An 8-year-old patient with a history of asthma is being treated for pneumonia with Azithromycin due to a penicillin allergy. Despite supplemental oxygen, she continues to exhibit signs of respiratory distress. What is the most appropriate nursing intervention to address her current respiratory status?

B) Administer a nebulized bronchodilator as ordered.

A) Increase the oxygen flow rate to 4 liters per minute.

B) Administer a nebulized bronchodilator as ordered.

C) Encourage deep breathing and coughing exercises.

D) Discontinue oxygen therapy and monitor saturation closely.

An 8-year-old patient with pneumonia, a penicillin allergy, and a history of asthma is being treated with Azithromycin. Despite supplemental oxygen therapy, her oxygen saturation is 94%, and she presents with wheezing and crackles in her lung fields. Which nursing intervention should be prioritized to address her respiratory distress?

A) Administer a nebulized bronchodilator to reduce bronchospasm.

B) Increase the oxygen flow rate to improve oxygen saturation.

C) Perform chest physiotherapy to facilitate mucus clearance.

D) Initiate a high-flow oxygen therapy to enhance ventilation.

A nurse is reviewing the latest assessment data of a patient with asthma and a suspected bacterial infection. The patient is receiving nebulized bronchodilators and supplemental oxygen but continues to exhibit respiratory distress and fever. Which nursing intervention should be prioritized to address the patient's current condition?

D) Notify the healthcare provider about the need to adjust antibiotic therapy.

A) Increase the frequency of nebulized bronchodilator treatments.

B) Administer a corticosteroid to reduce airway inflammation.

C) Obtain a sputum culture to identify the specific pathogen.

D) Notify the healthcare provider about the need to adjust antibiotic therapy.

A patient with a history of asthma is receiving nebulized bronchodilators and supplemental oxygen for respiratory distress. Despite a slight improvement in wheezing, the patient continues to have crackles in the lungs, a fever of 38.5°C, a white blood cell count of 15,000/mm³, and elevated C-reactive protein levels. Considering these findings, which of the following nursing interventions would be most appropriate to address the patient's current condition?

B) Prepare to administer a corticosteroid as ordered to reduce airway inflammation.

A) Increase the frequency of nebulized bronchodilator treatments.

B) Prepare to administer a corticosteroid as ordered to reduce airway inflammation.

C) Encourage the patient to ambulate frequently to improve lung expansion.

D) Discontinue supplemental oxygen to assess the patient's baseline respiratory status.

A patient with a history of asthma presents with increased respiratory effort, intercostal retractions, and a new infiltrate in the right lower lobe on chest X-ray, despite being on supplemental oxygen. What is the most appropriate initial nursing intervention to prioritize respiratory support?

C) Position the patient in a high Fowler's position to facilitate lung expansion.

A) Increase the flow of supplemental oxygen to improve oxygen saturation.

B) Administer the prescribed corticosteroid to reduce airway inflammation.

C) Position the patient in a high Fowler's position to facilitate lung expansion.

D) Prepare for intubation and mechanical ventilation due to respiratory failure.

A patient with a history of asthma presents with increased respiratory effort, intercostal retractions, and a new infiltrate in the right lower lobe on chest X-ray. Her oxygen saturation is 92% on supplemental oxygen, respiratory rate is 34 breaths per minute, and heart rate is 112 beats per minute. Based on these findings, what is the priority nursing intervention to address her current respiratory status?

C) Administer the prescribed corticosteroid treatment immediately.

A) Increase the flow rate of supplemental oxygen to achieve oxygen saturation above 95%.

B) Prepare for possible intubation and mechanical ventilation.

C) Administer the prescribed corticosteroid treatment immediately.

D) Encourage the patient to perform deep breathing exercises to improve lung expansion.

A patient with respiratory distress presents with a respiratory rate of 38 breaths per minute, oxygen saturation of 90%, and signs of increased work of breathing. Blood gas analysis shows a pH of 7.32, PaCO2 of 48 mmHg, and PaO2 of 58 mmHg. What is the most appropriate initial nursing intervention?

C) Initiate non-invasive ventilation using CPAP.

A) Increase the flow rate of supplemental oxygen.

B) Position the patient in a high Fowler's position.

C) Initiate non-invasive ventilation using CPAP.

D) Prepare for endotracheal intubation.

A patient with pneumonia is being monitored after initiation of BiPAP therapy. She now presents with tachycardia, hypotension, and signs of increased work of breathing despite the intervention. Which of the following should be the nurse's priority action?

