A 28-year-old female patient with a history of asthma is admitted with suspected community-acquired pneumonia. Her vital signs reveal a heart rate of 112 bpm, respiratory rate of 24 breaths per minute, and oxygen saturation of 93% on room air. What is the priority nursing intervention for this patient?

C) Provide supplemental oxygen to maintain adequate oxygenation

A) Administer prescribed bronchodilator to improve airway patency

B) Initiate intravenous fluids to correct dehydration

C) Provide supplemental oxygen to maintain adequate oxygenation

D) Encourage deep breathing exercises to prevent atelectasis

A patient with a history of asthma is being treated for suspected community-acquired pneumonia. Despite antibiotic therapy and supportive care, her oxygen saturation remains at 93% on room air. Which nursing intervention is most appropriate at this time to address her respiratory status?

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

A) Increase the frequency of bronchodilator nebulizer treatments.

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

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

D) Administer an additional dose of IV antibiotics to combat the infection.

A patient with community-acquired pneumonia is being treated with antibiotics, bronchodilators, and supplemental oxygen. Despite these interventions, she presents with increasing wheezing and chest tightness. Which nursing intervention is most appropriate to address her current respiratory status?

A) Administering prescribed systemic corticosteroids to reduce airway inflammation.

B) Increasing the rate of intravenous fluids to improve hydration status.

C) Encouraging the patient to perform deep breathing exercises to enhance lung expansion.

D) Continuing the current medication regimen without changes to assess full effectiveness.

A patient with community-acquired pneumonia and a history of asthma is experiencing increased wheezing and chest tightness despite receiving bronchodilators and antibiotics. What is the most appropriate nursing intervention to address this complication?

D) Contact the healthcare provider to discuss initiating systemic corticosteroids

A) Administer an additional dose of bronchodilator via nebulizer

B) Increase the oxygen flow rate to improve oxygen saturation

C) Encourage the patient to perform deep breathing exercises

D) Contact the healthcare provider to discuss initiating systemic corticosteroids

A patient with asthma and suspected bacterial infection has shown improvements in some vital signs but continues to have persistent fever and mild confusion. The healthcare team is concerned about the possibility of hypoxemia or sepsis-related encephalopathy. Based on this information, what is the most appropriate nursing intervention to prioritize at this time?

B) Increase supplemental oxygen flow rate to address borderline hypoxemia

A) Administer antipyretics to address the patient's persistent fever

B) Increase supplemental oxygen flow rate to address borderline hypoxemia

C) Initiate seizure precautions due to the patient's confusion

D) Prepare for immediate intubation to secure the airway

A patient with asthma and suspected bacterial infection is experiencing mild confusion and disorientation. Her recent ABG analysis shows a pH of 7.35, PaCO2 of 45 mmHg, and PaO2 of 76 mmHg. Which nursing intervention is most appropriate to address the patient's current respiratory status?

A) Increase the supplemental oxygen flow rate to improve oxygenation.

B) Administer a bronchodilator to reduce airway constriction.

C) Initiate non-invasive ventilation to support respiratory effort.

D) Restrict fluids to prevent pulmonary edema.

A patient with suspected sepsis-related encephalopathy presents with confusion, a Glasgow Coma Scale score of 13, and positive blood cultures for multi-drug resistant Klebsiella pneumoniae. Which nursing intervention is most critical to prioritize to prevent further neurological deterioration?

C) Adjust oxygen delivery to maintain adequate saturation

A) Administer prescribed antipyretics to reduce fever

B) Monitor urine output to assess renal function

C) Adjust oxygen delivery to maintain adequate saturation

D) Initiate enteral nutrition to support metabolic demands

A patient with sepsis-related encephalopathy is receiving a new antibiotic regimen including meropenem and an aminoglycoside. The nurse should prioritize which of the following assessments to prevent potential complications?

A) Monitor for signs of ototoxicity, such as tinnitus or vertigo.

B) Evaluate for development of a rash or allergic reaction.

C) Assess for signs of gastrointestinal bleeding.

D) Check for peripheral edema and jugular vein distention.

A patient with a systemic infection caused by multi-drug resistant Klebsiella pneumoniae is on an aminoglycoside antibiotic regimen. She presents with an elevated heart rate, increased respiratory rate, persistent fever, and slight renal impairment. What is the most appropriate nursing intervention to address her current symptoms and prevent further complications?

B) Encourage increased oral fluid intake to prevent dehydration and support renal function.

A) Administer additional antipyretics to manage the persistent fever.

B) Encourage increased oral fluid intake to prevent dehydration and support renal function.

C) Request an immediate change in antibiotics to avoid nephrotoxicity.

