A 35-year-old patient with a history of asthma is being treated for a suspected bacterial respiratory infection with azithromycin due to a penicillin allergy. Within 48 hours of starting treatment, the patient experiences increased shortness of breath and a drop in oxygen saturation to 90% on exertion. Which nursing intervention is the priority at this time?

A) Administer supplemental oxygen to maintain adequate oxygenation.

B) Increase the frequency of albuterol inhaler to manage bronchospasm.

C) Reassess the patient's response to the antibiotic therapy.

D) Initiate a consultation with a respiratory therapist for further evaluation.

A 35-year-old patient with a history of asthma is being treated with azithromycin for a suspected bacterial respiratory infection. Despite treatment, the patient's condition worsens within 48 hours, with oxygen saturation dropping to 90% on exertion and increased shortness of breath and fatigue. As a nurse, what is the most appropriate initial action to take in response to this change in the patient's condition?

D) Reassess the patient's vital signs and respiratory status

A) Administer a dose of albuterol via nebulizer

B) Increase the flow rate of supplemental oxygen

C) Notify the healthcare provider immediately

D) Reassess the patient's vital signs and respiratory status

A patient with worsening pneumonia and asthma is started on supplemental oxygen and intensified bronchodilator therapy. Which of the following interventions should the nurse prioritize to ensure effective respiratory management?

B) Evaluate the patient's peak expiratory flow rate (PEFR) regularly.

A) Monitor the patient's blood pressure and heart rate every 4 hours.

B) Evaluate the patient's peak expiratory flow rate (PEFR) regularly.

C) Encourage the patient to perform incentive spirometry every hour.

D) Assess the patient's skin for signs of peripheral cyanosis.

A patient with worsening pneumonia and asthma exacerbation is experiencing respiratory acidosis and hypoxemia. The clinical team has initiated supplemental oxygen and intensified bronchodilator therapy. Which nursing intervention is the most appropriate to prioritize at this time to address the patient's respiratory status?

B) Position the patient in a high Fowler's position to facilitate optimal lung expansion and ease of breathing.

A) Encourage the patient to perform deep breathing exercises and use an incentive spirometer regularly.

B) Position the patient in a high Fowler's position to facilitate optimal lung expansion and ease of breathing.

C) Educate the patient on the importance of completing the full course of prescribed antibiotics.

D) Monitor the patient's fluid intake and output closely to prevent fluid overload and exacerbation of respiratory symptoms.

A patient with worsening respiratory acidosis and persistent hypoxemia is initiated on BiPAP therapy. Which nursing intervention is most important to implement when starting BiPAP to ensure patient safety and effectiveness of the therapy?

B) Ensure a proper mask fit and monitor for air leaks around the mask.

A) Increase the oxygen flow rate to 10 L/min to improve oxygenation.

B) Ensure a proper mask fit and monitor for air leaks around the mask.

C) Start corticosteroid therapy immediately to reduce airway inflammation.

D) Position the patient supine to facilitate easier ventilation.

A patient with worsening respiratory acidosis and persistent hypoxemia despite supplemental oxygen and bronchodilator therapy is now being considered for BiPAP therapy. As the nurse caring for this patient, what is the most appropriate initial assessment to perform to evaluate the effectiveness of the BiPAP therapy?

A) Measure the patient's oxygen saturation continuously.

B) Monitor for changes in the patient's level of consciousness.

C) Assess the patient's blood pressure every 15 minutes.

D) Check the patient's capillary refill time.

A patient receiving BiPAP therapy for respiratory distress develops a right-sided pleural effusion with associated atelectasis. The healthcare team contemplates a thoracentesis. What is the priority nursing intervention before this procedure?

A) Assess the patient's coagulation profile

B) Position the patient in a supine position

C) Administer prescribed antibiotics

D) Encourage coughing and deep breathing exercises

A patient on BiPAP therapy for respiratory distress shows modest improvement in respiratory rate and oxygen saturation. However, a chest X-ray reveals a new right-sided pleural effusion with associated atelectasis. Which nursing intervention is most appropriate to address this patient's current condition?

D) Prepare the patient for thoracentesis as ordered to relieve the pleural effusion.

A) Increase the BiPAP pressure settings to enhance lung expansion.

B) Encourage the patient to perform incentive spirometry regularly to promote lung expansion.

C) Administer diuretics as prescribed to reduce fluid accumulation.

D) Prepare the patient for thoracentesis as ordered to relieve the pleural effusion.

A patient with pleural effusion begins corticosteroid therapy and is scheduled for thoracentesis. After treatment initiation, the patient shows slight respiratory improvement but develops a low-grade fever, increased yellow-green sputum production, and mild tachycardia. Which of the following nursing interventions is most appropriate to address the patient's current condition?

D) Prepare for thoracentesis and initiate broad-spectrum antibiotics.

A) Increase the BiPAP settings to improve oxygenation.

