Question

showbcourseSessionld-a67e003d-1 a46-11 e 7-a6ac OccA 7alS25 10 Case Study, Chapter 23, Management of Patients With Chest and Lower Respiratory Tract Disorders 1. Harry Smith, 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, PaO: 55, PaCO: 50, HCO; 25. Chest x-ray results reveal right lower lobe consolidation, presence of apical bullac, 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 aby sputum. (Learning Objective 3) What nursing assessment findings support the diagnosis of pneumonia? a. b. What diagnostic findings suppornt the diagnosis of pneumonia? c. What nursing diagnoses should the nurse formulate for the patient What goals should the nurse develop for the patient? d. What overall interventions should the nurse provide? e. 2. Marie Perez, a 53-ycar-old patient, is day I after a gastric bypass. She complains of

Answer 1

a.The assessment which support the diagnosis of pneumonia are

• Smoking history
• Subjective data:Fatigue,shortness of breath
• Objective dara:Vitals (tachycardia, tachpenea, hypoxia, fever, diaphoretic,using accessory muscles to breath,coughing. Auscultation:diminished breath sounds

b.The diagnostic findings like Chest X Ray which reveals right lower lobe consolidations, apical bullea, flattened diaphragm. The ABG indicates a primary consolidated respiratory ascidosis.Blood test indicating infection

c.Impaired gas exchange related to consolidation as evidenced by hypoxia,tachpenea ,breathlessness

d.The goals to be developed are

• To maintain a normal oxygen level by correcting hypoxia,respiratory acidosis
• Relieving the consolidation ,pleural effusion
• treating infection

e. The nursing interventions are

• Administration of oxygen
• Providing IV fluids to normalize the BP
• Monitor vital signs with saturation
• Administration of antibiotic therapy as per order
• Following a strict infection control practice
• Chest physio to relieve consolidation
• Assisting in pleural tapping as per the order