Mr. Hernandez is hospitalized with left lower lobe pneumonia. Arterial blood gas results are pH-7.47, pO2-60, pCO2-48, and HCO3-28. The nurse has completed a health history and a physical exam of the skin, head, eyes, ears, nose, mouth, and throat. Now, the nurse must perform an assessment of the respiratory system. The nurse begins the physical assessment by conducting a brief history of the symptoms Mr. Hernandez has experienced related to the respiratory system. The nurse gathers the following history.
He developed a productive cough with thick, yellow-green mucous, shortness of breath, and chest pain over the past week. The healthcare provider ordered a chest X-ray, which showed left lower lobe pneumonia. He was admitted for treatment of his left lower lobe pneumonia. He has a history of gastroesophageal reflux disease (GERD) and chronic obstructive pulmonary disease (COPD). His home medications are Zantac 150 mg 1 tablet by mouth twice a day, Proventil inhaler 2 puffs as needed for shortness of breath, and Advair Diskus 1 puff three times a day. He denies having a flu shot this year and has not had a pneumonia vaccine for 5 years. He has frequent sinus congestion whenever there is a change in the weather. He usually takes over-the-counter sinus medicine that will take care of the problem. He notes that he started with sinus congestion about two weeks ago, which continued to get worse and made his throat sore from the drainage and the frequent coughing. He thinks this is why he developed the pneumonia that caused him to be admitted to the hospital this time.
Based on the physical examination results, describe the abnormal findings and the significance of each of the abnormal findings.
Pick two respiratory disorders from the list below and describe what you would expect during a respiratory physical assessment (list your responses under the heading Inspection, Palpation, Percussion, and Auscultation).
Asthma
Atelectasis
Chronic bronchitis
Emphysema
Lobar pneumonia
Pleural effusion
Pneumothorax
What assessment findings are consistent with aging, and how might these factors influence the nursing plan of care?