C) Initiate intravenous fluid bolus to address hypotension

A) Increase the settings on the BiPAP machine

B) Administer prescribed antibiotics for Streptococcus pneumoniae

C) Initiate intravenous fluid bolus to address hypotension

D) Prepare for possible intubation and invasive mechanical ventilation

A patient with pneumonia complicated by suspected sepsis is receiving BiPAP therapy. Despite an initial improvement in respiratory status, she now exhibits tachycardia and hypotension. What is the most appropriate nursing intervention to address her current hemodynamic instability?

B) Administer intravenous fluids as ordered to support blood pressure.

A) Increase the pressure settings on the BiPAP to improve oxygenation.

B) Administer intravenous fluids as ordered to support blood pressure.

C) Prepare to intubate the patient immediately to secure the airway.

D) Administer a vasopressor to raise blood pressure quickly.

pediatric community-acquired pneumonia moderate risk - Nursing Case Study

Pathophysiology

• Primary mechanism: Inhalation of pathogens such as Streptococcus pneumoniae leads to infection and inflammation in the alveoli, causing fluid accumulation and impaired gas exchange.

• Secondary mechanism: The immune response, involving cytokine release and recruitment of immune cells, further exacerbates inflammation, leading to alveolar consolidation and reduced lung compliance.

• Key complication: Inadequate oxygenation due to impaired gas exchange may result in respiratory distress, necessitating supportive interventions to maintain adequate oxygen levels.

Patient Profile

Demographics:

8-year-old female, elementary school student

History:

• Key past medical history: History of mild asthma, no previous hospitalizations

• Current medications: Albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent cough and difficulty breathing

• Key symptoms: Fever, productive cough with yellow sputum, wheezing, decreased appetite

• Vital signs: Temperature 101.8°F, heart rate 110 bpm, respiratory rate 28 breaths per minute, oxygen saturation 92% on room air

Section 1

As the healthcare team continues to monitor the 8-year-old patient, new diagnostic results reveal a moderate elevation in her white blood cell count, indicative of an active bacterial infection. A chest X-ray shows bilateral infiltrates consistent with pneumonia, with particular consolidation noted in the right lower lobe. Due to her penicillin allergy, the decision is made to initiate treatment with a macrolide antibiotic, Azithromycin, to target the suspected Streptococcus pneumoniae. Additionally, a complete blood count and C-reactive protein levels have been ordered to further assess the inflammatory response and infection severity.

Despite receiving supplemental oxygen via nasal cannula at 2 liters per minute, her oxygen saturation remains marginally improved at 94%. The fever persists, and her respiratory rate remains elevated at 30 breaths per minute, indicating ongoing respiratory distress. A repeat assessment of lung sounds reveals persistent wheezing with crackles, suggesting that the inflammation and mucus production are yet to be adequately controlled. Concern arises regarding her history of asthma, as it could complicate her recovery by increasing airway hyperreactivity.

These findings prompt the healthcare team to consider adjunctive therapies to aid in her recovery. The introduction of nebulized bronchodilators is proposed to alleviate bronchospasm and reduce wheezing, while continued monitoring of her respiratory status is crucial to detect any potential deterioration. The team also discusses the potential benefits of chest physiotherapy to facilitate mucus clearance, thereby improving ventilation and gas exchange. Close observation will determine if these interventions are effective or if further escalation of care, such as increased respiratory support or additional pharmacological therapy, becomes necessary.

Section 2

As the healthcare team continues to deliver care, the patient's response to the initiated interventions is closely monitored. Over the next 24 hours, the administration of nebulized bronchodilators results in a noticeable improvement in her wheezing, although crackles persist in the bilateral lung fields. Her respiratory rate decreases slightly to 28 breaths per minute, but her oxygen saturation remains at 94% despite supplemental oxygen, indicating persistent alveolar compromise. The fever continues unabated at 38.5°C (101.3°F), suggesting ongoing infection and inflammation.

New laboratory results reveal further insights into the patient's condition. The complete blood count shows a white blood cell count of 15,000/mm³, consistent with bacterial infection, and an elevated C-reactive protein level of 12 mg/L, reinforcing the presence of significant inflammatory activity. The team also notes a slight increase in the patient's heart rate to 110 beats per minute, raising concern about the possibility of developing sepsis if the infection is not brought under control. Given these findings, there is an urgent need to reassess the current treatment plan and consider additional measures.

The team deliberates the potential introduction of a corticosteroid to address airway inflammation, especially considering the patient's asthma history. This decision involves weighing the benefits of reduced inflammation against the risk of immunosuppression. Moreover, the possibility of a secondary bacterial superinfection is considered, prompting a review of antibiotic coverage. Close monitoring of the patient's clinical status is maintained, with a focus on identifying any signs of hemodynamic instability or respiratory decline, which would necessitate a more aggressive intervention strategy.