D) Increase monitoring frequency of vital signs to detect early signs of deterioration.

fever - Nursing Case Study

Pathophysiology

• Primary mechanism: The hypothalamus, the body's thermostat, increases the set point in response to pyrogens (fever-inducing substances like cytokines from immune cells), leading to the production of prostaglandin E2 (PGE2). This initiates heat-conservation and heat-production processes, raising body temperature.

• Secondary mechanism: Cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), stimulate the hypothalamus and promote the synthesis of PGE2, enhancing the febrile response and mobilizing immune defenses.

• Key complication: Persistent high fever can lead to dehydration, increased metabolic demand, and stress on cardiovascular and neurological systems, necessitating careful management in clinical settings to prevent adverse outcomes.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: Asthma, occasional migraines

• Current medications: Albuterol inhaler as needed, Ibuprofen for migraines

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Fever and fatigue

• Key symptoms: Persistent fever for 3 days, headache, muscle aches, mild shortness of breath, dry cough

• Vital signs: Temperature 101.8°F (38.8°C), Heart rate 110 bpm, Respiratory rate 22 breaths/min, Blood pressure 118/76 mmHg, Oxygen saturation 95% on room air

Section 1

As the medical team proceeds with the initial assessment, they note that the patient's fever and associated symptoms have persisted despite over-the-counter antipyretics. During the examination, her skin appears flushed and dry, suggesting dehydration. Crackles are auscultated in the lower lobes of her lungs, raising concerns about a potential underlying respiratory infection. Given her history of asthma, the mild shortness of breath and dry cough are particularly concerning, warranting close monitoring of her respiratory status. Her heart rate remains elevated at 112 bpm, and her respiratory rate is slightly increased to 24 breaths per minute, indicating a compensatory response to the fever and possible respiratory compromise.

Laboratory investigations reveal a white blood cell count of 15,000 cells/mm³, pointing toward an ongoing infectious process. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values further support the presence of inflammation. Sputum cultures are pending, but initial blood cultures are negative for any bacterial growth. Her oxygen saturation has dropped slightly to 93% on room air, suggesting that her respiratory condition may be deteriorating. Given these findings, the clinical team considers the possibility of community-acquired pneumonia as a complication of her current illness.

In response to these developments, the medical team decides to initiate empirical antibiotic therapy, carefully selecting a regimen that avoids penicillin due to her allergy. They also administer intravenous fluids to address her dehydration and provide supplemental oxygen to maintain adequate saturation levels. The patient's asthma management plan is reviewed and adjusted to ensure effective bronchodilation and address any potential exacerbation. These interventions aim to stabilize her condition and prevent further complications, as the team continues to closely monitor her response and adjust the treatment plan accordingly.

Section 2

As the medical team closely monitors the patient's response to the interventions, they note a mixed response. The patient's vital signs show some stabilization, with her heart rate decreasing slightly to 104 bpm and her respiratory rate improving to 20 breaths per minute following the administration of bronchodilators and supplemental oxygen. However, her temperature remains elevated at 101.5°F, and her oxygen saturation continues to hover around 94% despite oxygen therapy. The intravenous fluids have improved her hydration status, evidenced by improved skin turgor and moisture, yet the patient still reports persistent fatigue and malaise.

New diagnostic results provide further insights into her condition. The sputum culture returns positive for Streptococcus pneumoniae, confirming the preliminary diagnosis of community-acquired pneumonia. Additionally, a chest X-ray reveals patchy infiltrates in the right lower lobe, correlating with the crackles auscultated earlier. This finding reinforces the need for ongoing antibiotic therapy, though the team decides to reassess the current regimen to ensure optimal coverage and effectiveness. Serum electrolytes reveal a mild hyponatremia, likely secondary to the combination of dehydration and ongoing febrile illness, prompting the team to adjust the fluid composition accordingly.

Despite these interventions, the patient develops a new complication: increasing wheezing and chest tightness, suggestive of an asthma exacerbation likely triggered by the respiratory infection. The medical team escalates her asthma management plan, increasing the frequency of nebulized bronchodilators and initiating a short course of systemic corticosteroids to reduce airway inflammation. This adjustment aims to prevent further respiratory compromise while addressing the underlying infectious process. The team continues to monitor her closely, ready to adjust the treatment plan based on her evolving clinical status, with the goal of achieving stabilization and eventual recovery.

Section 3

As the medical team continues to monitor the patient, they observe a notable change in her clinical status. Approximately 24 hours after the escalation of her asthma management plan and continued antibiotic therapy, the patient reports a decrease in chest tightness and wheezing. Her respiratory rate has decreased further to 18 breaths per minute, and her heart rate has stabilized at 98 bpm. However, despite these improvements, her oxygen saturation remains at 94%, and her temperature persists at 101.2°F. The team is concerned about the persistent fever and considers the possibility of an additional or resistant organism contributing to her symptoms.

