Chapter 41, Problem 1CAQ

Summary Introduction

To discuss:

The interventions or orders or treatment need to care of Mr. E, after the acute change in Mr. E at the beginning of the scenario, including his vital and lab results along with a diagnosis of pneumonia as the source of infection.

Case summary:

Mr. E is a 75-year-old who is admitted in the hospital for suspected pneumonia. 48-hours after admission, Mr. E was dyspneic with abnormal lung sounds in both upper and lower base of the lung and he coughs and spits thick yellow sputum. His vitals showed blood pressure of 88/42 mm Hg, pulse rate of 110 beats/min, respiration of 32 breaths/min, and SpO₂ of 82%. Mr. E had difficulty in speaking and unable to lie flat, a non-rebreather mask at oxygen of 60% was kept for him. His arterial blood gas level showed respiratory acidosis and PaO₂ was 65 mm Hg with pH of 7.30 and SpO₂ of 80%. Mr. E spent 5 days in the ICU and 2 weeks in a transitional care unit and discharged with home oxygen therapy. The discharge plan states that he should start an outpatient rehabilitation program after 1 month.       

Explanation of Solution

The nurse diagnosis includes that the impairment of the breathing is caused by pulmonary secretion due to pneumonia, dyspnea, and abnormal sounds in the right upper and lower base of both the lungs. The nurse interventions include clearing of the patient’s airway, and also to encourage the patient to take deep breaths and to cough every one hour, placing the patient in semi-Fowler’s position, and administration of 2 L/min of 60% oxygen via nasal cannula.  

Conclusion

The pneumonia is infection or inflammation of the lung can be caused due to bacterial infections or viral or other factors like smoking. The nurse must assess the patient condition and need to conclude a diagnosis plan care for the patient with worsened pneumonia.