Which nursing intervention is most appropriate for managing a patient with early-stage community-acquired pneumonia who is allergic to Penicillin?

B) Encourage increased fluid intake to help loosen secretions

A) Administer prescribed Loratadine to manage fever

B) Encourage increased fluid intake to help loosen secretions

C) Monitor blood pressure closely to prevent hypotension

D) Place the patient on a high-protein diet to boost immune function

A patient with early-stage community-acquired pneumonia is being treated with azithromycin due to a penicillin allergy. Which nursing intervention is most important to ensure the effectiveness of the antibiotic therapy?

A) Ensure the patient completes the entire course of antibiotics as prescribed.

B) Administer the antibiotic with a high-fat meal to enhance absorption.

C) Encourage the patient to stop the medication if gastrointestinal upset occurs.

D) Monitor the patient's blood pressure before and after each dose.

What is the primary reason for instructing a patient to complete the full course of prescribed antibiotics, even if symptoms improve?

C) To ensure the infection is fully eradicated

A) To prevent antibiotic resistance

B) To reduce the risk of side effects

C) To ensure the infection is fully eradicated

What is the best indicator that the patient is responding positively to azithromycin therapy for her respiratory infection?

C) Oxygen saturation improved to 96% on room air

A) Patient reports feeling less fatigued

B) Decreased crackles in the right lower lobe

C) Oxygen saturation improved to 96% on room air

Which intervention should the nurse prioritize to address the patient's mild bronchospasm?

C) Administer the prescribed bronchodilator, such as albuterol

A) Administer oxygen via nasal cannula

B) Encourage the patient to rest in a supine position

C) Administer the prescribed bronchodilator, such as albuterol

D) Increase the patient's fluid intake immediately

What is the primary action of a bronchodilator like albuterol in managing respiratory conditions?

C) Relaxes and opens the airways

A) Reduces inflammation in the airways

B) Increases the production of mucus

C) Relaxes and opens the airways

What is the primary purpose of monitoring a patient's respiratory rate after initiating bronchodilator therapy?

B) To evaluate the effectiveness of the medication

A) To assess for potential allergic reactions

B) To evaluate the effectiveness of the medication

C) To determine the patient's energy level

D) To check for changes in blood pressure

pneumonia - Nursing Case Study

Pathophysiology

• Primary mechanism: Inhalation of pathogens like bacteria, viruses, or fungi leads to infection and inflammation in the alveoli, the tiny air sacs in the lungs where gas exchange occurs.

• Secondary mechanism: The inflammatory response causes the alveoli to fill with fluid and pus, which impairs oxygen exchange, resulting in symptoms such as cough, fever, and difficulty breathing.

• Key complication: If untreated, pneumonia can lead to reduced oxygen levels in the blood, potentially causing organ dysfunction and severe respiratory distress.

Patient Profile

Demographics:

45-year-old female, school teacher

History:

• Key past medical history: Seasonal allergies

• Current medications: Loratadine 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild cough and fatigue

• Key symptoms: Low-grade fever, productive cough with clear sputum, slight shortness of breath

• Vital signs: Temperature 99.1°F, Heart rate 82 bpm, Blood pressure 118/76 mmHg, Respiratory rate 18 breaths per minute, Oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

During the initial nursing assessment, the patient, a 45-year-old female school teacher, presented with a mild cough and fatigue. Upon inspection, the patient appeared slightly fatigued but was in no acute distress. Auscultation of the lungs revealed slight crackles at the bases bilaterally, indicating the presence of fluid in the alveoli. These findings were consistent with the early stages of pneumonia. The patient reported a productive cough with clear sputum, and her slight shortness of breath was evident but manageable. Her skin was warm to the touch, correlating with her low-grade fever of 99.1°F.

The patient's medical history of seasonal allergies and current use of Loratadine 10 mg daily were noted, along with her allergy to Penicillin, which will guide the selection of antibiotics. Her vital signs were relatively stable: a heart rate of 82 bpm, blood pressure of 118/76 mmHg, respiratory rate of 18 breaths per minute, and an oxygen saturation of 96% on room air. These findings suggested that the patient was in a stable condition despite her symptoms. The initial impression was that she had a mild case of community-acquired pneumonia without significant complications at this stage. The nursing team developed a care plan focusing on symptom management, monitoring for any changes in respiratory status, and ensuring appropriate antibiotic therapy was initiated, considering her penicillin allergy.

This assessment laid the groundwork for clinical reasoning by highlighting the need for close monitoring of respiratory status, potential adjustments to her medication regimen, and education on recognizing signs of worsening symptoms. The nursing team planned to reassess the patient regularly and coordinate with the healthcare provider to review any new diagnostic results or changes in the patient's condition.

Section 2

New Diagnostic Results

As part of the patient's ongoing assessment, the healthcare team decided to conduct a chest X-ray and obtain a complete blood count (CBC) to confirm the diagnosis and assess the extent of the infection. The chest X-ray revealed a mild infiltrate in the right lower lobe, consistent with the diagnosis of early-stage community-acquired pneumonia. This finding aligned with the clinical presentation of the patient's mild crackles heard during auscultation. The CBC results showed a slightly elevated white blood cell count of 11,200/mm³, indicating a mild inflammatory response, which was expected given her infection. The differential showed a slight increase in neutrophils, supporting a bacterial origin of the pneumonia.

