Question:
You are providing nursing care to a patient with pneumonia. A.L. is a 64-year-old male and was admitted to your unit in the middle of the night from the ED. He developed a harsh, productive cough four days prior to coming to the ED, at his wife's urging. The sputum is thick and yellow with streaks of blood. He developed a fever, shaking, chills and malaise along with the cough. One day ago he developed pain in his right chest that intensifies with inspiration. The patient lost 15 lbs. over the past few months but claims he did not lose his appetite. "I just thought I had the flu." Past history reveals that he had a chronic smoker's cough for "10 or 15 years" which he describes as being mild, non-productive and occurring most often in the early morning. He smoked 2 packs of cigarettes per day for the past 50 years. The patient is a retired truck driver who has been treated for mild hypertension, bronchitis, appendicitis (as a young adult), hemorrhoids and a fractured femur and splenic injury. (motorcycle accident).
The patient is an elderly man who appears tired and underweight. His complexion is sallow. He coughs continuously. Sitting in a chair, he leans to his right side, holding his right chest with his left arm. Vital signs are as follows:
- blood pressure 152/90
- apical heart rate 112/minute and regular
- respiratory rate 24/minute and somewhat labored
- temperature 102.6 F
Examination of the neck reveals a large, non-tender hard lymph node in the right supraclavicular fossa. Auscultation of lungs reveals bilateral diminished vesicular breath sounds, rhonchi and late inspiratory crackles heard in the area of the right mid-anterior and right mid-lateral lung fields. The remainder of the lung fields is clear. Percussion and auscultation of the heart reveals no significant abnormality.
Labs: WBC 17,000/mm3; neutrophils 70%, bands 15%, lymphocytes 15%
CXR revealed an acute pneumonia in the right middle lobe, the patient was treated with antibiotics while in the ED.
Questions:
Q1. Identify the patient problems from the history.
Q2. Identify and explain the significance of physical findings. In length with resources.