B) Administer antipyretics and monitor temperature trends.

C) Encourage deep breathing exercises and monitor sputum characteristics.

D) Prepare for thoracentesis and initiate broad-spectrum antibiotics.

A patient with pleural effusion is undergoing corticosteroid therapy and is being considered for thoracentesis. After several hours, the patient develops a low-grade fever and reports increased yellow-green sputum production. Which nursing intervention should take priority in managing this patient's current condition?

A) Administer prescribed broad-spectrum antibiotics to address potential infection.

B) Encourage deep breathing exercises to promote sputum expectoration.

C) Increase BiPAP settings to improve oxygenation.

D) Administer antipyretics to reduce the patient's fever.

cough - Nursing Case Study

Pathophysiology

• Primary mechanism: Irritation of Cough Receptors - Located in the respiratory tract, these receptors are activated by irritants (e.g., mucus, foreign particles, inflammation) triggering the cough reflex via the vagus nerve to expel the irritant.

• Secondary mechanism: Neural Reflex Arc - The signal travels to the brain's cough center (medulla), which coordinates the contraction of respiratory muscles, producing a forceful expulsion of air to clear the airway.

• Key complication: Persistent Cough - Chronic stimulation of cough receptors can lead to airway inflammation and damage, potentially causing or exacerbating conditions like asthma or chronic bronchitis, impacting patient quality of life.

Patient Profile

Demographics:

35-year-old male, construction worker

History:

• Key past medical history: Asthma since childhood, seasonal allergies

• Current medications: Albuterol inhaler as needed, loratadine 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent cough lasting two weeks

• Key symptoms: Productive cough with greenish sputum, mild chest discomfort, shortness of breath on exertion, intermittent fever

• Vital signs: Temperature 100.4°F, heart rate 92 bpm, respiratory rate 22 breaths per minute, blood pressure 132/84 mmHg, oxygen saturation 93% on room air

Section 1

As the clinical team further evaluates the 35-year-old patient, new diagnostic results reveal some concerning findings. A chest X-ray shows signs of patchy infiltrates in the right lower lobe, suggesting a possible bacterial infection contributing to the persistent cough and fever. Additionally, a sputum culture has been obtained, which preliminarily indicates the presence of a bacterial pathogen, pending full identification and sensitivity results. Blood tests reveal an elevated white blood cell count of 14,500/mm³, indicating a systemic inflammatory response, likely due to an infection. Given the patient's history of asthma, this respiratory infection could potentially exacerbate his underlying condition, leading to increased airway reactivity and further complicating his respiratory status.

In light of these findings, the medical team decides to initiate treatment with a broad-spectrum antibiotic, mindful of the patient's penicillin allergy. Azithromycin is chosen as an appropriate alternative, aiming to target the most likely respiratory pathogens while awaiting specific culture results. The patient's albuterol inhaler usage is also reviewed, and a short course of oral corticosteroids is considered to address any potential asthma exacerbation. The clinical team closely monitors the patient's response to these interventions, particularly focusing on improvements in oxygen saturation and respiratory effort.

However, within 48 hours of starting treatment, the patient experiences a change in status. His oxygen saturation drops to 90% on exertion, and he reports increased shortness of breath and fatigue. These developments necessitate a careful reassessment of his condition, including a repeat chest X-ray and further laboratory testing, to ensure that the current treatment approach is effective or if adjustments are needed. The possibility of complications like pneumonia or an asthma exacerbation prompts the team to enhance supportive care measures, such as supplemental oxygen and intensified bronchodilator therapy, highlighting the dynamic nature of his clinical management.

Section 2

The clinical team conducts a thorough reassessment of the patient's current condition, focusing on his respiratory status and overall clinical picture. Upon initial assessment, the patient's vital signs reveal a blood pressure of 130/85 mmHg, a heart rate of 105 beats per minute, and a respiratory rate of 22 breaths per minute, with an oxygen saturation of 92% on room air. During auscultation, diminished breath sounds are noted in the right lower lobe, accompanied by coarse crackles, suggesting localized consolidation. The patient continues to report increased fatigue and exertional dyspnea, which are concerning for a potential progression of the underlying infection or an asthma exacerbation.

In response to these findings, the clinical team orders a repeat chest X-ray and additional laboratory tests, including arterial blood gases (ABGs) to assess the patient's oxygenation and acid-base status. The chest X-ray reveals an increase in the density of the infiltrates in the right lower lobe, consistent with worsening pneumonia. The ABG results show a pH of 7.35, a PaCO2 of 47 mmHg, and a PaO2 of 68 mmHg, indicating respiratory acidosis and hypoxemia. These results suggest that the patient's respiratory function is deteriorating, necessitating immediate adjustments to his management plan to prevent further complications.

