Question

CASE STUDY –Pneumonia

Patient B is a man, 82 years of age, living at home. He has Chronic Obstructive Pulmonary Disease (COPD), a history of smoking, and arthritis. In the morning, his family notes that he has a temperature of 101°F, is confused, and has had a poor appetite over the last few days. His primary care practitioner is notified and he is transported to an acute care facility by ambulance.

1. What are some of the risk factors for pneumonia for this patient?

In the triage area of the emergency department, the nurse notes that the pt is diaphoretic and short of breath. The pulse ox reveals 88% O2. The nurse auscultates the lungs.

2. What lung sounds would the nurse expect to hear for this pt?
3. What diagnostic tests would you expect the doctor to order and why?

Patient B's chest x-ray reveals a new right lower lobe infiltrate, and his white blood cell count is 18,000/mm³. His temperature is 101°F, and he is noted to have purulent sputum. A diagnosis of community-associated pneumonia is made, a culture and sensitivity specimen is obtained, and the patient is started on moxifloxacin 400 mg IVPB once per day and Deltasone 20 mg two times per day. He is placed on supplemental oxygen 2L via nasal cannula to maintain an oxygen saturation of 90% or greater.

4.     What are the possible side effects of moxifloxacin?

5. What are some of the nursing considerations for pts taking steroidal medication?

6. What nursing interventions should be provide to this pt and why?

After three (3) days in the hospital, Mr. B is recovering well and has been cleared for discharge.

7. What instructions should the nurse include in the discharge plan?

Answer 1

#. The risk factors for pneumonia for this patient include :-

Age

COPD

Smoking

#. Crackling or bubbling noises (rales) made by movement of fluid in the tiny air sacs of the lung. Dull thuds heard when the chest is tapped (percussion dullness), which indicate that there is fluid in a lung or collapse of part of a lung.

#. Diagnostic tests include :-

Chest X-ray

Blood test

Sputum test

Pulse oximetry to measure oxygen level in blood

All other tests to find out the infection in lungs and how far it has spread .

#. Side effects :-