To further investigate, the team orders additional diagnostic tests, including repeat blood cultures and a procalcitonin level, to evaluate the potential for a more severe or atypical bacterial infection. The procalcitonin result returns elevated, suggesting a significant bacterial inflammatory response, which prompts the clinicians to broaden the antibiotic coverage while awaiting blood culture results. Meanwhile, the patient's serum sodium level has improved to 133 mEq/L after electrolyte repletion, indicating a positive response to the adjusted fluid therapy.

Despite the recent stabilization of some vital signs and improvement in asthma symptoms, the patient begins to experience new complications. She develops mild confusion and disorientation, raising concerns about possible hypoxemia or sepsis-related encephalopathy. A repeat arterial blood gas analysis shows a pH of 7.35, PaCO2 of 45 mmHg, and PaO2 of 76 mmHg, indicating a compensated respiratory acidosis with borderline hypoxemia. The team decides to increase the supplemental oxygen flow rate and discuss the potential need for non-invasive ventilation to improve oxygenation while they continue to address the underlying infectious process. The team remains vigilant, prioritizing close monitoring and timely intervention to prevent further decline.

Section 4

As the medical team intensifies their monitoring efforts, they notice that the patient's confusion and disorientation have worsened, raising the suspicion of sepsis-related encephalopathy. In response, they decide to conduct a thorough neurological assessment. The examination reveals that the patient is oriented only to person, with difficulty recalling recent events and a Glasgow Coma Scale score of 13, primarily due to confusion. Her pupils are equal and reactive to light, but she exhibits slight tremors in her hands, suggesting possible metabolic derangements or neurological involvement. These findings prompt the team to prioritize maintaining adequate oxygenation and perfusion to the brain.

Simultaneously, new diagnostic results arrive, which provide further insights into the patient's condition. The repeat blood cultures return positive for a multi-drug resistant Klebsiella pneumoniae, aligning with the elevated procalcitonin levels and confirming the presence of a significant bacterial infection. This discovery necessitates a modification of the antibiotic regimen to include agents specifically targeting resistant organisms, such as a combination of meropenem and an aminoglycoside. The team also reviews the patient's recent medication history and laboratory results for potential drug interactions or renal impairment, given the nephrotoxic potential of some antibiotics.

The patient's vital signs are continuously monitored, revealing a heart rate that has increased slightly to 102 bpm, with blood pressure stable at 110/70 mmHg. Her oxygen saturation has improved marginally to 95% following the increase in supplemental oxygen, but her temperature remains elevated at 101.5°F. The team decides to initiate a more aggressive antipyretic regimen and considers the need for further imaging studies, such as a chest CT, to evaluate for any complications like abscess formation or pleural effusion. As they implement these changes, they remain vigilant for any signs of improvement or further deterioration, understanding the critical balance required in managing her complex clinical picture.

Section 5

As the medical team closely monitors the patient's response to the revised antibiotic regimen, they notice a subtle yet concerning change in her status. Her heart rate has increased further to 110 bpm, and her respiratory rate is now elevated at 24 breaths per minute, indicating increased metabolic demand or potential respiratory compromise. Despite the ongoing antipyretic therapy, her temperature remains stubbornly high at 102.2°F, prompting the team to reassess their approach to fever management. Meanwhile, her neurological status shows minimal improvement; she remains disoriented, with a Glasgow Coma Scale score unchanged at 13. These observations suggest that the systemic infection might still be exerting significant effects, possibly compounded by her body's inflammatory response.

In light of these developments, the team decides to conduct a chest CT scan to explore the possibility of complications such as abscess formation or pleural effusion that might be contributing to her persistent fever and respiratory symptoms. The imaging reveals a small pleural effusion on the right side and mild consolidation in the right lower lobe, consistent with ongoing pneumonia. These findings correlate with the bacteremia caused by the multi-drug resistant Klebsiella pneumoniae and underscore the need to ensure optimal antibiotic penetration and efficacy.

Additionally, the laboratory results show a slight increase in serum creatinine levels, suggesting early renal impairment, likely exacerbated by the nephrotoxic potential of the aminoglycoside component of her antibiotic regimen. This prompts the team to adjust the dosing schedule and increase hydration to mitigate renal stress while maintaining effective antimicrobial coverage. These strategic adjustments aim to stabilize her condition, reduce the infectious burden, and prevent further complications, while the team remains vigilant for any signs of clinical improvement or further decline.