Section 3

As the healthcare team remains vigilant in monitoring the patient's condition, a change in her status becomes apparent. Over the next 12 hours, the patient's respiratory effort appears to increase, with intercostal retractions noted during the physical assessment. Her oxygen saturation drops to 92% despite maintaining supplemental oxygen, and her respiratory rate increases to 34 breaths per minute. This deterioration prompts immediate concern for her ability to maintain adequate gas exchange.

Further diagnostic investigations reveal new findings that contribute to the evolving clinical picture. A chest X-ray is performed, revealing the development of a new infiltrate in the right lower lobe, suggesting the possibility of a progressing or secondary bacterial infection. In response to these findings, the team decides to broaden the antibiotic regimen, adding coverage for atypical pathogens, and to initiate a corticosteroid treatment to address the increasing airway inflammation, taking into account her asthmatic background.

The patient's heart rate remains elevated at 112 beats per minute, and her fever persists, indicating that the infection's systemic effects are ongoing. The combination of clinical deterioration and the new diagnostic findings underscores the need for a reassessment of her care plan, with a focus on preventing further respiratory compromise and addressing potential complications. The team prepares for potential escalation to more intensive respiratory support if her condition does not stabilize, emphasizing the importance of continuous monitoring and timely interventions.

Section 4

The patient's condition continues to evolve, and the healthcare team remains attentive to any changes that may indicate further complications. Within the next few hours, her respiratory status shows signs of increased distress. Despite the broadened antibiotic regimen and corticosteroid treatment, her oxygen saturation decreases slightly to 90%, and her respiratory rate climbs to 38 breaths per minute. Auscultation of the lungs reveals diminished breath sounds on the right side, particularly in the lower lobe, aligning with the recent chest X-ray findings. Additionally, the patient exhibits increased work of breathing, evidenced by nasal flaring and accessory muscle use.

Blood gas analysis is performed to assess her current respiratory function and reveals a mild respiratory acidosis, with a pH of 7.32, PaCO2 of 48 mmHg, and PaO2 of 58 mmHg. This data suggests that her ability to effectively ventilate is compromised, necessitating close observation and prompt action to prevent further respiratory failure. A complete blood count shows a leukocytosis of 16,000/mm³, which is consistent with an ongoing infectious process but also raises the concern for an exacerbating inflammatory response.

Recognizing the potential for rapid deterioration, the healthcare team discusses the need to escalate respiratory support. Non-invasive ventilation, such as CPAP or BiPAP, is considered to improve her oxygenation and work of breathing while avoiding the invasiveness of intubation at this stage. Meanwhile, the team continues to monitor her hemodynamic status, ensuring adequate hydration and considering antipyretics to manage her persistent fever. The focus remains on stabilizing her respiratory function while evaluating the effectiveness of the current treatment plan and adjusting it as necessary to prevent further complications.

Section 5

As the healthcare team implements non-invasive ventilation using BiPAP, the patient's condition requires close monitoring to evaluate the response to this intervention. Over the next few hours, her respiratory rate shows a slight improvement, decreasing to 34 breaths per minute, and her oxygen saturation stabilizes at 92%. However, her work of breathing remains significant, with persistent nasal flaring and use of accessory muscles. The team remains vigilant, aware that while BiPAP seems to offer some benefit, it may not fully address the underlying issue.

New diagnostic results come in, shedding light on her condition. A follow-up chest X-ray shows an increase in opacity in the right lower lobe, suggesting the potential progression of the pneumonia to a lobar consolidation. This finding raises the suspicion of a complication such as a developing pleural effusion or an abscess, warranting further investigation. An ultrasound of the thoracic cavity is ordered to differentiate between these possibilities. In parallel, blood cultures taken earlier finally return, revealing the presence of Streptococcus pneumoniae, confirming the causative bacterial pathogen and guiding antibiotic adjustment to ensure optimal coverage.

Despite these adjustments, the patient begins to exhibit signs of a new complication: tachycardia, with a heart rate climbing to 130 bpm, combined with hypotension, as her blood pressure drops to 88/56 mmHg. This hemodynamic instability prompts the team to consider the possibility of sepsis or an evolving systemic inflammatory response. Intravenous fluids are administered cautiously to support her blood pressure while avoiding fluid overload, given the respiratory compromise. The team prepares for potential escalation in care, including the possibility of invasive mechanical ventilation, if her condition does not stabilize, emphasizing the need for continuous assessment and rapid intervention to prevent further deterioration.