Reference no: EM133670697
Yesterday:
Mr. Telles is 60 years old man who presented at the ED this AM at 0855 accompanied by his wife. He developed a harsh, productive cough 4 days prior to seeking care in the ED. The Sputum is thick and yellow and at times contains streak 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 10 lbs. over the past several weeks, but claims he did not lose his appetite. He has never receive Pneumovax or flu shot. Denies history use of tobacco.
Past history suffered multiple trauma to a motorcycle accident at the age of 22. He sustained a fractured femur and splenic injury necessitating splenectory. A fractured larynx lead to a permanent tracheostomy.
Physical examination
The patient appears tired haggard and underweight, His complexion is sallow. He cough continuesly. Sitting in a chair, he leans to his right side, holding his right chest with his left arm. His skin is pale, face is flushed. There is tenting of the skin over the sternum when pinched. Oral mucous membranes are dry, tongue is furrowed. HE is using accessory muscles with respiration. O2sat is 88% on RA. Increase to 93% when place on hi fowler (10L/min) humidified o2 via tracheostomy mask. Vital signs are as follows: BP 152/90, apical HR 112 regular, Res.24/min abd somewhat labored, temp 102. Examination reveals a large, non tender hard lymph node in the right supraclavicular fossa. Left lungs is resonant by percussion. The right upper lobe is resonant, the right middle and lover lobe fields are dull. Auscultation reveals bilateral diminished vesicular breath sounds. Bronchial breath sounds, rhonchi and late inspiration crackles (are heard) in the area of the right mid-anterior, right mid-lateral and posterior right base lungs fields. The right upper lobe and left lung are clear. No clubbing.
**patient will be admitted with Dx of community-acquired pneumonia & dehydration
The cultures were obtained, and antibiotic therapy was started. The patient remains febrile at 101.6F. his cough is weak and ineffective and requires tracheal suctioning approx. q2h.
Questions:
1. What major risk factors does Mr. Telles have for developing Community-Acquired Pneumonia (CAP)?
2. Why are blood cultures ordered to be drawn from two different sites?
3. Is the IV fluid of D5 ½ NS appropriate for Mr. Telles? Describe your rationale.
4. How can you "Utilizes previously learned principles in performing nursing care skills and/or therapeutic measures" in this scenario?