Given these developments, the team decides to escalate supportive care measures. The patient is started on supplemental oxygen via nasal cannula to maintain oxygen saturation above 94%, and his bronchodilator therapy is intensified with more frequent dosing of albuterol. The team also considers adding a long-acting beta-agonist to improve asthma control. In light of the potential for resistant organisms, the antibiotic regimen is reviewed, and the team awaits the full sputum culture and sensitivity results to potentially tailor the antibiotic therapy. Close monitoring of the patient's response to these interventions is critical, as the team remains vigilant for any signs of further decompensation or the emergence of additional complications.

Section 3

As the clinical team continues to monitor the patient closely, they observe a change in his status over the next 24 hours. Despite the implementation of supplemental oxygen and intensified bronchodilator therapy, his oxygen saturation remains marginally stable around 93% with nasal cannula support. However, his respiratory rate has increased to 28 breaths per minute, and he appears more tachypneic and uncomfortable. The patient reports increased chest tightness and is visibly anxious, indicating possible worsening of his respiratory condition or the onset of a new complication.

A repeat arterial blood gas shows a pH of 7.32, a PaCO2 of 50 mmHg, and a PaO2 of 65 mmHg, confirming worsening respiratory acidosis and persistent hypoxemia. These findings, coupled with the clinical presentation, suggest that the patient is not adequately ventilating, potentially due to either progressive pneumonia or an exacerbation of underlying asthma that has not responded adequately to the current therapy. This prompts the clinical team to consider the need for non-invasive ventilation to improve alveolar ventilation and correct the acid-base imbalance.

In response to the patient's deteriorating condition, the team opts to initiate bi-level positive airway pressure (BiPAP) therapy to support his ventilation and improve gas exchange. They also review the need for potential corticosteroid therapy to reduce airway inflammation, which could be contributing to the increased respiratory distress. Additionally, pending results from the sputum culture and sensitivity may necessitate a change in the antibiotic regimen if resistant organisms are identified. The team remains vigilant, ready to escalate care, including possible transition to intensive care, should the patient's status not improve with these interventions.

Section 4

As BiPAP therapy is initiated, the clinical team closely monitors the patient's response to the intervention. Over the next few hours, there is a modest improvement in his respiratory rate, which decreases to 24 breaths per minute, and his oxygen saturation increases to 95% on BiPAP support. Despite these improvements, the patient continues to report significant chest tightness and remains visibly anxious. A follow-up assessment reveals diminished breath sounds in the right lower lobe, prompting consideration of atelectasis or a pleural effusion as potential new complications.

To investigate further, a chest X-ray is obtained, revealing a new right-sided pleural effusion with associated atelectasis. This new finding suggests that fluid accumulation may be contributing to the patient's respiratory distress and ineffective ventilation. The team contemplates the necessity of a thoracentesis to relieve the effusion and improve lung expansion. Meanwhile, corticosteroid therapy is initiated to address potential underlying inflammatory processes and further enhance respiratory function.

While awaiting the results of the sputum culture and sensitivity, which will guide any necessary changes in antibiotic therapy, the patient's condition is closely monitored for any signs of further decompensation. The healthcare team prepares for possible escalation of care, maintaining readiness for a consult with the intensive care team should the patient's respiratory status fail to improve with current interventions. This vigilant approach ensures that any new complications are promptly identified and addressed, providing the best chance for the patient's recovery.

Section 5

After initiating corticosteroid therapy and considering thoracentesis for the pleural effusion, the clinical team continues to closely monitor the patient's response to these interventions. Over the next several hours, the patient's respiratory status shows slight improvement; the respiratory rate stabilizes at 22 breaths per minute, and the patient reports a mild reduction in chest tightness. However, his anxiety persists, and he expresses difficulty sleeping due to discomfort and concern about his breathing. Vital signs reveal a heart rate of 110 beats per minute and blood pressure of 140/85 mmHg, indicating mild tachycardia and hypertension, possibly related to anxiety or as a side effect of steroid therapy. Oxygen saturation remains stable at 95% on BiPAP.

The team notices that despite the stabilization in respiratory parameters, the patient begins to exhibit a low-grade fever, with a temperature of 100.8°F. This new development prompts consideration of an infectious process or inflammatory response as a contributing factor to his condition. A complete blood count (CBC) shows a white blood cell count of 13,000 cells/mcL, suggesting a possible underlying infection or stress response. Additionally, the patient reports increased sputum production, which is now tinged with a yellow-green hue, raising concerns about a potential bacterial infection exacerbating his respiratory issues.

Given these findings, the healthcare team decides to expedite the thoracentesis to relieve the pleural effusion and send pleural fluid for analysis, which may provide critical insights into the cause of the effusion and guide further treatment. Meanwhile, empirical broad-spectrum antibiotics are initiated while awaiting sputum culture results, ensuring a comprehensive approach to managing possible infection. The team remains vigilant, ready to escalate care if the patient's condition worsens, and continues to emphasize effective communication and support to alleviate his anxiety and enhance overall recovery efforts.