Based on these results, the healthcare provider was able to confirm the diagnosis and prescribe an appropriate antibiotic regimen, taking into account the patient’s allergy to penicillin. The antibiotic of choice was azithromycin, known for its efficacy in treating mild community-acquired pneumonia and its safety profile in patients with penicillin allergies. The nursing team reinforced the importance of adhering to the antibiotic schedule and educated the patient about potential side effects, such as gastrointestinal upset, and the need to report any adverse reactions immediately.

With these diagnostic results, the nursing team could focus on monitoring the patient's response to the antibiotic therapy and any potential side effects. They planned to continue assessing her respiratory status, including breath sounds, oxygen saturation, and overall symptom progression. The team also emphasized the importance of hydration, rest, and gradual activity to support her recovery. These steps were crucial to ensure that the patient remained stable and to prevent any progression of the pneumonia, thereby facilitating her return to health and daily activities.

Section 3

Response to Interventions

After 48 hours of initiating azithromycin therapy, the nursing team conducted a follow-up assessment to evaluate the patient's response to the treatment. The patient reported feeling slightly better, noting a reduction in fatigue and a decrease in the severity of her cough. Upon auscultation, the nurse observed that the crackles in the right lower lobe had diminished, indicating a positive response to the antibiotic. The patient's oxygen saturation had improved to 96% on room air, and she was maintaining stable vital signs with a temperature of 98.6°F, heart rate of 82 beats per minute, and blood pressure of 118/76 mmHg. These clinical findings suggested that the infection was responding well to the prescribed intervention.

In addition to monitoring clinical signs, the nursing team continued to educate the patient on the importance of completing the full course of antibiotics, even if symptoms continued to improve. The patient was advised to maintain adequate fluid intake and incorporate deep breathing exercises into her daily routine to facilitate lung expansion and promote airway clearance. Despite the positive progress, the nurse reminded the patient to remain vigilant for any new or worsening symptoms, such as increased shortness of breath or chest pain, which would require immediate medical attention.

The patient's positive response to the intervention allowed for a gradual resumption of her daily activities, with recommendations for adequate rest periods to avoid overexertion. The care team planned to reassess the patient in another 48 hours to ensure continued improvement and to make any necessary adjustments to the care plan. This proactive and supportive approach aimed to optimize the patient's recovery trajectory and prevent any potential complications as she moved towards full recovery.

Section 4

Following the initial positive response to the azithromycin therapy, the nursing team conducted another assessment 48 hours later to evaluate ongoing progress and identify any new complications. The patient continued to report an overall improvement in her symptoms, noting further reduction in cough frequency and intensity. Her energy levels were slowly returning, and she expressed optimism about her recovery. However, the nurse noted a mild increase in respiratory rate, now at 22 breaths per minute, with a slight wheeze audible upon auscultation in the right lower lobe. These findings suggested the possibility of mild bronchospasm, a potential minor complication requiring attention.

To address this, the nursing team collaborated with the physician to introduce a bronchodilator, such as albuterol, to manage the wheezing and improve airflow. The patient was instructed on the correct use of a metered-dose inhaler and was encouraged to continue her deep breathing exercises to aid in lung expansion. Vital signs remained stable, with an oxygen saturation of 95% on room air, heart rate at 84 beats per minute, and blood pressure at 120/78 mmHg, indicating no significant deterioration in overall status.

Laboratory results showed a slight improvement in the white blood cell count, trending towards normal, which reinforced the effectiveness of the current treatment regimen. The patient was reminded of the importance of adhering to the full course of antibiotics and the newly prescribed bronchodilator. The nursing team planned to monitor her closely, focusing on respiratory function and ensuring that she remained comfortable and symptom-free. This comprehensive approach aimed to prevent further complications and support a smooth transition towards complete recovery.

Section 5

As the nursing team continued to monitor the patient, attention was focused on her response to the newly introduced bronchodilator therapy. Within hours of using the albuterol inhaler, the patient reported a noticeable decrease in wheezing and an easier time breathing. Her respiratory rate gradually decreased to 18 breaths per minute, indicating an effective response to the bronchodilator. The nurse observed improved airflow during auscultation, with diminished wheezing in the right lower lobe. This positive change suggested that the mild bronchospasm was being effectively managed.

In addition to the improvement in respiratory symptoms, the patient's energy levels continued to rise, allowing her to engage more actively in light activities such as walking around her room and participating in gentle stretching exercises. Her vital signs remained stable, with an oxygen saturation of 96% on room air, a heart rate of 82 beats per minute, and blood pressure maintaining at 118/76 mmHg. These stable parameters further supported the effectiveness of the current treatment plan and the patient's gradual but steady progression towards recovery.

The nursing team encouraged the patient to continue with her prescribed medications and deep breathing exercises, emphasizing the importance of consistent use of the bronchodilator to prevent any recurrence of symptoms. They also planned to reassess her condition in another 48 hours to ensure sustained improvement and to catch any potential deviations from the recovery path early. This proactive approach aimed to facilitate a smooth transition to discharge, with a focus on maintaining respiratory health and preventing future complications.