A 27-year-old patient with early-stage pneumonia has a known allergy to penicillin. Which of the following actions should the nurse prioritize?

B) Encourage the patient to increase fluid intake to help thin secretions.

A) Administer a broad-spectrum antibiotic such as amoxicillin.

B) Encourage the patient to increase fluid intake to help thin secretions.

C) Prepare to administer a penicillin-based antibiotic as ordered.

D) Disregard the patient's allergy since the pneumonia is mild.

A 27-year-old patient with early-stage pneumonia and a mild asthma history presents with a productive cough and slight shortness of breath. Which nursing intervention is most important to implement during the initial assessment phase to maintain adequate oxygenation?

D) Position the patient in a high Fowler's position

A) Encourage the patient to drink plenty of fluids

B) Administer supplemental oxygen via nasal cannula

C) Instruct the patient on the use of an incentive spirometer

D) Position the patient in a high Fowler's position

A patient with pneumonia caused by Streptococcus pneumoniae is prescribed azithromycin. What is the most important reason for the nurse to emphasize the completion of the antibiotic course?

B) To avoid the development of antibiotic resistance

A) To prevent the recurrence of symptoms

B) To avoid the development of antibiotic resistance

C) To minimize the risk of an allergic reaction

D) To ensure adequate hydration of the patient

Which nursing assessment finding indicates that the patient is responding well to the antibiotic therapy for her respiratory infection?

B) Diminished crackles in the lower lobes

C) Oxygen saturation of 92% on room air

D) Increased use of albuterol inhaler

Which of the following vital signs indicates that the patient is improving after antibiotic therapy for pneumonia?

C) Respiratory rate of 18 breaths per minute

B) Heart rate of 120 beats per minute

C) Respiratory rate of 18 breaths per minute

D) Oxygen saturation of 88% on room air

A patient with pneumonia is showing marked improvement with reduced lung infiltrates and a normalized white blood cell count. What is the most appropriate action for the nurse to reinforce during patient education?

B) Continue the current antibiotic therapy until the prescribed course is finished

A) Discontinue the antibiotic therapy immediately

B) Continue the current antibiotic therapy until the prescribed course is finished

C) Reduce the frequency of breathing exercises

D) Cancel the final follow-up appointment as recovery is apparent

What is the most likely indicator that the patient's pneumonia is improving based on the recent diagnostic results?

B) Normalization of white blood cell count

A) Increased lung infiltrates on the chest X-ray

B) Normalization of white blood cell count

C) Increased shortness of breath

What is the primary purpose of ordering a CRP level in a patient recovering from pneumonia?

C) To check for residual inflammation

B) To assess blood sugar levels

C) To check for residual inflammation

During the follow-up assessment of a patient recovering from pneumonia, which of the following interventions should the nurse prioritize to aid in lung clearance?

B) Advise the patient to take deep breaths and perform coughing exercises

A) Encourage the patient to rest and limit physical activity

B) Advise the patient to take deep breaths and perform coughing exercises

C) Recommend the patient increase their dietary fiber intake

D) Suggest the patient use a heating pad on the chest for comfort

phneumonia - Nursing Case Study

Pathophysiology

• Primary mechanism: Inhalation of pathogens (like bacteria, viruses, or fungi) leads to infection in the alveoli, the tiny air sacs in the lungs. This infection causes inflammation, filling the alveoli with fluid or pus, which impairs gas exchange and leads to symptoms like coughing and difficulty breathing.

• Secondary mechanism: The body's immune response to the infection further contributes to inflammation and fluid accumulation. White blood cells are sent to the lungs to fight the infection, but this can also lead to more swelling and impaired oxygenation.

• Key complication: If untreated, the inflammation can spread, potentially causing pleurisy (inflammation of the tissues lining the lungs and chest cavity) or even sepsis, a life-threatening response to infection that can lead to organ failure.

Patient Profile

Demographics:

27, female, elementary school teacher

History:

• Key past medical history: Mild asthma diagnosed at age 15

• Current medications: Albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Cough and mild shortness of breath

• Key symptoms: Low-grade fever, productive cough, fatigue

• Vital signs: Temperature 99.1°F, Heart rate 78 bpm, Blood pressure 118/74 mmHg, Respiratory rate 18 breaths/min, Oxygen saturation 96% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the patient, a 27-year-old elementary school teacher, presents with a productive cough and mild shortness of breath. She reports feeling fatigued and slightly feverish for the past two days. Her vital signs reveal a low-grade fever of 99.1°F, a heart rate of 78 bpm, blood pressure of 118/74 mmHg, respiratory rate of 18 breaths/min, and an oxygen saturation level of 96% on room air. The lung auscultation identifies scattered crackles in the lower lobes, which are indicative of fluid in the alveoli, consistent with early-stage pneumonia. The patient denies any chest pain but expresses slight discomfort when taking deep breaths.

In reviewing her history, it's noted that she has mild asthma, for which she uses an albuterol inhaler as needed, and has a known allergy to penicillin. Given her stable vital signs and the absence of severe respiratory distress, the patient is classified as having early-stage pneumonia. The primary nursing focus is on maintaining adequate oxygenation and monitoring for any signs of deterioration or complications. The nurse educates the patient about the importance of hydration, adequate rest, and using the inhaler to manage any asthma-related symptoms that might exacerbate her current condition.

To confirm the diagnosis and assess the extent of the infection, a chest X-ray is ordered, and sputum cultures are taken to identify the causative pathogen. The patient is advised to report any increase in symptoms, such as increased shortness of breath or chest pain, which would necessitate immediate medical attention. The nursing team plans to follow up with the results of the diagnostic tests to tailor the treatment plan effectively, ensuring the patient receives appropriate care while monitoring her for any potential complications.

