapy.
12. Low Hematocrit indicates anemic. So Iron supplements to be given.
13. Respiratory failure led to increased HR and RR.
14. patient to be accompanied with a bistander since he may fall due to the confusion and illness.