Section 2

New Diagnostic Results:

The chest X-ray results confirm the presence of infiltrates in the lower lobes, consistent with a mild case of pneumonia. The sputum culture identifies Streptococcus pneumoniae as the causative organism, guiding the medical team to prescribe a course of azithromycin, an antibiotic effective against this bacterium and safe for the patient given her penicillin allergy. The patient is instructed to take the antibiotic once daily for five days, and the importance of completing the full course is emphasized to prevent antibiotic resistance and ensure full recovery.

In addition to the antibiotic regimen, the nurse reinforces the importance of supportive care measures. The patient is encouraged to maintain adequate fluid intake, which will help thin mucus secretions and facilitate expectoration. She is also advised to continue using her albuterol inhaler as needed to manage asthma symptoms, particularly before physical activity or if she experiences increased shortness of breath. The nurse teaches the patient breathing exercises, such as diaphragmatic breathing, to improve lung expansion and promote airway clearance.

The nursing team continues to monitor the patient’s vital signs and respiratory status closely, looking for any potential signs of deterioration, such as increased respiratory rate, decreased oxygen saturation, or worsening crackles upon auscultation. The patient is advised to report any new or worsening symptoms immediately, including persistent fever, increased cough, or chest discomfort. This vigilant approach ensures that any changes in the patient's condition are promptly addressed, allowing for timely adjustments in her care plan if necessary. The follow-up appointment is scheduled in a few days to reassess the patient's response to treatment and ensure she is progressing toward recovery.

Section 3

Response to Interventions:

After three days of antibiotic therapy and supportive care, the patient returns for her follow-up appointment. During the visit, the nurse conducts a thorough assessment to evaluate the patient’s response to the interventions. The patient reports a significant reduction in her cough and less chest discomfort. She mentions that her sputum production has decreased and that she feels more energetic than before. The patient has been diligent in maintaining her fluid intake and performing the recommended breathing exercises, which she feels have helped her breathing.

The nurse notes that the patient's vital signs are stable: her temperature is 98.6°F, heart rate is 78 beats per minute, respiratory rate is 18 breaths per minute, and blood pressure is 118/76 mmHg. Her oxygen saturation is 96% on room air, indicating adequate oxygenation. Upon auscultation, the nurse hears diminished crackles in the lower lobes, suggesting improvement in lung clearance. The patient's lung fields are expanding more evenly, and her use of the albuterol inhaler has decreased to once daily, primarily before physical activity.

Overall, the patient’s response to the interventions is positive, demonstrating effective antibiotic therapy and supportive care. The nurse reinforces the importance of completing the remaining two days of the antibiotic course to ensure full bacterial eradication. The patient is advised to continue with her current supportive care measures and to remain vigilant for any recurrence of symptoms. The nurse also schedules a final follow-up appointment in one week to confirm complete resolution of the pneumonia and to address any further questions or concerns the patient might have.

Section 4

New Diagnostic Results:

During the follow-up visit, the nurse reviews the results of the recent chest X-ray and lab tests ordered to monitor the patient's progress. The chest X-ray shows a marked reduction in the previously noted lung infiltrates, confirming that the infection is resolving. The lab results reveal that the patient's white blood cell count has normalized, dropping from 12,000 cells/mm³ at the onset of pneumonia to 7,500 cells/mm³, indicating a positive response to the antibiotic therapy. These findings align with the observed clinical improvements, supporting the effectiveness of the current treatment regimen.

The nurse discusses these results with the patient, explaining that the reduction in lung infiltrates and normalization of blood counts are promising signs. These improvements correlate with the patient's subjective reports of feeling better and having increased energy levels. The patient is encouraged to continue her breathing exercises and hydration, both of which have contributed significantly to her recovery. The nurse reminds her of the importance of finishing the antibiotic course and maintaining follow-up appointments to ensure complete resolution of the infection.

With these new diagnostic results, the patient's confidence in her recovery is boosted. The nurse also reinforces the importance of monitoring for any new or returning symptoms, such as increased cough or shortness of breath, and advises the patient to seek medical attention if they occur. This proactive approach helps ensure that any potential complications are addressed promptly, facilitating continued recovery and preventing relapse. The nurse schedules a final follow-up appointment in one week to confirm the patient's full recovery and to provide an opportunity for any further questions or discussions. This structured approach ensures that the patient remains on track for a complete and uncomplicated recovery.

Section 5

Several days after the follow-up visit, the patient contacts her healthcare provider's office, reporting mild but persistent fatigue and a slight cough that seems to have worsened. Understanding the importance of early detection of any complications, the nurse schedules an additional assessment to evaluate the patient's current condition. During the assessment, the nurse notes that while the patient's vital signs remain stable, there is a slightly elevated respiratory rate of 22 breaths per minute, with an oxygen saturation of 95% on room air. Auscultation reveals faint crackles in the lower lobes, persisting from the initial presentation but less pronounced.

Given the new findings, the nurse considers possible explanations, such as residual inflammation or mild bronchospasm, which can occur as the lungs continue to heal from pneumonia. The patient's energy levels and overall progress suggest that these symptoms might be part of the normal recovery process. However, to rule out any new complications, the nurse collaborates with the physician to order a repeat chest X-ray and additional lab work, including a CRP level to assess for any residual inflammation.

As the nurse explains the plan to the patient, she emphasizes the importance of maintaining hydration and continuing with prescribed breathing exercises to aid in lung clearance. The patient is reassured that these mild symptoms are not uncommon during the recovery phase and that the scheduled tests will help ensure there are no underlying issues. The nurse sets a follow-up appointment to review the new test results, providing an opportunity to adjust the care plan as necessary and further support the patient's recovery journey. This careful monitoring and supportive reassurance help to maintain the patient’s confidence and adherence to the treatment plan, paving the way for a smooth and complete recovery.